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5‐aminosalicylic acid agents for prevention of recurrent diverticulitis: A systematic review and meta‐analysis
Author(s) -
Urushidani Seigo,
Kuriyama Akira,
Matsumura Masami
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13846
Subject(s) - medicine , diverticulitis , randomized controlled trial , diverticulosis , meta analysis , relative risk , adverse effect , incidence (geometry) , cochrane library , medline , confidence interval , physics , political science , law , optics
Background and Aim Prevalence of colonic diverticulosis is increasing worldwide with age, and up to 25% of patients who have colonic diverticulosis might experience diverticulitis. However, a definitive approach of preventing recurrent diverticulitis remains unknown. 5‐aminosalicylic acid (5‐ASA) agents are anti‐inflammatory agents and have been used to prevent recurrent diverticulitis, and there have been some randomized clinical trials (RCTs). However, the efficacy results for secondary prevention in uncomplicated diverticulitis differed across studies. Our aim was to clarify the efficacy and safety of 5‐ASA agents in the prevention of recurrent diverticulitis. Methods We searched MEDLINE, EMBASE, Web of Science, and the Cochrane library with no language restrictions. Two reviewers independently assessed and selected RCTs. The data were pooled using a random effect model and were presented in the pooled risk ratio (RR) and 95% confidence interval (CI). Cochrane's Q and I‐squared statistics were used to assess heterogeneity. The protocol was registered at PROSPERO. Results Seven articles with eight RCTs from 329 potentially relevant articles were included. 5‐ASA agents were not superior to controls in preventing recurrent diverticulitis (RR 0.86, 95% CI 0.63 to 1.17, I 2 = 60%) and the incidence of adverse events was not different between 5‐ASA agents and controls (RR 0.97, 95% CI 0.84 to 1.11, I 2 = 45%). However, some included studies were few in number of participants and substantial risk of bias. Conclusions 5‐aminosalicylic acid agents were not associated with prevention of recurrent diverticulitis.