Treatment Options for Uncomplicated Diverticular Disease of the Colon

Abstract

Patients affected by uncomplicated diverticular disease (DD) suffer from colicky, unexplained, recurrent, and short-lived but often debilitating abdominal pain and alteration in bowel habit. Although the goals of therapy, such as to improve symptoms and to prevent both recurrent attacks and complications, are clearly established, the standard approach remains still debated. We examined the current scientific evidence supporting the different treatment options for uncomplicated DD. An internet-based search strategy of the Medline and Science Citation Index was performed using the keywords: diverticulosis, DD, fiber, bran, diet, antibiotics, rifaximin, probiotics, prebiotics, bacteria, lactobacillus, bifidobacteria, 5-aminosalicylic acid, sulfasalazine, mesalazine, balsalazide in various combinations to select randomized trials published in the English language between January 1966 and March 2009. The use of fiber and nonabsorbable antibiotics is supported by the existence of randomized controlled studies. More recently, alternative treatments, such as probiotics and mesalazine have been proposed even if no definite data are available. Although the preliminary results seem to be promising, randomized, placebo-controlled studies are needed before new therapies can be recommended in the management of uncomplicated DD.

New strategies for the management of diverticular disease: insights for the clinician

“…2007]. These studies suggested that cyclic administration of rifaximin was effective in reducing symptoms (abdominal pain, bloating), complication frequency and severity of diverticular disease [Rocco et al . 2009].…”

“…These studies suggested that cyclic administration of rifaximin was effective in reducing symptoms (abdominal pain, bloating), complication frequency and severity of diverticular disease [Rocco et al 2009]. Latella and colleagues pointed out that rifaximin reduced the metabolic activity of the intestinal bacterial flora, in particular the degradation of dietary fiber and the production of methane [Latella et al 2003].…”

Medical treatment of colonic diverticular disease: are we sure the aim is right?

“…Therefore, we feel that there is more than a fleeting possibility that the present efforts based on decreasing low grade mucosal inflammation in DD are aimed at a wrong target, i.e., decreasing irritable bowel syndrome-like symptoms [16], especially considering that notwithstanding several studies on the use of mesalazine that are available in the literature, there is still no firm documentation of such an efficacy of the drug in this setting [17].…”