Efficacy of Mesalazine in the Treatment of Symptomatic Diverticular Disease

Abstract

We aimed to improve symptoms by means of mesalazine in symptomatic colonic diverticular disease patients. One hundred seventy outpatients (98 M, 72 F; age, 67.1 years; range, 39-84 years) were assigned to four different schedules: rifaximin, 200 mg bid (Group R1: 39 pts), rifaximin, 400 mg bid (Group R2: 43 pts), mesalazine, 400 mg bid (Group M1: 40 pts), and mesalazine, 800 mg bid (Group M2: 48 pts), for 10 days per month. At baseline and after 3 months we recorded 11 clinical variables (upper/lower abdominal pain/discomfort, bloating, tenesmus, diarrhea, abdominal tenderness, fever, general illness, nausea, emesis, dysuria), scored from 0 = no symptoms to 3 = severe. The global symptomatic score was the sum of all symptom scores. After 3 months in all schedules but Group R1, 3 of the 11 symptoms improved (P < 0.03); the global score decreased in all groups but Group R1 (P < 0.0001). Mesalazine-treated patients had the lowest global score at 3 months (P < 0.001). Mesalazine is as effective as rifaximin (higher dosage schedule) for diminishing some symptoms, but it appears to be better than rifaximin for improving the global score in those patients.

Vacuum inversion and securing of distal colonic pseudodiverticula with novel spiked O-rings

“…Although more recent studies have downscaled the estimates of lifetime risk of the development of diverticulitis from 25% 11,12 to 4%, 13 it remains a major burden of disease for our society. Mesalamine and rifaximin have been proposed for prevention of diverticulatis [14][15][16][17] ; however, larger controlled trials on mesalamine had negative results, 18 leaving laparoscopic or open surgery as the remaining option.…”

Management of colonic diverticular disease with poorly absorbed antibiotics and other therapies

“…Mesalazine given at 800 mg twice daily for 10 days a month has a similarly effect to rifaximin (400 mg twice daily) [Di Mario et al 2005]. It must however be emphasized that these data came from a single-center, randomized, open trial.…”

Colonic Diverticular Disease

“…[22] The RCT found that, at 3 months, either dose of mesalazine reduced physician-rated global symptom score significantly more than rifaximin 200 mg twice daily (170 people with symptomatic colonic diverticular disease; global symptom score range: 0 = no symptoms to 33 = most severe symptoms; mean score reduction from baseline: 4.3 with mesalazine 400 mg twice daily v 3.9 with mesalazine 800 mg twice daily v 0.8 with rifaximin 200 mg twice daily v 3.9 with rifaximin 400 mg twice daily; P less than 0.05 for either dose mesalazine v rifaximin 200 mg twice daily). There was no significant difference between either dose of mesalazine and rifaximin 400 mg twice daily in global symptom score (difference reported as not significant; P value not reported).…”

“…The RCT had several methodological flaws: [22] the study was open label; no details were given about the randomisation protocol; a non-validated physician-rated global symptom scale was used as an outcome measure; no power calculation was performed; and there was no placebo arm. It should be noted that mesalazine was given intermittently in this RCT.…”

“…Directness points deducted for uncertainty about definition of outcome or other disease states Very low 0 -2 0 -1 4 Lactulose v placebo Symptom relief 1 (43) [19] Quality point deducted for incomplete reporting of results. Consistency point deducted for conflicting results [20] [21] Quality points deducted for sparse data, methodological flaws (randomisation/blinding flaws), and incomVery low 0 -1 -1 -3 4 Mesalazine v rifaximin Symptom relief 1 (170) [22] plete reporting of results. Consistency point deducted for conflicting results.…”