Medical Management of Diverticular Disease

Surgical evaluation and treatment is commonly required for the treatment of diverticulitis in both the acute and elective situations. This chapter discusses the surgical treatment of the clinically important manifestations of diverticular disease. Different options for surgical treatment are described for patients in both the urgent and elective settings, including technical aspects of these options. Current controversies are reviewed, including resection versus laparoscopic lavage for the treatment of purulent peritonitis, the use of gastrointestinal diversion in the surgical treatment of acute diverticulitis, and timing of operation for recurrent diverticulitis. This review contains 8 figures, 4 tables, and 67 references. Key Words: acute diverticulitis, complicated diverticulitis, diverticular disease, diverticulitis, diverticulosis, Hartmann procedure, laparoscopic lavage, sigmoid resection with primary anastomosis, uncomplicated diverticulitis

Mesalazine for People with Diverticular Disease: A Systematic Review of Randomized Controlled Trials

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/5437135 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12 ◽

Cited By ~ 5

Author(s):

Andrea Iannone ◽

Marinella Ruospo ◽

Germaine Wong ◽

Michele Barone ◽

Mariabeatrice Principi ◽

...

Keyword(s):

Diverticular Disease ◽

Acute Diverticulitis ◽

Disease Recurrence ◽

Current Evidence ◽

Random Effects Models ◽

Disease Remission ◽

Uncomplicated Diverticulitis ◽

Disease Subtype ◽

Uncomplicated Diverticular Disease ◽

Acute Uncomplicated Diverticulitis

Background. Diverticular disease treatment is limited to fibres, antibiotics, and surgery. There is conflicting evidence on mesalazine benefits and harms. Aim. We systematically reviewed current evidence on benefits and harms of mesalazine versus all other treatments in people with diverticular disease. Methods. We searched MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov for studies published to July 2018. We estimated risk ratios (RR) for dichotomous outcomes (disease remission/recurrence, acute diverticulitis in symptomatic uncomplicated diverticular disease, need for surgery/hospitalization, all-cause/disease-related mortality, adverse events), mean differences (MD) or standardized MD (SMD) for continuous outcomes (quality of life, symptoms score, time to recurrence/remission), and their 95% confidence intervals (CI) using random-effects models. We quantified heterogeneity by Chi2 and I2 tests. We performed subgroup analyses by disease subtype, comparator, follow-up duration, mesalazine dose, and mode of administration. Results. We identified 13 randomized trials (n=3028 participants). There was a higher likelihood of disease remission with mesalazine than controls in acute uncomplicated diverticulitis (1 trial, 81 participants, RR=2.67, 95%CI=1.05-6.79), but not in symptomatic uncomplicated diverticular disease (1 trial, 123 participants, RR=1.04, 95%CI=0.81-1.34). There was a lower likelihood of disease recurrence with mesalazine than controls in symptomatic uncomplicated diverticular disease (2 trials, 216 participants, RR=0.52, 95%CI=0.28-0.97), but not in acute uncomplicated diverticulitis (7 trials, 2196 participants, RR=0.90, 95%CI=0.61-1.33). There was no difference in the likelihood of developing acute diverticulitis in symptomatic uncomplicated diverticular disease between the two groups (3 trials, 484 participants, RR=0.26, 95%CI=0.06-1.20). There was a higher global symptoms score reduction with mesalazine than controls in symptomatic uncomplicated diverticular disease (2 trials, 326 participants, SMD=-1.01, 95%CI=-1.51,-0.52) and acute uncomplicated diverticulitis (2 trials, 153 participants, SMD=-0.56, 95%CI=-0.88,-0.24). Conclusions. Mesalazine may reduce recurrences in symptomatic uncomplicated diverticular disease. There is uncertainty on the effect of mesalazine in achieving diverticular disease remission. Mesalazine may not prevent acute diverticulitis in symptomatic uncomplicated diverticular disease.

Diagnosis and Management of Acute Diverticulitis

10.2310/surg.2391 ◽

2019 ◽

Author(s):

Tiffany K Weidner ◽

John T Kidwell ◽

David A Etzioni

Keyword(s):

United States ◽

Acute Diverticulitis ◽

The United States ◽

Complicated Diverticulitis ◽

Perforated Diverticulitis ◽

Uncomplicated Diverticulitis ◽

Urgent Surgery ◽

Colonic Fistula ◽

Surgical Evaluation ◽

Acute Uncomplicated Diverticulitis

Diverticulitis is the cause of 300,000 inpatient admissions in the United States each year. Surgical evaluation and treatment are commonly required for the treatment of diverticulitis. This chapter discusses the diagnosis, triage, and treatment of acute diverticulitis. Medical treatment, as well as the indications for surgical treatment for diverticulitis, is discussed. Current controversies, including the need for antibiotics for a patient with acute uncomplicated diverticulitis, necessity of colonoscopy after resolution of an acute episode, and indications for urgent surgery, are reviewed. This review contains 10 figures, 3 tables, and 67 references. keywords: acute diverticulitis, colonic fistula, complicated diverticulitis, diverticular abscess, diverticular disease, diverticulitis, diverticulosis, perforated diverticulitis, uncomplicated diverticulitis

