Colonic diverticular disease. Treatment and prevention

Gargallo-Puyuelo, Carla J.; Sopeña, Federico; Arbeloa, Ángel Lanas

doi:10.1016/j.gastrohep.2015.03.010

Cited by 16 publications

(14 citation statements)

References 95 publications

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“…The proportion of subjects with diverticulosis that eventually develop SUDD or acute diverticulitis is unknown. Consensus papers and reviews 17 , 46 , 47 state that 80–85% of subjects with diverticulosis will remain asymptomatic throughout their life, whereas 15–20% of symptomatic patients will suffer from diverticular disease without inflammation, while the remainder will have diverticulitis. However, estimates of progression need to be based on more reliable studies.…”

Section: What Are the Aims Of Treatment?mentioning

confidence: 99%

“…Pharmacological treatment of SUDD should reduce intensity and frequency of symptoms and prevent the progression to diverticulitis 17 , 46 , 47 ( Table 2 ). Most symptoms in SUDD are mild to moderate but they impair the patients’ quality of life.…”

Section: What Are the Aims Of Treatment?mentioning

confidence: 99%

“…The objectives of therapy in patients who develop acute diverticulitis include the treatment of symptoms, the colonic infection, the prevention of complications and the recurrence of the condition 47 ( Table 3 ). Based on the severity of symptoms, ability to tolerate oral intake, presence of comorbidities and adequate outpatient support, the decision on whether patients should be hospitalized or receive ambulatory care should be carefully considered.…”

Section: What Are the Aims Of Treatment?mentioning

confidence: 99%

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Management of colonic diverticular disease in the third millennium: Highlights from a symposium held during the United European Gastroenterology Week 2017

Scarpignato

Barbara

Lanas

et al. 2018

Therap Adv Gastroenterol

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Diverticulosis is a common anatomical condition, which appears to be age-dependent. Individuals who develop chronic gastrointestinal symptoms or complications are referred to as having diverticular disease. Although the diagnosis of this condition can be relatively straightforward, randomized controlled trials are scarce and management often follows tradition rather than principles of evidence-based medicine. This report deals with the topics discussed during a symposium held during the United European Gastroenterology Week (Barcelona, October 2017). During the meeting, the role of dysbiosis in the pathogenesis of diverticular disease and its treatment were thoroughly discussed, by examining the efficacy and mechanisms of action of the currently used drugs. Recent studies have shown the presence of dysbiosis in patients with diverticular disease and suggest an imbalance in favor of bacteria with pro-inflammatory and pathogenetic potential. These microbiota changes correlate with mucosal immune activation, mirrored by a marked increase of macrophages in colonic mucosa, both in the diverticular region and at distant sites. The low-grade inflammation, driven by bacteria-induced immune activation, could be involved in the pathophysiology of symptoms. As a consequence, pharmacological approaches targeting enteric bacteria (with poorly absorbed antibiotics, like rifaximin, or probiotics) or intestinal inflammation (with 5-ASA derivatives or rifaximin) have shown capability of controlling symptoms and also preventing complications, albeit more research is needed to establish the optimal regimen (daily dose and duration) of therapy. Well-designed randomized-controlled trials (RCTs), including homogeneous populations of patients, are therefore needed. The future of management of many GI diseases, including symptomatic uncomplicated diverticular disease, will rely on the so-called ‘microbiota-directed therapies’.

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Section: What Are the Aims Of Treatment?mentioning

confidence: 99%

Section: What Are the Aims Of Treatment?mentioning

confidence: 99%

Section: What Are the Aims Of Treatment?mentioning

confidence: 99%

See 1 more Smart Citation

Management of colonic diverticular disease in the third millennium: Highlights from a symposium held during the United European Gastroenterology Week 2017

Scarpignato

Barbara

Lanas

et al. 2018

Therap Adv Gastroenterol

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“…DDC includes a number of conditions, ranging from asymptomatic diverticular disease to complicated acute diverticulitis (AD). 1 Because it is often asymptomatic and may never be identified, the true incidence and prevalence of DDC is still not accurately established, although it is now widely accepted that the global incidence of both uncomplicated and complicated DDC is increasing. In recent years, several studies have assessed the economic impact of this disease.…”

Section: The Magnitude Of the Problemmentioning

confidence: 99%

“…At some point in their disease course, an estimated 5–25% of patients with colonic diverticulosis will suffer an episode of AD and up to a third may experience complications. 1 Data from the English Health Care System indicate that 16.3% of inpatient admissions related to diverticular disease eventually involve surgery, of which 58.1% are emergency surgeries and 41.9% elective. The overall surgical admission mortality rates are 10.1% and 15.5% at 30 days and 1 year, respectively (mortality rates, 2.1% and 5.3% at 30 days and 1 year for elective surgery; 15.9% and 22.8% at 30 days and 1 year with emergency surgery), and overall inpatient admissions mortality rates are 5.1% and 14.5% at 30 days and 1 year, respectively.…”

Section: The Magnitude Of the Problemmentioning

confidence: 99%

Progress and challenges in the management of diverticular disease: which treatment?

