Diverticular disease of the large bowel – a new perspective on classification and therapy

Czech version

Authors: Lukáš M.
Authors‘ workplace: Klinické a výzkumné centrum pro střevní záněty ISCARE I. V. F. a. s. a 1. LF UK, Praha
Published in: Gastroent Hepatol 2019; 73(5): 413-417
Category: Gastrointestinal Oncology: Review Article
doi: https://doi.org/10.14735/amgh2019413

Overview

Symptomatic, uncomplicated diverticular disease (SUDD) of the large bowel is the most frequent form of diverticular disease experienced by a gastroenterologist. This entity is clinically characterized by intermittent or long-term abdominal pain, excess bowel gas, flatulence, and irregular bowel movement. In some patients, SUDD can occur after a flare-up of acute diverticulitis but in other patients it can cause diverticulitis. The current therapy comprises lifestyle changes in diet, namely the ingestion of fiber rich food and intermittent therapy with antibiotics. A promising therapy seems to be intermittent therapy with the nonabsorbable antibiotic rifaximin.

Keywords:

diverticular disease of the large bowel – diverticulitis – rifaximin

Sources

1. Shahedi K, Fuller G, Bolus R et al. Lon-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol 2013; 11 (12): 1609–1613. doi: 10.1016/j.cgh.2013.06.020.

2. Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. Br Med J 1971; 2 (5759): 450–454. doi: 10.1136/bmj.2.5759.450.

3. Ryska O. Divertikulární choroba tlustého střeva – nové trendy v léčbě. Kardiol Rev Int Med 2014; 16 (3): 71–76.

4. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet 2004; 363 (9409): 631–639. doi: 10.1016/S0140-6736 (04) 15597-9.

5. Špičák J, Kučera M, Suchánková G. Divertikulární choroba. Gastroent Hepatol 2018. In press. doi: 10.14735/amgh2018csgh.info01.

6. Barbara G, Scaioli E, Barbaro MR et al. Gut microbiota, metabolome and immune signatures in patients with uncomplicated diverticular disease. Gut 2017; 66 (7): 1252–1261. doi: 10.1136/gutjnl-2016-312377.

7. Daniels L, Philipszoon LE, Boermasster MA. A hypothesis: important role for gut microbiota in the ethiopathogenesis of diverticular disease. Dis colon Rectum 2014; 57 (4): 539–543. doi: 10.1097/DCR.0000000000000078.

8. Kvasnovsky CL, Adams K, Papagrigoridaris S. Diverticular disease is a chronic gastrointestinal condition: experience from a specialist clinic. Eur J Gastroenterol Hepatol 2015; 27 (4): 442–448. doi: 10.1097/MEG.0000000000000304.

9. Tursi A, Elisei W, Picchio M et al. Moderate to severe left-lower abdominal pain is the best symptom characterizing symptomatic uncomplicated diverticular disease of the colon: a comparison with fecal calprotectin and clinical setting. J Clin Gastroenterol 2015; 49 (3): 218–221. doi: 10.1097/MCG.0000000000000094.

10. Peery AF, Barrett PR, Park D et al. A high fiber diet does not predict against asymptomatic diverticulosis. Gastroenterology 2012; 142 (2): 266–272. doi: 10.1053/j.gastro.2011.10. 035.

11. Fric P, Zavoral M. The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon. Eur J Gastroenterol Hepatol 2003; 15 (3): 313–315. doi: 10.1097/01.meg.0000049998.68425.e2.

12. Raskin BJ, Kamm MA, Jamal MM et al. Mesalazine did not prevent reccurent diverticulitis in phase 3 controlled trials. Gastroenterology 2014; 147 (4): 793–802. doi: 10.1053/j.gastro.2014.07.004.

13. Gracie DJ, Ford AD. Editorial: mesalazine to prevent reccurent acute diverticulitis – the final nail in the coffin. Aliment Pharmacol Therapeutic 2017; 46 (4): 461–462. doi: 10.1111/apt.14180.

14. DuPont HL. Review article: the antimicrobial effects of rifaximin on the gut microbiota. Aliment Pharmacol Ther 2016; 43 (Suppl 1): 3–10. doi: 10.1111/apt.13434.

15. Colecchia A, Vestito A, Pasqui F et al. Efﬁcacy of long term administration of the poorly absorbed antibiotic Rifaximin in symptomatic, uncomplicated colonic diverticular disease. World J Gastroenterol 2007; 13 (2): 264–269. 10.3748/wjg.v13.i2.264.

16. Bianchi M, Vesta F, Moretti A et al. Meta-analysis: long-term therapy with rifaximin in the management of uncomplicated diverticular disease. Aliment Pharmacol Ther 2011; 33 (8): 902–910. doi: 10.1111/j.1365-2036.2011.04606.x.

17. Huang JS, Jiang ZD, Garey KW et al. Use od rifamycin drugs and development of infection by rifamycin-resistant strains of Clostridium difficile. Antimicrob Agents Chemother 2013; 57 (6): 2690–2693. doi: 10.1128/AAC.00548-13.