Diverticular Disease: Epidemiology and Management

Canadian Journal of Gastroenterology ◽

10.1155/2011/795241 ◽

2011 ◽

Vol 25 (7) ◽

pp. 385-389 ◽

Cited By ~ 122

Author(s):

Adam V Weizman ◽

Geoffrey C Nguyen

Keyword(s):

Diverticular Disease ◽

The Elderly ◽

Western Society ◽

Disease Epidemiology ◽

Uncomplicated Diverticulitis ◽

Outpatient Visits ◽

Recurrent Diverticulitis ◽

Inflammatory Bowel ◽

Bowel Rest ◽

Peridiverticular Abscess

Diverticular disease of the colon is among the most prevalent conditions in western society and is among the leading reasons for outpatient visits and causes of hospitalization. While previously considered to be a disease primarily affecting the elderly, there is increasing incidence among individuals younger than 40 years of age. Diverticular disease most frequently presents as uncomplicated diverticulitis, and the cornerstone of management is antibiotic therapy and bowel rest. Segmental colitis associated with diverticula shares common histopathological features with inflammatory bowel disease and may benefit from treatment with 5-aminosalicylates. Surgical management may be required for patients with recurrent diverticulitis or one of its complications including peridiverticular abscess, perforation, fistulizing disease, and strictures and/or obstruction.

1069 Diverticular Disease: An Audit of Adherence to NICE Guidelines

British Journal of Surgery ◽

10.1093/bjs/znab259.419 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

O Lesi ◽

M R Iqbal ◽

L Khan

Keyword(s):

Diverticular Disease ◽

Complicated Diverticulitis ◽

University Hospital ◽

Full Blood Count ◽

C Reactive Protein ◽

Nice Guidelines ◽

Reactive Protein ◽

Presenting Symptoms ◽

Uncomplicated Diverticulitis ◽

Retrospective Audit

Abstract Introduction Diverticular disease is a common surgical problem ranging from diverticulosis to uncomplicated diverticulitis to complicated diverticulitis. The NICE Guidelines for diverticular disease recommended that antibiotics should only be given in patients who are systemically unwell, background of immunosuppression or have complicated diverticulitis. We aimed to access the compliance to these guidelines with regards to the use of antibiotics at our local institute. Method This was a retrospective audit reviewing the management of patients with Computed Tomography Scan findings of uncomplicated acute diverticulitis (Hinchey Ia) at the surgical emergency unit at Basildon University Hospital between August 2018 and May 2020. Data obtained included demographic data, presenting symptoms (fever, abdominal pain), haematological investigations (full blood count and c-reactive protein) and use of intravenous/oral antibiotics. Results Twenty patients were included, the M:F ratio was 1:1.9, the age range was between 36-80 years. 13 patients (65%) had left iliac fossa pain as part of their presenting symptom while only three (15%) had pyrexia. Seventeen patients(85%) had NEWS score between 0-1 with 60% of the patients presenting with elevated white blood cell count and 75% with c-reactive protein >5. All our patients were prescribed antibiotics. Conclusions There was no discrimination in the use of antibiotics/admission for uncomplicated diverticulitis as all patients had antibiotics and as such there is need for increased awareness about the guidelines among the surgical team and adherence to the protocol to prevent indiscriminate use of antibiotics.

161 Current Practice of Antibiotic Prescription in Acute Uncomplicated Diverticulitis

British Journal of Surgery ◽

10.1093/bjs/znab259.011 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Patel ◽

N Darwish ◽

N Kirmani

Keyword(s):

Current Practice ◽

Antibiotic Prescription ◽

Lower Abdominal Pain ◽

Complicated Diverticulitis ◽

Antibiotic Prescribing ◽

Antibiotic Administration ◽

Nice Guidelines ◽

Uncomplicated Diverticulitis ◽

Prescribing Practice ◽

Acute Uncomplicated Diverticulitis

Abstract Aim To review the current antibiotic prescribing practice for patients with acute uncomplicated diverticulitis against the NICE guidelines November 2019, to avoid unnecessary/overuse of antibiotics. Method A retrospective review of patients presenting with lower abdominal pain between 1/11/2019 -31/1/2020. All patients with suspected diverticulitis were included. Patients who were subsequently diagnosed with complicated diverticulitis/alternate diagnosis were excluded from the analysis. Results 22/27 (81.5%) of the patients were admitted. 26 out of 27 (96.3%) patients with acute uncomplicated diverticulitis were administered antibiotics. Antibiotics were indicated as per NICE guidelines in 17 patients (62.97%) and not indicated in 9 patients (33.34%). Admission was not indicated in 20 patients (90.91%) according to NICE guidelines. Conclusions Our adherence to NICE guidelines is 66.67% in terms of antibiotic administration, however the drug and duration of antibiotic administration needs to be reviewed. NICE guidelines recommend that acute uncomplicated diverticulitis can be managed as an outpatient. Antibiotics should be administered only if patient is systemically unwell, is immunosupressed or has significant co morbidities

T04.02.4 THE EFFICACY OF A MIX OF THREE PROBIOTIC STRAINS IN REDUCING ABDOMINAL PAIN AND INFLAMMATORY BIOMARKERS IN ACUTE UNCOMPLICATED DIVERTICULITIS

Digestive and Liver Disease ◽

10.1016/s1590-8658(20)30782-9 ◽

2020 ◽

Vol 52 ◽

pp. S129

Author(s):

C. Petruzziello ◽

M. Marannino ◽

A. Migneco ◽

M. Brigida ◽

A. Saviano ◽

...

