Treatment of diverticular disease: an update on latest evidence and clinical implications

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Abstract

Background: Diverticular disease (DD) is a common condition, especially in Western countries. In about 80% of patients, colonic diverticula remain asymptomatic (diverticulosis), while approximately 20% of patients may develop abdominal symptoms (symptomatic uncomplicated diverticular disease, SUDD) and, eventually complications as acute diverticulitis (AD). The management of this condition has been improved, and in the last five years European countries and the USA have published guidelines and recommendations.

Scope: To summarize the latest evidence and clinical implication in treatment of DD focusing the attention either on the treatment of diverticulosis, SUDD and AD together with the primary and secondary prevention of diverticulitis.

Findings: The present review was based on the latest evidence in the treatment of DD in the last 10 years. In the last 5 years, six countries issued guidelines on DD with differences regarding covered topics and recommendations regarding treatments. At present there is a lack of rationale for drug use in patients with asymptomatic diverticulosis, but there are limited indications to suggest an increase in dietary fibre to reduce risk of DD. To achieve symptomatic relief in SUDD patients, several therapeutic strategies with fibre, probiotics, rifaximin and mesalazine have been proposed even if a standard therapeutic approach remained to be defined. Agreement has been reached for the management of AD, since recent guidelines showed that antibiotics can be used selectively, rather than routinely in uncomplicated AD, although use of antibiotics remained crucial in the management of complicated cases. With regard to treatment for the primary and secondary prevention of AD, the efficacy of rifaximin and mesalazine has been proposed although with discordant recommendations among guidelines.

Conclusion: Treatment of DD represented an important challenge in clinical practice, especially concerning management of SUDD and the primary and secondary prevention of AD.

Keywords: acute diverticulitis, diverticulosis, fibre, guidelines, mesalazine, probiotics, rifaximin, symptomatic uncomplicated diverticular disease, treatment.

Citation: Carabotti M, Annibale B. Treatment of diverticular disease: an update on latest evidence and clinical implications. Drugs in Context 2018; 7: 212526. DOI: 10.7573/dic.212526

Contributions: Marilia Carabotti performed the data extraction and collection, and wrote the manuscript. Bruno Annibale contributed to the conception and design of the study and to the final revision of the manuscript. Both authors approved the final draft submitted.

Disclosure and potential conflicts of interest: Marilia Carabotti has no conflict of interest to declare; Bruno Annibale reports grants and personal fees from Alfa Wassermann, grants and personal fees from Allergan, personal fees from Malesci, and grants from Biohit. These are all outside of the submitted work. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at: https://www.drugsincontext.com/wp-content/uploads/2018/02/dic.212526-COI.pdf

Funding declaration: No funding was provided.

Copyright: Copyright © 2018 Carabotti M, Annibale B. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2018 Carabotti M, Annibale B. https://doi.org/10.7573/dic.212526. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/treatment-of-diverticular-disease-an-update-on-latest-evidence-and-clinical-implications

Correspondence: Bruno Annibale, Via di Grottarossa 1035-1039, 00189 Rome, Italy. bruno.annibale@uniroma1.it

Provenance: invited; externally peer reviewed.

Submitted: 17 January 2018; Peer review comments to author: 21 February 2018; Revised manuscript received: 23 February 2018; Accepted: 23 February 2018; Publication date: 21 March 2018.

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