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Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon
Author(s) -
Tursi A.,
Papa A.,
Danese S.
Publication year - 2015
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13322
Subject(s) - diverticulosis , diverticulitis , medicine , diverticular disease , rifaximin , mesalazine , randomized controlled trial , inflammatory bowel disease , disease , gastroenterology , intensive care medicine , antibiotics , microbiology and biotechnology , biology
Summary Background The incidence of diverticulosis and diverticular disease of the colon, including diverticulitis, is increasing worldwide, and becoming a significant burden on national health systems. Treatment of patients with diverticulosis and DD is generally based on high‐fibre diet and antibiotics, respectively. However, new pathophysiological knowledge suggests that further treatment may be useful. Aim To review the current treatment of diverticulosis and diverticular disease. Methods A search of PubMed and Medline databases was performed to identify articles relevant to the management of diverticulosis and diverticular disease. Major international conferences were also reviewed. Results Two randomised controlled trials ( RCT ) found the role of antibiotics in managing acute diverticulitis to be questionable, particularly in patients with no complicating comorbidities. One RCT found mesalazine to be effective in preventing acute diverticulitis in patients with symptomatic uncomplicated diverticular disease. The role of rifaximin or mesalazine in preventing diverticulitis recurrence, based on the results of 1 and 4 RCTs , respectively, remains unclear. RCT s found rifaximin and mesalazine to be effective in treating symptomatic uncomplicated diverticular disease. The use of probiotics in diverticular disease and in preventing acute diverticulitis occurrence/recurrence appears promising but unconclusive. Finally, the role of fibre in treating diverticulosis remains unclear. Conclusions Available evidence suggests that antibiotics have a role only in the treatment of complicated diverticulitis. It appears to be some evidence for a role for rifaximin and mesalazine in treating symptomatic uncomplicated diverticular disease. Finally, there is not currently adequate evidence to recommend any medical treatment for the prevention of diverticulitis recurrence.