Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study

Isacson, Daniel; Thorisson, Arnar; Andreasson, Kalle; Nikberg, Maziar; Smedh, K.; Chabok, Abbas

doi:10.1007/s00384-015-2258-y

Cited by 68 publications

(68 citation statements)

References 32 publications

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“…One recently published prospective study went further by a step and treated UD without antibiotics [21] , based on the results of a randomized CT comparing antibiotics with no antibiotics in its population cohort [9] . It is of interest to note that the results without antibiotics seemed comparable to the other studies testing various types of antibiotics in an out-patient setting.…”

Section: Discussionmentioning

confidence: 99%

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Out-Patient Management of Mild or Uncomplicated Diverticulitis: A Systematic Review

Balasubramanian

Fleming²,

Mohan³

et al. 2016

Dig Surg

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Background: Management of diverticular disease has undergone a paradigm shift, with movement towards a less invasive management strategy. In keeping with this, outpatient management of uncomplicated diverticulitis (UD) has been advocated in several studies, but concerns still remain regarding the safety of this practice. Aim: To assess outcomes of out-patient management of acute UD. Methods: A comprehensive search for published studies using the search terms ‘uncomplicated diverticulitis', ‘mild diverticulitis' and ‘out-patient' was performed. The primary outcomes were failure of medical treatment. Secondary outcomes were recurrence rate at follow up and medical cost savings. Results: The search yielded 192 publications. Of these, 10 studies met the inclusion criteria including 1 randomized controlled trial, 6 clinical controlled trials and 3 case series. There was no difference in failure rates of medical treatment (6.5 vs. 4.6%, p = 0.32) or in recurrence rates (13.0 vs. 12.1%, p = 0.81) between those receiving ambulatory care and in-patient care for UD. Ambulatory treatment is associated with an estimated daily cost savings of between 600 and 1,900 euros per patient treated. Meta-analysis of data was not possible due to heterogeneity in study designs and inclusion criteria. Conclusion: Ambulatory management of acute UD is reasonable in selected patients.

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Section: Discussionmentioning

confidence: 99%

“…Only 5 studies reported the recurrence of diverticulitis as requiring further treatment with or without hospitalization during a period of longer follow-up [15,17,[19][20][21] . The period of follow-up in which recurrence was noted was highly variable ranging between 1 and 24 months.…”

Section: Study Characteristicsmentioning

confidence: 99%

Out-Patient Management of Mild or Uncomplicated Diverticulitis: A Systematic Review

Balasubramanian

Fleming²,

Mohan³

et al. 2016

Dig Surg

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“…El fundamento de esta estrategia ha sido que cualquier inflamación resulta en microperforación del divertículo, teniendo como consecuencia contaminación del peritoneo. Sin embargo, estudios recientes plantean la necesidad de reevaluar esta indicación en casos no complicados 69,70 . Chabok y cols.…”

Section: Fármacosunclassified

Enfermedad diverticular: mitos y realidades

Fluxá

Quera

2017

Rev. méd. Chile

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“…A recent study has shown that outpatient, non-antibiotic management of acute uncomplicated diverticulitis may be a feasible and safe option. (22) However the ability to identify these patients is still difficult. Bilirubin, WBC and CRP are commonly measured as part of a standard workup for abdominal pain in the emergency department.…”

Section: Introductionmentioning

confidence: 99%

The Use of Biochemical Markers in Complicated and Uncomplicated Acute Diverticulitis

Kumarasinghe

Zahid

O’Grady

et al. 2018

International Surgery

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Abstract:Abstract BACKGROUND: Diverticulosis is extremely common in western society. A recent study has shown that outpatient, non-antibiotic management of acute uncomplicated diverticulitis may be a feasible and safe option. However the ability to identify these patients is still difficult. This study explores the ability of white cell count, C-reactive protein and bilirubin in differentiating patients with complicated and uncomplicated diverticulitis as well as progression to surgical intervention. METHODS: This is a retrospective study of patients admitted with acute diverticulitis over a 5-year period (2009)(2010)(2011)(2012)(2013)(2014) at a single institution in Australia. Patients were classified into three groups; uncomplicated diverticulitis, complicated diverticulitis without surgery and complicated diverticulitis with surgery. ANOVA and Bonferroni's post-hoc analyses were used to compare markers across the groups. RESULTS: A total of 541 patients met the inclusion criteria for this study. One-way ANOVA showed a significant difference in white cell count (p<0.0001), C-reactive protein (p<0.0001) and bilirubin (p=0.0006) between all three groups. Post-hoc analyses showed a significant difference in white cell count, C-reactive protein and bilirubin when comparing uncomplicated diverticulitis against complicated diverticulitis without surgery (p<0.05) and complicated diverticulitis with surgery (p<0.05). White cell count also showed a significant difference when comparing complicated diverticulitis without surgery and complicated diverticulitis with surgery (p<0.05). CONCLUSIONS: White cell count, C-reactive protein and bilirubin can distinguish between uncomplicated and complicated diverticulitis.

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Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study

Abstract: Previous results of low complication rates with the non-antibiotic policy were confirmed. The new policy of outpatient management without antibiotics in acute uncomplicated diverticulitis is now shown to be feasible, well functioning, and safe.

Cited by 68 publications

References 32 publications

Out-Patient Management of Mild or Uncomplicated Diverticulitis: A Systematic Review

Out-Patient Management of Mild or Uncomplicated Diverticulitis: A Systematic Review

Enfermedad diverticular: mitos y realidades

The Use of Biochemical Markers in Complicated and Uncomplicated Acute Diverticulitis

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