Low risk of complications in patients with first-time acute uncomplicated diverticulitis

Chabok, Abbas; Andreasson, Kalle; Nikberg, Maziar

doi:10.1007/s00384-017-2912-7

Cited by 14 publications

(17 citation statements)

References 10 publications

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“…Generally, the first episode is the most severe, with only 2% of recurrences resulting in a complicated case. Surgical treatment does not prevent the risk of recurrence, the rate of which is around 15% 22 , 23 .…”

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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“… 128 The second episode carries another 30% risk of having a third event, 4 but the first episode seems the most severe. 129 Patients also present often chronic abdominal pain after an AD event that may be difficult to manage. 130 Although quality evidence is still insufficient to identify the best preventive treatment, several secondary prevention strategies have been suggested and include a high-fiber diet, cyclic antibiotic treatment with rifaximin, probiotics, mesalazine treatment, and avoiding NSAIDs.…”

Section: Asymptomatic Ddcmentioning

confidence: 99%

Progress and challenges in the management of diverticular disease: which treatment?

Lanas

Abad-Baroja

Lanas-Gimeno

2018

Therap Adv Gastroenterol

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Diverticular disease of the colon (DDC) includes a spectrum of conditions from asymptomatic diverticulosis to symptomatic uncomplicated diverticulosis, segmental colitis associated with diverticulosis, and acute diverticulitis without or with complications that may have serious consequences. Clinical and scientific interest in DDC is increasing because of the rising incidence of all conditions within the DDC spectrum, a better, although still limited understanding of the pathogenic mechanisms involved; the increasing socioeconomic burden; and the new therapeutic options being tested. The goals of treatment in DDC are symptom and inflammation relief and preventing disease progression or recurrence. The basis for preventing disease progression remains a high-fiber diet and physical exercise, although evidence is poor. Other current strategies do not meet expectations or lack a solid mechanistic foundation; these strategies include modulation of gut microbiota or dysbiosis with rifaximin or probiotics, or using mesalazine for low-grade inflammation in uncomplicated symptomatic diverticulosis. Most acute diverticulitis is uncomplicated, and the trend is to avoid hospitalization and unnecessary antibiotic therapy, but patients with comorbidities, sepsis, or immunodeficiency should receive broad spectrum and appropriate antibiotics. Complicated acute diverticulitis may require interventional radiology or surgery, although the best surgical approach (open versus laparoscopic) remains a matter of discussion. Prevention of acute diverticulitis recurrence remains undefined, as do therapeutic strategies. Mesalazine with or without probiotics has failed to prevent diverticulitis recurrence, whereas new studies are needed to validate preliminary positive results with rifaximin. Surgery is another option, but the number of acute events cannot guide this indication. We need to identify risk factors and disease progression or recurrence mechanisms to implement appropriate preventive strategies.

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“…In patients with suspected diverticulitis, diagnostic imaging is performed to establish the correct diagnosis, exclude complications, and direct patient management. A CT scan should be obtained in patients with signs of complicated diverticulitis including patients with clinical suspicion of perforation, peritonitis, or abscess, and those with complex anatomy and broader differentials 1,2 . A shift in the understanding of the underlying disease process of diverticulitis along with advances in medical and surgical management has led gastroenterologists and surgeons to increasingly adopt a more conservative approach to treatment 2,3 .…”

Section: Introductionmentioning

confidence: 99%

“…A CT scan should be obtained in patients with signs of complicated diverticulitis including patients with clinical suspicion of perforation, peritonitis, or abscess, and those with complex anatomy and broader differentials 1,2 . A shift in the understanding of the underlying disease process of diverticulitis along with advances in medical and surgical management has led gastroenterologists and surgeons to increasingly adopt a more conservative approach to treatment 2,3 . As such, patients with a high pretest probability of uncomplicated diverticulitis in whom CT imaging is of uncertain added value are therefore potentially subject to high rates of unnecessary radiation, long wait times, and costly ED visits 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Utility of point‐of‐care ultrasound in patients with suspected diverticulitis in the emergency department

Shokoohi

Nasser

Pyle

et al. 2020

J of Clinical Ultrasound

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In emergency department (ED) cases with clinically suspected diverticulitis, diagnostic imaging is often needed for diagnostic confirmation, to exclude complications, and to direct patient management. Patients typically undergo a CT scan in the ED; however, in a subset of cases with suspected diverticulitis, point-of-care ultrasound (POCUS) may provide sufficient data to confirm the diagnosis and ascertain a safe plan for outpatient management.We review the main sonographic features of diverticulitis and discuss the diagnostic accuracy and potential benefits of a POCUS First model. K E Y W O R D S bowel, diverticulitis, emergency department, gastrointestinal system, point-of-care ultrasound

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Low risk of complications in patients with first-time acute uncomplicated diverticulitis

Cited by 14 publications

References 10 publications

Recent advances in understanding and managing diverticulitis

Recent advances in understanding and managing diverticulitis

Progress and challenges in the management of diverticular disease: which treatment?

Utility of point‐of‐care ultrasound in patients with suspected diverticulitis in the emergency department

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