Effect of mesalazine on recurrence of diverticulitis in patients with symptomatic uncomplicated diverticular disease: a meta‐analysis with trial sequential analysis of randomized controlled trials

Khan, Rao Muhammad Asaf; Ali, Baqar; Hajibandeh, Shahin

doi:10.1111/codi.14064

Cited by 25 publications

(27 citation statements)

References 22 publications

(49 reference statements)

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“…In a meta-analysis, six trials that evaluated the efficacy of mesalazine in the prevention of recurrent diverticulitis in 2,461 patients showed no significant difference in the rate of recurrent diverticulitis with mesalazine treatment 199 . However, mesalazine use after an episode of diverticulitis should not be precluded.…”

Section: Ok?]mentioning

confidence: 99%

Colonic diverticular disease

Tursi

Scarpignato

Strate

et al. 2020

Nat Rev Dis Primers

166

172

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Queries are meant to draw your attention to edits, inconsistencies or issues that are unclear. If we just ask you to confirm edits are correct, a simple yes/ok between the brackets will do [Au: OK? Is this what you meant? Edits OK? yes]. If questions are asked, please rephrase/update the manuscript text when addressing queries, so that the message is conveyed to the reader (do NOT just type your answer to our query).] [Au: Throughout the manuscript, please use consistent terminology. For example, acute diverticulitis is diverticular disease and in several instances, they are mentioned separately. For clearer understanding, please use consistent terminology and define cleary what diverticular disease refers to. Similarly, there is a slight ambiguity between the terms diverticulosis and asymptomatic diverticulosis. My understanding is that diverticulosis is always asymptomatic. Please refer to them consistently if they are used to refer to the same condition. Is acute uncomplicated diverticulitis as in some instances, its refered to as uncomplicated acute diverticulitis? Please also use the abbreviation, AUD, if this terminology is widely accepted in the field. Just wanted to flag these here to make it easier for you to address.][Au: Important! As I am managing the references for this manuscript, it is essential that changes to references are noted to me in a comment rather than edited manually (as this will likely unlink the references and cause much confusion). If a reference needs to be added, include the full reference details (at a minimum, PMID or DOI are needed) and precise location to be cited. If a reference needs to be deleted, state which reference (author, year) and not just the reference number (as this will change with every change to the references).You can move text around, including the references associated with any given statement, but please don't edit the reference list at the end of the document.

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Section: Ok?]mentioning

confidence: 99%

Colonic diverticular disease

Tursi

Scarpignato

Strate

et al. 2020

Nat Rev Dis Primers

166

172

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“…Mesalazine has also been tested in the prevention of recurrent acute diverticulitis. Most studies (including the two randomized, double-blind, placebo-controlled multicenter trials 72 , 73 ) and a very recent meta-analysis 74 failed to show a positive effect with mesalazine. In a small, retrospective, observational, long-term study, 75 treatment with rifaximin (800 mg daily, 10 days a month) was more effective than mesalazine (2.4 g daily, 10 days a month) in preventing recurrence of acute diverticulitis.…”

Section: Which Drugs Are Effective?mentioning

confidence: 99%

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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“…Even though a recent updated meta-analysis did not find a significant difference in the rate of recurrent diverticulitis with mesalazine treatment [49], the mesalazine use after an episode of diverticulitis should not be precluded. Mesalazine treatment resulted in fewer and less severe symptoms than placebo [3,50].…”

Section: Pharmacological Therapiesmentioning

confidence: 97%

Course of the Diverticular Disease: What is changing?

Milosavljević¹,

Brandimarte²,

Stollman³

et al. 2020

JGLD

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In this session several critical issues in diverticular disease were considered, including “It is Symptomatic Diverticular Disease or Irritable Bowel Syndrome?”, “What do determine evolution to diverticulitis, bowel habits alteration or inflammation?”, and “Prevention of acute diverticulitis: Is it at all possible?”. The first talking compared symptoms and laboratory findings between Symptomatic Uncomplicated Diverticular Disease (SUDD) and Irritable Bowel Syndrome (IBS). Although both disease share some symptoms, and although IBS can occur in patients having diverticulosis, SUDD and IBS can be differentiate using a combination of symptoms and laboratory tools. The second talking debated what are the most important risk factors for the evolution towards acute diverticulitis. Current data seem to exclude a significant role of bowel habits alteration, while inflammation seems to have a stronger role, especially in causing acute diverticulitis recurrence. The third talking analyzed about the acute diverticulitis prevention. Primary prevention seem to be little better when using mesalazine, while no definite conclusion can be drawn about the use of fiber and rifaximin. About the secondary prevention, no drugs can be currently advised due to lacking of definite results. At the same time, surgery should be advised on case-by-case basis.

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Effect of mesalazine on recurrence of diverticulitis in patients with symptomatic uncomplicated diverticular disease: a meta‐analysis with trial sequential analysis of randomized controlled trials

Abstract: Mesalazine does not prevent the recurrence of diverticulitis in patients with SUDD. Further studies are required to investigate the role of mesalazine as an adjunct to other medical agents in the prevention of diverticulitis in patients with SUDD.

Cited by 25 publications

References 22 publications

Colonic diverticular disease

Colonic diverticular disease

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

Course of the Diverticular Disease: What is changing?

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