Expanding Applications: The Potential Usage of 5-Aminosalicylic Acid in Diverticular Disease

Abstract

Diverticular disease is a common bowel condition, the pathogenesis of which is incompletely understood. Acute exacerbations of diverticular disease usually require dietary changes, antibiotic therapy, and may necessitate urgent surgery. Approximately 25-33% of patients experience symptomatic and acute inflammatory disease recurrence, suggesting that current long-term management is inadequate. Because inflammatory complications of diverticular disease, including diverticulitis, are similarities to inflammatory bowel diseases, evidence suggests that patients may respond to anti-inflammatory therapies used in these conditions. Here, we explore the rationale and evidence for use of inflammatory bowel disease treatment, namely 5-aminosalicylic acid (5-ASA; mesalamine), in diverticular disease, and review clinical data on the efficacy of mesalamine either alone or in combination with other agents for the treatment of diverticular disease. PubMed and conference abstracts were searched for clinical studies examining the use of mesalamine in treating diverticular disease. Studies were evaluated for treatment efficacy in symptom reduction, recurrence prevention, or improving quality of life. The results of our search suggest that single-agent mesalamine can reduce diverticular disease symptoms and improve quality of life more effectively than antibiotic treatment alone. Mesalamine in combination with antibiotics can also reduce symptoms and improve quality of life with greater efficacy than either treatment alone. Combining mesalamine and probiotics treatments may reduce recurrent attacks of diverticular disease. Further randomized, well-controlled studies are required for validation; however, it seems that mesalamine is an important agent in future diverticular disease management.

Musosal tumour necrosis factor α in diverticular disease of the colon is overexpressed with disease severity

“…The first studies of the effectiveness of mesalazine for DD were performed without any knowledge of the presence of microscopic inflammation, cytokines or other factors. The findings of the present study support the contention that inflammation may play a role in DD [1,41–43].…”

Mucosal tumour necrosis factor-alpha in diverticular disease of the colon is overexpressed with disease severity

“…The first studies of the effectiveness of mesalazine for DD were performed without any knowledge of the presence of microscopic inflammation, cytokines or other factors. The findings of the present study support the contention that inflammation may play a role in DD (1,41,42,43). This study suffers from some possible sources of error.…”

Mucosal expression of basic fibroblastic growth factor, Syndecan 1 and tumor necrosis factor‐alpha in diverticular disease of the colon: a case–control study

“…In fact, being an acute colonic inflammation, it might be expected that TNF‐α is overexpressed in AUD, but it is also important that TNF‐α is overexpressed in SUDD in which, by definition, an endoscopic inflammation cannot be detected. The detection of TNF‐α overexpression in DD is further confirmation that inflammation may play an important role in determining the phenotype of the disease, justifying the use of anti‐inflammatory drugs (namely mesalazine) to obtain and maintain remission in those patients 42 . Of course, limiting pathologic assessment only to neutrophils and lymphocytes is quite puzzling in such a context, and may be a limitation concerning inflammation.…”