Treatment of diverticular disease, targeting symptoms or underlying mechanisms

Cuomo, Rosario; Cargiolli, Martina; Cassarano, Sara; Carabotti, Marilia; Annibale, Bruno

doi:10.1016/j.coph.2018.09.006

Cited by 9 publications

(4 citation statements)

References 53 publications

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“…Consensus on optimal treatment is lacking, and the long-standing recommendation of systemic antibiotics (ABX) to routinely treat acute diverticulitis has recently been challenged [ 9 ]. Current guidelines suggest the adoption of a no-antibiotic (NABX) strategy in treating patients with acute diverticulitis without systemic upset (uncomplicated cases) [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

Mohamedahmed,

Zaman,

Das

et al. 2024

Int J Colorectal Dis

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Background To evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey grade 1a) acute diverticulitis. Methods A systematic online search was conducted using electronic databases. Comparative studies of OP versus IP treatment and ABX versus NABX approach in the treatment of Hinchey grade 1a acute diverticulitis were included. Primary outcome was recurrence of diverticulitis. Emergency and elective surgical resections, development of complicated diverticulitis, mortality rate, and length of hospital stay were the other evaluated secondary outcome parameters. Results The literature search identified twelve studies (n = 3,875) comparing NABX (n = 2,008) versus ABX (n = 1,867). The NABX group showed a lower disease recurrence rate and shorter length of hospital stay compared with the ABX group (P = 0.01) and (P = 0.004). No significant difference was observed in emergency resections (P = 0.33), elective resections (P = 0.73), development of complicated diverticulitis (P = 0.65), hospital re-admissions (P = 0.65) and 30-day mortality rate (P = 0.91). Twelve studies (n = 2,286) compared OP (n = 1,021) versus IP (n = 1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P = 0.10), emergency surgical resection (P = 0.40), elective resection (P = 0.30), disease recurrence (P = 0.22), and mortality rate (P = 0.61). Conclusion Observation-only treatment is feasible and safe in selected clinically stable patients with uncomplicated acute diverticulitis (Hinchey 1a classification). It may provide better outcomes including decreased length of hospital stay. Moreover, the OP approach in treating patients with Hinchey 1a acute diverticulitis is comparable to IP management. Future high-quality randomised controlled studies are needed to understand the outcomes of the NABX approach used in an OP setting in managing patients with uncomplicated acute diverticulitis.

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Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

Mohamedahmed,

Zaman,

Das

et al. 2024

Int J Colorectal Dis

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“…Причины появления свищей весьма разнообразны: воспалительные заболевания кишечника, межпетельные абсцессы и гематомы, грубые интраоперационные манипуляции и незаметные десерозации стенки кишки при разделении спаек, травмы живота. В последнее время все чаще отмечают появление свищей у пациентов с дивертикулярной болезнью ободочной кишки (ДБОК), осложненной воспалительным процессом [1,2].…”

Section: Introductionunclassified

“…Выделяют внутренние и наружные кишечные свищи. При внутренних свищах просвет пораженного участка кишки сообщается с просветом прочих органов брюшной полости, которые не имеют сообщения с внешней средой [1,3,4]. Эти свищи развиваются в течение длительного времени, протекают бессимптомно, диагностируются случайно при проведении инструментальных методов диагностики (ирригоскопии, колоноскопии, КТ с болюсным контрастированием).…”

