Open AccessParadigm shift: the Copernican revolution in diverticular disease
Author(s) -
Angelo Zullo,
Luigi Gatta,
Roberto Vassallo,
Vincenzo De Francesco,
Raffaele Manta,
Fabio Monica,
Giulia Fiorini,
Dino Vaira
Publication year - 2019
Publication title -
annals of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.886
H-Index - 33
eISSN - 1792-7463
pISSN - 1108-7471
DOI - 10.20524/aog.2019.0410
Subject(s) - medicine , diverticular disease , diverticulitis , diverticulosis , intensive care medicine , disease , clinical practice , general surgery , antibiotics , physical therapy , microbiology and biotechnology , biology
Diverticular disease (DD) is an umbrella definition that includes different clinical conditions ranging from diverticulosis to severe and potentially life-threatening complications. In the last decade, new concepts regarding pathogenetic alterations have been developed, while the diagnostic, clinical and therapeutic approaches to the management of DD patients have changed. The protective role of dietary factors (i.e., fiber) has been questioned, whilst some drugs widely used in clinical practice have been found to have a deleterious effect. The use of antibiotics in all patients with acute uncomplicated diverticulitis was reconsidered, as well as the need for a surgical approach in these patients. Conflicting recommendations in different guidelines were proposed for the treatment of symptomatic uncomplicated DD. An endoscopic classification of DD was introduced, and a "curative" endoscopic approach has been pioneered. Based on these observations, which together amount to a kind of "Copernican revolution" in the management of DD patients, we performed a comprehensive and critical reappraisal of the proposed modifications, aiming to discriminate between certainties and doubts on this issue.