Mesalamine Did Not Prevent Recurrent Diverticulitis in Phase 3 Controlled Trials

Raskin, Jeffrey B.; Kamm, Michael A.; Jamal, M. Mazen; Márquez, Juan Ricardo; Melzer, Ehud; Schoen, Robert E.; Szalóki, Tibor; Barrett, Karen; Streck, Paul

doi:10.1053/j.gastro.2014.07.004

Cited by 95 publications

(85 citation statements)

References 30 publications

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“…Therefore, we expected to find a marked difference in every field between surgeons and gastroenterologists; however, this was not the case. Treatment is becoming more and more a tailor-made decision [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. The use of mesalazine, which is opted by the greater part of participating gastroenterologists, remains a subject of debate.…”

Section: Discussionmentioning

confidence: 99%

“…The use of mesalazine, which is opted by the greater part of participating gastroenterologists, remains a subject of debate. Recently, 2 identical phase 3, randomized, double-blind, placebo-controlled, multicenter trials have evaluated the efficacy of mesalazine and found that there is no benefit compared to the benefits of placebos [26,27]. Therefore, the use of mesalazine warrants a cautious attitude.…”

Section: Discussionmentioning

confidence: 99%

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Recurrences and Ongoing Complaints of Diverticulitis; Results of a Survey among Gastroenterologists and Surgeons

Stam¹,

Draaisma²,

Consten³

et al. 2016

Hum Hered

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Objective: This study aims to investigate the current opinion of gastroenterologists and surgeons on treatment strategies for patients, with recurrences or ongoing complaints of diverticulitis. Background: Treatment of recurrences and ongoing complaints remains a point of debate. No randomized trials have been published yet and guidelines are not uniform in their advice. Design: A web-based survey was conducted among gastroenterologists and GE-surgeons. Questions were aimed at the treatment options for recurrent diverticulitis and ongoing complaints. Results: In total, 123 surveys were filled out. The number of patients with recurrent or ongoing diverticulitis who were seen at the outpatient clinic each year was 7 (0-30) and 5 (0-115) respectively. Surgeons see significantly more patients on an annual basis 20 vs. 15% (p = 0.00). Both surgeons and gastroenterologists preferred to treat patients in a conservative manner using pain medication and lifestyle advise (64.4 vs. 54.0, p = 0.27); however, gastroenterologists would treat patients with mesalazine medication, which is significantly more (28%, p = 0.04) than in the surgical group. Surgeons are inclined more towards surgery (31.5%, p = 0.02). Conclusions: Both surgeons and gastroenterologists prefer to treat recurrent diverticulitis and ongoing complaints in a conservative manner. Quality of life, the risk of complications and the viewpoint of the patient are considered important factors in the decision to resect the affected colon.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Recurrences and Ongoing Complaints of Diverticulitis; Results of a Survey among Gastroenterologists and Surgeons

Stam¹,

Draaisma²,

Consten³

et al. 2016

Hum Hered

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show abstract

“…The role of anti-inflammatory, aminosalicyclate (5 ASA) compounds to counteract this, including mesalazine has been investigated. However, multiple placebo controlled trials have shown that they neither reduce recurrent episodes nor improve symptomatology [23,24]. These findings are confirmed in a 2017 systematic review and meta-analysis of 8 randomised controlled trials.…”

Section: Mesalazine and Probioticsmentioning

confidence: 93%

Current Controversies in the Management of Diverticulitis: A Review

Nally

Kavanagh

2018

Dig Surg

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Background: Symptomatic diverticular disease is challenging for patients, clinicians and health services. The prevalence increases with age and BMI and as such, the burden of this disease is set to increase with higher rates of acute presentations already documented. The natural history of recurrent episodes, complications and symptom progression is not fully understood. Furthermore, medical and surgical management strategies are under constant appraisal, debate and evolution. Methods: A review of the contemporary literature was performed to examine the emerging trend towards conservative treatment. Results: Routine use of in-patient, intravenous antibiotics may not be required and outpatient management is possible for certain patients. Universal colonoscopy examination after uncomplicated acute diverticulitis is controversial but is mandatory after complicated episodes. Recent, high-profile, clinical trials suggest that less aggressive surgical management of both acute and chronic presentations may be feasible in some cases. Conclusions: Diverticulitis is a common yet challenging topic that demands clinicians to provide an individualised yet evidence-based approach.

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“…Results have been variable [31, 32]. Carter et al [33], in a 2017 Cochrane systematic review and meta-analysis of seven randomized trials, found no evidence of the benefit of mesalamine for the prevention of recurrent diverticulitis.…”

Section: Treatmentmentioning

confidence: 99%

Recurrent Acute Diverticulitis: When to Operate?

et al. 2018

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Objective: Recurrent acute diverticulitis carries a major burden to any form of health care. Patients present repeatedly to medical centers with a multitude of symptoms and may require different modalities of treatment with significant morbidities and impact on quality of life. Methods: We therefore wanted to identify factors that would imply the need and time of surgery versus conservative management. The literature was thoroughly searched for major studies tackling this topic. Furthermore, studies reporting on decision making based on quality of life were included. Risks of developing recurrent diverticulitis and the potential need of surgery were identified. Relevant surgical details that would decrease recurrence were also denoted. Results: Surgery has been the mainstay of treatment for quite some time. However, the paradigms of treatment have changed over the last few years, especially when long-term population studies confirmed that not all patients require surgical treatment with its associated risk of morbidity. Conclusion: Treatment now has to be patient-tailored with special attention to the subgroup of high-risk patients. These patients must be adequately selected, identifying the impact of the disease on the quality of life and weighing in the risks of the surgical intervention.

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Mesalamine Did Not Prevent Recurrent Diverticulitis in Phase 3 Controlled Trials

Cited by 95 publications

References 30 publications

Recurrences and Ongoing Complaints of Diverticulitis; Results of a Survey among Gastroenterologists and Surgeons

Recurrences and Ongoing Complaints of Diverticulitis; Results of a Survey among Gastroenterologists and Surgeons

Current Controversies in the Management of Diverticulitis: A Review

Recurrent Acute Diverticulitis: When to Operate?

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