Section: Introductionunclassified

Sigmoduodenal Fistula Complicating Diverticular Disease of the Colon

Хаджи-Исмаил¹,

Шулейко²,

Кириленко³

et al. 2023

Хирургия. Восточная Европа

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Введение. Ободочно-кишечные свищи – тяжелый патологический процесс, требующий хирургического лечения. Причины их появления весьма разнообразны: воспалительные заболевания кишечника, межпетельные абсцессы и гематомы, грубые интраоперационные манипуляции и незаметные десерозации стенки кишки при разделении спаек, травмы живота, осложненная дивертикулярная болезнь ободочной кишки (ДБОК). Выделяют внутренние и наружные свищи. Факторы риска образования ободочно-кишечных свищей при ДБОК следующие: мобильная удлиненная двупетлистая или многопетлистая сигмовидная кишка; угол ректосигмоидного соединения <70º; операции на органах брюшной полости и малого таза; противобрыжеечное и смешанное (брыжеечное, противобрыжеечное) расположение дивертикулов; патологическая перистальтика ободочной кишки с высоким просветным давлением; мужской пол. Цель. Демонстрация редкого варианта формирования внутреннего свища сигмовидной кишки при ДБОК и сложность его диагностики. Материалы и методы. Проведен анализ проспективных данных 153 пациентов, среди них были 84 (54,9%) женщины в возрасте от 34 до 86 лет и 69 (45,1%) мужчин в возрасте от 34 до 82 лет. Расположение дивертикулов ободочной кишки у этих пациентов по отношению к брыжейке было следующим: брыжеечный край – 74 (48,4%), противобрыжеечный край – 36 (23,5%) и смешанная локализация – 43 (28,1%). Результаты. Анализ ретроспективных данных показывает, что при ДБОК свищи (наружные и внутренние) развиваются у лиц мужского пола чаще, чем у женского, что составляет 15,9% и 8,4% соответственно. При этом изолированная наружная свищевая форма у мужчин преобладает над внутренней формой и составляет 54,5% и 45,5% соответственно. Заключение. Левосторонняя локализация дивертикулярной болезни ободочной кишки может проявляться различными формами осложнений. Сигмодуоденальный свищ является достаточно редким осложнением в хирургической практике, в том числе при дивертикулярной болезни ободочной кишки, из-за анатомических ограничений и отдаленного расположения сигмы и двенадцатиперстной кишки. Тем не менее врач не должен игнорировать такой вариант проявления осложнений. Introduction. Colonic fistulas are a severe pathological process requiring surgical treatment. The reasons for their appearance of fistulas is very diverse: inflammatory bowel diseases, interstitial abscesses and hematomas, rough intraoperative manipulations and imperceptible deserization of the intestinal wall during the separation of adhesions, abdominal trauma, complicated diverticular colon disease. Internal and external fistulas are allocated. Risk factors for the formation of colonic fistulas in diverticular colon disease are as follows: mobile elongated double-looped or multi-looped sigmoid colon, rectosigmoid junction angle <70º, operations on the organs of the abdominal cavity and pelvis, anti-mesenteric and mixed (mesenteric and anti-mesenteric) location of diverticula, abnormal peristalsis of the colon with high luminal pressure, male gender. Purpose. Demonstration of a rare variant of the formation of an internal fistula of the sigmoid colon in DBOK and the complexity of its diagnosis. Materials and methods. The analysis of prospective data of 153 patients was carried out, among them were 84 (54.9%) women 34–86 years in age and 69 (45.1%) men 34–82 years in age. The location of the colon diverticula in these patients in relation to the mesentery was as follows: mesenteric margin – 74 (48.4%), mesenteric margin – 36 (23.5%) and mixed localization – 43 (28.1%). Results. The analysis of retrospective data shows that in DD of the colon, fistulas (external and internal) develop in males more often than in women, which is 15.9% and 8.4%, respectively. At the same time, the isolated external fistula form in men prevails over the internal form and amounts to 54.5% and 45.5%, respectively. Conclusion. Left-sided localization of diverticular disease of the colon can manifest itself in various forms of complications. Sigmoduodenal fistula is a rather rare complication in surgical practice, including diverticular disease of the colon due to anatomical limitations and remote location of the sigmoid and duodenum. However, the doctor should not ignore this variant of the manifestation of complications.

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“…Gunčar et al [3] describe medical diagnosis as the method of deciding which disease better describes the symptoms and signs of an individual. Physicians utilize their medical knowledge, abilities, and experiences with laboratory analysis, which measures various elements in the blood, to find the diseases that best explain an individual's symptoms and signs [4]. A patient's medical history is indispensable in gathering information and data for diagnosis.…”

Section: Introductionmentioning

confidence: 99%

A comparative analysis of haemoglobin variants using machine learning algorithms

Okandeji¹,

Odeyinka²,

Sogbesan³

et al. 2022

Nig. J. Tech.

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In medical sciences, to ascertain the origin of a sickness, professionals utilize their expertise and knowledge to analyze a person's symptoms and indications. These symptoms (indicators) are threshold values that health specialists use to determine the cause of the illness by comparing a specific proportion of measurements to where a healthy population would fall. Consequently, diagnostic mistakes occur as a result of inaccuracy and imprecision. This study utilizes machine learning to categorize haemoglobin variations. Specifically, the data set used in this study includes 752 complete blood count laboratory analyses of adult patients aged eighteen and above obtained from Lagos State University Teaching Hospital (LASUTH). Multiple machine learning methods were utilized for classification from which five of the methods employed were examined and assessed. Comparative analysis was done using the five algorithms (K-Nearest Neighbors (KNN), Support Vector Machine (SVM), Decision Tree (DT), Random Forest (RF), and Naive Bayes (NB)). Contrary to work done by previous researchers, it was observed that the SVM model showed the best classification accuracy of 94.7%, with an F1-score of 94.5%, precision of 94.8%, recall of 94.7%, specificity of 97.3%, and area under curve (AUC) of 99.0%. Among the other models considered, the RF model gave the least accuracy result of 87.4%. The study shows that the support vector machine algorithm outperforms the other classifiers in terms of accuracy when predicting haemoglobin variants given the haematological parameters.

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Treatment of diverticular disease, targeting symptoms or underlying mechanisms

Cited by 9 publications

References 53 publications

Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

Sigmoduodenal Fistula Complicating Diverticular Disease of the Colon

A comparative analysis of haemoglobin variants using machine learning algorithms

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