Conservative Treatment of Acute Colonic Diverticulitis

Dijk, S. T. van; Rottier, S. J.; Geloven, A. A. W. van; Boermeester, Marja A.

doi:10.1007/s11908-017-0600-y

Cited by 17 publications

(11 citation statements)

References 37 publications

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“…Recent randomized controlled trials (RCTs) confirmed, and national guidelines recommended, that patients with uncomplicated AD are eligible for outpatient treatment without the use of systemic antibiotics, which should be used in complicated patients instead 16 – 19 . This conservative management strategy, if adopted, could positively influence the relative economic burden on health costs.…”

Section: Open Clinical Questionsmentioning

confidence: 99%

Recent advances in understanding and managing diverticulitis

Severi

Carabotti²,

Cicenia

et al. 2018

F1000Res

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In the past few decades, the increasing socioeconomic burden of acute diverticulitis (AD) has become evident, and with the growth of the population age, this significant economic impact will likely continue to rise. Furthermore, recent evidence showed an increased rate of hospital admissions especially evident among women and younger individuals. The natural history and pathophysiology of this clinical condition is still to be fully defined, and efforts continue to be made in the identification of risk factors and the establishment of relative preventive strategies. The actual therapeutic strategies aimed to modulate gut microbiota, such as rifaximin or probiotics, or to reduce mucosal inflammation, such as mesalazine, present a relatively poor efficacy for both the prevention of the first AD episode (primary prevention) and its recurrence (secondary prevention). In the last few years, the main goal achieved has been in the management of AD in that uncomplicated AD can, to a larger extent, be managed in an outpatient setting with no or little supportive therapy, a strategy that will certainly impact on the health costs of this disease. The problem of AD recurrence remains a topic of debate. The aim of this review is to present updated evidence on AD epidemiology and relative open clinical questions and to analyze in detail predisposing and protective factors with an attempt to integrate their possible modes of action into the several pathogenic mechanisms that have been suggested to contribute to this multifactorial disease. A unifying hypothesis dealing with the colonic luminal and extra-luminal microenvironments separately is provided. Finally, evidence-based changes in therapeutic management will be summarized. Because of an ascertained multifactorial pathogenesis of uncomplicated and complicated AD, it is probable that a single ‘causa prima’ will not be identifiable, and a better stratification of patients could allow one to pursue tailored therapeutic algorithm strategies.

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Section: Open Clinical Questionsmentioning

confidence: 99%

Recent advances in understanding and managing diverticulitis

Severi

Carabotti²,

Cicenia

et al. 2018

F1000Res

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“…Although both our own study and previous studies [14,21] showed that conservative treatment of acute RCD was safe and effective, it remains unclear whether or not patients with uncomplicated and complicated RCD are both recommended for the same treatment. All patients were, therefore, divided into either a uncomplicated group or a complicated group, according to their radiological imaging features and clinical assessment.…”

Section: Resultsmentioning

confidence: 72%

“…Although it is recognized that RCD is more common in Eastern than in Western countries, the management of RCD remains controversial. In past decades, there has been a strong tendency towards more conservative management of acute RCD [21,24]. A study by Destek et al showed that conservative management of uncomplicated RCD with antibiotics is a safe and effective treatment option [14].…”

