D J Humes1, R C Spiller. 1. Nottingham Digestive Diseases Centre and Biomedical Research Unit, Nottingham University Hospital NHS Trust, Nottingham, UK.
Abstract
BACKGROUND: Acute diverticulitis, defined as acute inflammation associated with a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians. There have been advances in both the medical and the surgical treatments offered to patients in recent years. AIM: To review the current understanding of the aetiology and treatment of acute diverticulitis. METHODS: A search of PubMed and Medline databases was performed to identify articles relevant to the aetiology, pathogenesis and management of acute diverticulitis. RESULTS: There are 75 hospital admissions per year for acute diverticulitis per 100,000 of the population in the United States. Recent reports suggest a 26% increase in admissions over a 7-year period. Factors predisposing to the development of acute diverticulitis include obesity, smoking, diet, lack of physical activity and medication use such as aspirin and nonsteroidal anti-inflammatory drugs. The condition is associated with a low mortality of about 1% following medical therapy, rising to 4% in-hospital mortality in those requiring surgery. There is limited evidence on the efficacy of individual antibiotic regimens, and antibiotic treatment may not be required in all patients. The rates of recurrence reported for patients with acute diverticulitis following medical management vary from 13% to 36%. The surgical management of those patients who fail medical treatment has moved towards a laparoscopic nonresectional approach; however, the evidence supporting this is limited. CONCLUSIONS: Further high-quality randomised controlled trials are required of both medical and surgical treatments in patients with acute diverticulitis, if management is to be evidence-based.
BACKGROUND: Acute diverticulitis, defined as acute inflammation associated with a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians. There have been advances in both the medical and the surgical treatments offered to patients in recent years. AIM: To review the current understanding of the aetiology and treatment of acute diverticulitis. METHODS: A search of PubMed and Medline databases was performed to identify articles relevant to the aetiology, pathogenesis and management of acute diverticulitis. RESULTS: There are 75 hospital admissions per year for acute diverticulitis per 100,000 of the population in the United States. Recent reports suggest a 26% increase in admissions over a 7-year period. Factors predisposing to the development of acute diverticulitis include obesity, smoking, diet, lack of physical activity and medication use such as aspirin and nonsteroidal anti-inflammatory drugs. The condition is associated with a low mortality of about 1% following medical therapy, rising to 4% in-hospital mortality in those requiring surgery. There is limited evidence on the efficacy of individual antibiotic regimens, and antibiotic treatment may not be required in all patients. The rates of recurrence reported for patients with acute diverticulitis following medical management vary from 13% to 36%. The surgical management of those patients who fail medical treatment has moved towards a laparoscopic nonresectional approach; however, the evidence supporting this is limited. CONCLUSIONS: Further high-quality randomised controlled trials are required of both medical and surgical treatments in patients with acute diverticulitis, if management is to be evidence-based.
Authors: Manol Jovani; Wenjie Ma; Amit D Joshi; Po-Hong Liu; Long H Nguyen; Yin Cao; Idy Tam; Kana Wu; Edward L Giovannucci; Andrew T Chan; Lisa L Strate Journal: Am J Gastroenterol Date: 2019-02 Impact factor: 10.864
Authors: Antonio Tursi; Giovanni Brandimarte; Francesco Di Mario; Maria L Annunziata; Mauro Bafutto; Maria A Bianco; Raffaele Colucci; Rita Conigliaro; Silvio Danese; Rudi De Bastiani; Walter Elisei; Ricardo Escalante; Roberto Faggiani; Luciano Ferrini; Giacomo Forti; Giovanni Latella; Maria G Graziani; Enio C Oliveira; Alfredo Papa; Antonio Penna; Piero Portincasa; Kjetil Søreide; Antonio Spadaccini; Paolo Usai; Stefanos Bonovas; Carmelo Scarpignato; Marcello Picchio; Piera G Lecca; Costantino Zampaletta; Claudio Cassieri; Alberto Damiani; Kari F Desserud; Serafina Fiorella; Rosario Landi; Elisabetta Goni; Maria A Lai; Flavia Pigò; Gianluca Rotondano; Giuseppe Schiaccianoce Journal: United European Gastroenterol J Date: 2015-11-13 Impact factor: 4.623
Authors: Wenjie Ma; Manol Jovani; Long H Nguyen; Fred K Tabung; Mingyang Song; Po-Hong Liu; Yin Cao; Idy Tam; Kana Wu; Edward L Giovannucci; Lisa L Strate; Andrew T Chan Journal: Clin Gastroenterol Hepatol Date: 2019-11-08 Impact factor: 11.382