Mesalazine for diverticular disease of the colon – a new role for an old drug

Abstract

Colonic diverticulosis is among the most common diseases of developed countries. Its prevalence is approximately 5 - 10% of the population by age 50, and 30, 50 and 66% of those > 50, > 70 and > 85years of age, respectively. Antibiotics have been successfully used in the treatment of uncomplicated diverticular disease; however, the use of mesalazine (alone or in combination with antibiotics) in treating uncomplicated diverticulitis has been successfully developed in recent years. Indeed, mesalazine (with or without antibiotics) showed significant superiority in improving the severity of symptoms, bowel habits, and in preventing symptomatic recurrence of diverticulitis over antibiotics alone. More-over, in light of some preliminary results, it is probable that the association of mesalazine with probiotics may in the future be the first-choice treatment for mild-to-moderate uncomplicated attacks of acute diverticulitis.

Review article: the current and evolving treatment of colonic diverticular disease

“…It is thought that the development of diverticulitis is associated with an increase in pro-inflammatory cytokines, such as interleukin-1 (IL-1), tumour necrosis factor a (TNFa) and a decrease in anti-inflammatory cytokines IL-1ra, IL-4, IL-10 and IL-11. 55 In a study of patients with diverticulitis or peritonitis, it was indeed found that patients with diverticulitis had higher expression of cells in the omentum ⁄ blood positive for TNF-a (51% ⁄ 35%), interferon (IFN)-c (47% ⁄ 32%) and IL-2 (33% ⁄ 20%). This was not the case for IL-4 expression (0.8% ⁄ 1.3%).…”

Diverticular Disease in the Elderly

“…Postulates include mucosal prolapse, relative ischemia, bacterial overgrowth, increased exposure to intraluminal toxins and antigens secondary to fecal stasis [19,20] . Some of these factors are similar to those implicated in the pathogenesis of inflammatory bowel disease (IBD) and this colitis may be considered a 'bridge' disease between classic IBD and diverticulitis [21] . There is also evidence that diverticular disease may be based on a disorder of the enteral nervous system, which may, in turn, be caused by an inflammatory process.…”

Möglichkeiten und Grenzen der ambulanten Therapie der Divertikelkrankheit

“…Für den Einsatz von Mesalazin (5-Aminosalicylsäure (5-ASA)) zur Sekundärprophylaxe einer Divertikulitis und der Behandlung der chronischen Divertikelerkrankung gibt es ebenso vereinzelt Studien [44,98,100] [18]. Ein ähnliches Setup hatte eine spanische prospektive Studie mit 176 Patienten [19].…”

“…Neuere Studien weisen trotz Ermangelung einer systemischen Entzündungsreaktion und fehlenden Entzündungszei-chen in der Bildgebung dennoch lokale Entzündungsreaktio-nen in Form eines leicht erhöhten Calprotectins auf [42,43]. Diese Hypothese der Mikroentzündung wird durch die Symptombesserung einer Langzeittherapie durch antiinflammatorische oder antibiotische Therapie bestätigt [44][45][46][47][48].…”