Lanas

Abad-Baroja

Lanas-Gimeno

2018

Therap Adv Gastroenterol

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Diverticular disease of the colon (DDC) includes a spectrum of conditions from asymptomatic diverticulosis to symptomatic uncomplicated diverticulosis, segmental colitis associated with diverticulosis, and acute diverticulitis without or with complications that may have serious consequences. Clinical and scientific interest in DDC is increasing because of the rising incidence of all conditions within the DDC spectrum, a better, although still limited understanding of the pathogenic mechanisms involved; the increasing socioeconomic burden; and the new therapeutic options being tested. The goals of treatment in DDC are symptom and inflammation relief and preventing disease progression or recurrence. The basis for preventing disease progression remains a high-fiber diet and physical exercise, although evidence is poor. Other current strategies do not meet expectations or lack a solid mechanistic foundation; these strategies include modulation of gut microbiota or dysbiosis with rifaximin or probiotics, or using mesalazine for low-grade inflammation in uncomplicated symptomatic diverticulosis. Most acute diverticulitis is uncomplicated, and the trend is to avoid hospitalization and unnecessary antibiotic therapy, but patients with comorbidities, sepsis, or immunodeficiency should receive broad spectrum and appropriate antibiotics. Complicated acute diverticulitis may require interventional radiology or surgery, although the best surgical approach (open versus laparoscopic) remains a matter of discussion. Prevention of acute diverticulitis recurrence remains undefined, as do therapeutic strategies. Mesalazine with or without probiotics has failed to prevent diverticulitis recurrence, whereas new studies are needed to validate preliminary positive results with rifaximin. Surgery is another option, but the number of acute events cannot guide this indication. We need to identify risk factors and disease progression or recurrence mechanisms to implement appropriate preventive strategies.

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CT colonography followed by elective surgery in patients with acute diverticulitis: a radiological-pathological correlation study

et al. 2020

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Purpose To perform a radiologic-pathologic correlation analysis of sigmoid colon in patients undergoing pre-operative CT Colonography (CTC) after an episode of acute diverticulitis (AD). Methods Fifty-nine consecutive patients (31/28 M/F; 58 ± 13 years) underwent CTC 55 ± 18 days after AD, 8 ± 4 weeks before surgery. Thirty-seven patients (63%) underwent conventional abdominal CT at time of AD. An experienced blinded radiologist retrospectively analyzed all images: disease severity was graded according to the Ambrosetti classification on conventional CT and according to the diverticular disease severity score (DDSS) on CTC. A GI pathologist performed a dedicated analysis, evaluating the presence of acute and chronic inflammation, and fibrosis, using 0-3 point scale for each variable. Results Of 59 patients, 41 (69%) had at least one previous AD episode; twenty-six patients (44%) had a complicated AD. DDSS was mild-moderate in 34/59 (58%), and severe in 25/59 (42%). All patients had chronic inflammation, while 90% had low-to-severe fibrosis. Patients with moderate/severe fibrosis were older than those with no/mild fibrosis (61 ± 13 versus 54 ± 13). We found a significant correlation between DDSS and chronic inflammation (p = 0.004), as well as DDSS and fibrosis (p = 0.005). Furthermore, fibrosis was correlated with complicated acute diverticulitis (p = 0.0.27), and with age (p = 0.067). At multivariate analysis, complicated diverticulitis was the best predictor of fibrosis (odds ratio 4.4). Patient age and DDSS were other independent predictors. Conclusion DDSS-based assessment on preoperative CTC was a good predictor of chronic colonic inflammation and fibrosis. In addition, the presence of complicated diverticulitis on CT during the acute episode was most predictive of fibrosis.

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Colonic diverticular disease. Treatment and prevention

Cited by 16 publications

References 95 publications

Management of colonic diverticular disease in the third millennium: Highlights from a symposium held during the United European Gastroenterology Week 2017

Management of colonic diverticular disease in the third millennium: Highlights from a symposium held during the United European Gastroenterology Week 2017

Progress and challenges in the management of diverticular disease: which treatment?

CT colonography followed by elective surgery in patients with acute diverticulitis: a radiological-pathological correlation study

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