Section: Discussionmentioning

confidence: 99%

Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence

Chen

Zhou

et al. 2022

Preprint

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Background: Acute right-sided colonic diverticulitis (RCD) is a common disease in Asian populations for which the optimal treatment remains controversial. The aim of this study was to investigate management and evaluate long-term outcomes of treatment in patients with acute RCD. Methods: We retrospectively collected and analyzed clinical data for patients with acute RCD admitted to the Tongren Hospital, Shanghai Jiao Tong University School of Medicine from December 2015 to December 2020. The patients were divided into two groups, according to primary treatment strategy, which was either conservative treatment or surgical treatment. Results: A total of 162 consecutive patients with acute RCD were enrolled in the study. There was no significant difference in age, sex, history of abdominal surgery, medical co-morbidities, fever, previous history of RCD, treatment success rate and incidence of complications between the conservative and surgery groups. However, the recurrence rate in conservative groups was significantly higher than in surgery groups (16.53% vs 2.44%, P = 0.020). And more frequent bowel movements and previous history of RCD increased the risk of recurrence of acute RCD. Moreover, there was no significant difference in either treatment success rate or the overall recurrence rate between the patients with uncomplicated diverticulitis and patients with complicated diverticulitis. Conclusions: Surgical treatment is also safe and effective for acute RCD. Surgical treatment should mainly be considered for patients with acute RCD with recurrence risk factors (more frequent bowel movements and previous history of RCD) or with complicated acute RCD.

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“…With shifts towards conservative outpatient management of uncomplicated diverticulitis, there is a widening gap between the level of treatment administered for uncomplicated and complicated diverticulitis cases [28] . Many uncomplicated diverticulitis episodes are treated outpatient with physicians forgoing antibiotics and imaging in favor of reducing the cost burden associated with this disease [29][30][31][32][33] .…”

Section: Discussionmentioning

confidence: 99%

Redefining Hemorrhage in Diverticulitis: Complicated Diverticulitis or Exacerbation of Diverticular Bleeding?

French

Johnson

2020

Journal of Gastroenterology and Hepatology Research

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AIM: Lower gastrointestinal hemorrhage in a patient presenting with diverticulitis shifts the diagnosis from uncomplicated to complicated diverticulitis leading to more aggressive treatment measures. This study sought to determine the demographic characteristics of patients hospitalized with diverticular bleeding and diverticulitis with a focus on identifying factors that predispose to hemorrhage. We aim to use demographic information to elucidate whether hemorrhage in the setting of diverticulitis is more similar mechanistically to diverticular bleeding or diverticulitis. MATERIALS AND METHODS: Inpatient data collected by the Pennsylvania Health Care Cost Containment Council was used to analyze 29,479 hospitalizations spanning from 2002 to 2018 at Philadelphia healthcare institutions where the primary diagnosis for admission was diverticulitis or diverticular bleeding. Age, race, and gender were collected for patients hospitalized with diverticular bleeding, di-verticulitis, and diverticulitis complications. Demographic data from the 2010 US Census was used for comparison. RESULTS: Diverticulitis (n = 20,260) disproportionately affects White individuals (p < 0.0001) while diverticular bleeding (n = 9,219) disproportionately affects Black individuals (p < 0.0001). Of all diverticulitis complications, hemorrhage (n = 1,429) had the highest proportion of Black individuals. Patients admitted for diverticular bleeding tend to be older (75.0 ± 12.1) than patients admitted for diverticulitis (60.2 ± 15.9; p < 0.00001). Among those with complicated diverticulitis, patients with hemorrhage are the oldest (70.2 ± 14.7). CONCLUSION: Patients admitted with diverticulitis complicated by hemorrhage were more similar demographically to patients admitted with diverticular bleeding than those admitted with other forms of diverticulitis. Reframing diverticulitis complicated by hemorrhage as uncomplicated diverticulitis with diverticular bleeding could prompt more appropriate treatment with avoidance of potentially unnecessary antibiotics and imaging.Synopsis: An epidemiological assessment of diverticular bleeding and diverticulitis found that patients admitted with diverticulitis complicated by hemorrhage were more similar demographically to patients admitted with diverticular bleeding than those admitted with other forms of diverticulitis. Because prior studies have suggested that demographic differences between diverticular bleeding and diverticulitis suggest distinct etiologies, we conclude that hemorrhage in the setting of diverticulitis should be treated as a diverticular bleed and not as a complication of diverticulitis itself.

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Conservative Treatment of Acute Colonic Diverticulitis

Cited by 17 publications

References 37 publications

Recent advances in understanding and managing diverticulitis

Recent advances in understanding and managing diverticulitis

Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence

Redefining Hemorrhage in Diverticulitis: Complicated Diverticulitis or Exacerbation of Diverticular Bleeding?

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