Keyword(s):

Abdominal Pain ◽

Inflammatory Biomarkers ◽

Uncomplicated Diverticulitis ◽

Probiotic Strains ◽

Acute Uncomplicated Diverticulitis

321 Role of Antibiotics in Acute uncomplicated diverticulitis, A Systematic Review and Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab134.404 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A A Tahir ◽

K M Ali ◽

A U Khan ◽

S Kamal ◽

A Hussain ◽

...

Keyword(s):

Systematic Review ◽

Statistical Analysis ◽

Treatment Failure ◽

Hospital Stay ◽

Meta Analysis ◽

Dietary Advice ◽

Duration Of Hospital Stay ◽

Uncomplicated Diverticulitis ◽

Acute Uncomplicated Diverticulitis

Abstract Introduction Diverticular disease is a common health problem with a wide clinical spectrum. About 75% of the patients would have uncomplicated diverticulitis. Cornerstones of treatment are antibiotics, analgesia, and dietary advice. Recent evidence has shown that its treatment is controversial, questioning the use of antibiotics. Aim is to assess the role of antibiotics in the treatment of acute uncomplicated diverticulitis. Method This is a systematic review and Meta-analysis. Literature review of the available studies was conducted using search engines like Pubmed, Medline, Embase, Google Scholar, and Cochrane databases. Statistical analysis was conducted using RevMan5.4. Results Out of 1754 records 1324 were duplicates, 430 studies were screened. 395 were further excluded.35 full text articles were assessed and in the final review 10 studies were included. PRISMA guidelines were used. Pooled OR for recurrence = 0.92 (95% CI = 0.74 to 1.13). Pooled OR for Hospital stay= -0.66 (95% CI= -1.12 to -0.21). Pooled OR for complications = 1.06 (95% CI = 0.69 to 1.64). Pooled OR for treatment failure= 1.24 (95% CI = 0.90-1.69). Conclusions We conclude that from the available evidence antibiotics have no role in reducing recurrence, complications, treatment failure, and duration of hospital stay in acute uncomplicated diverticulitis.

Complicated Diverticular Disease

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0040-1716701 ◽

2020 ◽

Author(s):

Kathleen M. Coakley ◽

Bradley R. Davis ◽

Kevin R. Kasten

Keyword(s):

Postoperative Complications ◽

Diverticular Disease ◽

Surgical Intervention ◽

Management Strategies ◽

Significant Risk ◽

Complicated Diverticulitis ◽

Careful Attention ◽

Correct Treatment ◽

Treatment Paradigm ◽

Colonic Diverticular Disease

AbstractThe modern management of colonic diverticular disease involves grouping patients into uncomplicated or complicated diverticulitis, after which the correct treatment paradigm is instituted. Recent controversies suggest overlap in management strategies between these two groups. While most reports still support surgical intervention for the treatment of complicated diverticular disease, more data are forthcoming suggesting complicated diverticulitis does not merit surgical resection in all scenarios. Given the significant risk for complication in surgery for diverticulitis, careful attention should be paid to patient and procedure selection. Here, we define complicated diverticulitis, discuss options for surgical intervention, and explain strategies for avoiding operative pitfalls that result in early and late postoperative complications.

Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review

Nutrients ◽

10.3390/nu13041288 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1288

Author(s):

Marilia Carabotti ◽

Francesca Falangone ◽

Rosario Cuomo ◽

Bruno Annibale

Keyword(s):

Systematic Review ◽

Diverticular Disease ◽

Dietary Habits ◽

Acute Diverticulitis ◽

High Quality ◽

Eligibility Criteria ◽

Diverticular Bleeding ◽

Recurrent Diverticulitis ◽

Increased Risk

Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the effect of dietary habits in the prevention of diverticula complications (i.e., acute diverticulitis and diverticula bleeding) in patients with diverticula disease. PubMed and Scopus databases were searched up to 19 January 2021, 330 records were identified, and 8 articles met the eligibility criteria and were subjected to data extraction. The quality of the studies was evaluated by the Newcastle-Ottawa quality assessment form. No study meets the criteria for being a high-quality study. A high intake of fiber was associated to a decreased risk of diverticulitis or hospitalization due to diverticular disease, with a protective effect for fruits and cereal fiber, but not for vegetable fiber; whereas, a high red meat consumption and a generally Western dietary pattern were associated with an increased risk of diverticulitis. Alcohol use seemed to be associated to diverticular bleeding, but not to recurrent diverticulitis or diverticular complications. Further high-quality studies are needed to better define these associations. It is mandatory to ascertain the role of dietary habits for the development of recurrent acute diverticulitis and diverticular bleeding.