Diverticular disease includes a spectrum of conditions sharing the underlying pathology of acquired diverticula of the colon: symptomatic uncomplicated diverticular disease, recurrent symptomatic uncomplicated diverticular disease, and complicated diverticular disease. Goals of therapy in diverticular disease should be to improve symptoms and to prevent recurrent attacks in symptomatic uncomplicated diverticular disease, and to prevent the complications of disease such as diverticulitis. Inflammation seems to play a key role in all forms of the disease. This is the rationale for the use of anti-inflammatory drugs such as mesalazine. Inflammation in such diseases seems to be generated by a heightened production of proinflammatory cytokines, reduced anti-inflammatory cytokines, and enhanced intramucosal synthesis of nitric oxide. The mechanisms of action of mesalazine are not yet well understood. It is an anti-inflammatory drug that inhibits factors of the inflammatory cascade (such as cyclooxygenase) and free radicals, and has an intrinsic antioxidant effect. Some recent studies confirm the efficacy of mesalazine in diverticular disease both in relief of symptoms in symptomatic uncomplicated forms and in prevention of recurrence of symptoms and main complications.
"The American Society of Colon and Rectal Surgeons published practice parameters for sigmoid diverticulitis [Rafferty et al. 2006]. It recommended dietary modification and use of antibiotics targeting common gut bacteria, which is successful in 70–100% of acute uncomplicated diverticulitis [West and Losada, 2004; Di Mario et al. 2006; Tursi et al. 2007; Rafferty et al. 2006]. Large diverticular abscesses (>3 cm) should undergo percutaneous drainage under radiological guidance. "
[Show abstract][Hide abstract] ABSTRACT: Diverticulosis is one of the most common gastrointestinal conditions affecting the general population in the Western world. It is estimated that over 2.5 million people are affected by diverticular disease in the United States. The spectrum of clinical manifestations of diverticulosis ranges from asymptomatic diverticulosis to complicated diverticulitis. Treatment for symptomatic diverticular disease is largely based on symptoms. Traditional therapy includes fiber, bowel rest, antibiotics, pain control and surgery for selected cases. This review discusses recent advances in the medical treatment of diverticular disease such as the use of mesalamine, rifaximin and probiotics as our understanding of the disease evolves.
[Show abstract][Hide abstract] ABSTRACT: Although most often clinically silent, colonic diverticula are responsible for a large number of gastrointestinal illnesses in our society. Complications of diverticular disease, including perforation and hemorrhage, may occur in 15% to 20% of patients with diverticula during their lifetime, and although often mild and self-limiting diseases, they too frequently cause life-threatening problems that require prompt surgical intervention. Despite a cadre of sophisticated laboratory and radiologic tests that have been developed to aid in the diagnosis of complicated diverticular disease, the diagnosis and treatment of diverticulitis still relies heavily on patient history, physical examination, physician judgment, and the patient's clinical response to treatment. Thus it is important for the managing physician to fully understand the pathogenesis of diverticula, the clinical consequences and modes of presentation of complicated diverticular disease, and the array of interventions available for treatment of these problems. This monograph summarizes our knowledge of diverticular disease to date and tries to give specific guidelines for the treatment of patients with complicated diverticulitis. However, it must be understood that the presentation and severity of these complications vary widely from patient to patient. Thus one cannot take a single approach toward a patient who has diverticulitis or diverticular bleeding. Rather, successful outcomes depend on an individual approach to each patient while maintaining certain generally accepted principles of treatment.
Current Problems in Surgery 04/1989; 26(3):133-89. DOI:10.1016/0011-3840(89)90031-2 · 1.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Diverticular disease is common among the elderly. Because of the advanced age and muted symptoms and signs of many of those affected, diagnosis can be difficult. Consequently, great demands are placed on the physician to diagnose and treat clinically evident diverticular disease. Endoscopic, radiologic, and surgical advances have increased the availability of more definitive therapies for patients with complicated diverticular disease and diverticular hemorrhage.
Gastroenterology Clinics of North America 07/2001; 30(2):475-96. DOI:10.1016/S0889-8553(05)70191-6 · 2.82 Impact Factor
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