-
Journal of Gastrointestinal and Liver... Mar 2016Diverticular disease is a common gastrointestinal condition. Low-grade inflammation and altered intestinal microbiota have been identified as factors contributing to... (Review)
Review
BACKGROUND AND AIMS
Diverticular disease is a common gastrointestinal condition. Low-grade inflammation and altered intestinal microbiota have been identified as factors contributing to abdominal symptoms. Probiotics may lead to symptoms improvement by modifying the gut microbiota and are promising treatments for diverticular disease. The aim of this study was to systematically review the efficacy of probiotics in diverticular disease in terms of remission of abdominal symptoms and prevention of acute diverticulitis.
METHODS
According to PRISMA, we identified studies on diverticular disease patients treated with probiotics (Pubmed, Embase, Cochrane). The quality of these studies was evaluated by the Jadad scale. Main outcomes measures were remission of abdominal symptoms and prevention of acute diverticulitis.
RESULTS
11 studies (2 double-blind randomized placebo-controlled, 5 open randomized, 4 non-randomized open studies) were eligible. Overall, diverticular disease patients were 764 (55.1% females, age 58-75 years). Three studies included patients with symptomatic uncomplicated diverticular disease, 4 studies with symptomatic uncomplicated diverticular disease in remission, 4 studies with complicated or acute diverticulitis. Mainly (72.7%) single probiotic strains had been used, most frequently Lactobacilli. Follow-up ranged from 1 to 24 months. Interventions were variable: in 8 studies the probiotic was administered together with antibiotic or anti-inflammatory agents and compared with the efficacy of the drug alone; in 3 studies the probiotic was compared with a high-fibre diet or used together with phytoextracts. As an outcome measure, 4 studies evaluated the occurrence rate of acute diverticulitis, 6 studies the reduction of abdominal symptoms, and 6 studies the recurrence of abdominal symptoms. Meta-analysis on the efficacy of probiotics in diverticular disease could not be performed due to the poor quality of retrieved studies.
CONCLUSION
This systematic review showed that high-quality data on the efficacy of probiotics in diverticular disease are scant: the available data do not permit conclusions. Further investigation is required to understand how probiotics can be employed in this condition.
Topics: Diverticulitis; Gastrointestinal Microbiome; Humans; Intestines; Probiotics; Remission Induction; Treatment Outcome
PubMed: 27014757
DOI: 10.15403/jgld.2014.1121.251.srw -
European Journal of Nutrition Dec 2017We conducted a systematic review and meta-analysis of prospective studies of the association between body mass index (BMI) and physical activity and diverticular disease... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We conducted a systematic review and meta-analysis of prospective studies of the association between body mass index (BMI) and physical activity and diverticular disease risk.
METHODS
PubMed and Embase databases were searched up to February 7, 2017. Summary relative risks and 95% confidence intervals (95% CIs) were calculated using a random effects model and nonlinear associations were modeled using fractional polynomial models.
RESULTS
Six cohort studies of BMI and diverticular disease risk (28,915 cases, 1,636,777 participants) and five cohort studies of physical activity and diverticular disease risk (2080 cases, 147,869 participants) were included. The summary relative risk (RR) of incident diverticular disease for a 5 unit BMI increment was 1.28 (95% CI: 1.18-1.40, I = 77%, n = 6) for diverticular disease, 1.31 (95% CI: 1.09-1.56, I = 74%, n = 2) for diverticulitis, and 1.20 (95% CI: 1.04-1.40, I = 56%, n = 3) for diverticular disease complications. There was no evidence of a nonlinear association between BMI and diverticular disease risk (p = 0.22), and risk increased even within the normal weight range. Compared to a BMI of 20, the summary RR for a BMI of 22.5, 25.0, 27.5, 30.0, 32.5, 35.0, 37.5, and 40.0 was 1.15 (1.07-1.23), 1.31 (1.17-1.47), 1.50 (1.31-1.71), 1.71 (1.52-1.94), 1.96 (1.77-2.18), 2.26 (2.00-2.54), 2.60 (2.11-3.21), and 3.01 (2.06-4.39), respectively. The summary RR was 0.76 (95% CI: 0.63-0.93, I = 54%, n = 5) for high vs. low physical activity and 0.74 (95% CI: 0.57-0.97, I = 39.5%, p = 0.20, n = 2) for high vs. low vigorous physical activity.
CONCLUSIONS
These results suggest that even moderate increases in BMI may increase the risk of diverticular disease as well as diverticular disease complications and that a higher level of physical activity may reduce the risk.
Topics: Body Mass Index; Diverticular Diseases; Exercise; Humans; Incidence; Obesity; Risk Factors; Sensitivity and Specificity; Waist Circumference; Waist-Hip Ratio
PubMed: 28393286
DOI: 10.1007/s00394-017-1443-x -
Diseases of the Colon and Rectum May 2020CT findings of acute diverticulitis can overlap with features of malignancy, and current guidelines recommend colonic evaluation after acute diverticulitis. However, the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
CT findings of acute diverticulitis can overlap with features of malignancy, and current guidelines recommend colonic evaluation after acute diverticulitis. However, the benefits of routine colonic evaluation have been questioned.
OBJECTIVE
We review 30 studies, composed of 29,348 subjects, to evaluate the role of routine colonic evaluation after CT-proven acute diverticulitis.
DATA SOURCES
Medline, EMBASE, and the Cochrane Library were searched for articles published up to July 2018 to identify all relevant articles.
STUDY SELECTION
A combination of both Medical Subject Headings and non-Medical Subject Headings key terms using Boolean operators were used on Medline, including colonic neoplasms, colorectal cancer, colon cancer, colonic cancer, colonoscopy, and diverticulitis. Any randomized or nonrandomized, English-language article that specifically analyzed incidence of colorectal cancer after performing colonoscopy in patients with previous diverticulitis was included.
MAIN OUTCOME MEASURES
The desired outcome was to evaluate for incidence of colonic malignancy in cases of acute colonic diverticulitis. Subgroup analyses for incidence of malignancy in uncomplicated and complicated diverticulitis, and Asian population studies were also performed.
RESULTS
Findings of colonic malignancy occurred in 1.67% (95% CI, 1.24-2.14) of patients with CT-diagnosed diverticulitis. The risk of malignancy in cases with uncomplicated diverticulitis was 1.22% (95% CI, 0.63-1.97) as compared with 6.14% (95% CI, 3.20-9.82) in cases with complicated diverticulitis, with a relative risk of 5.033 (95% CI, 3.194-7.930; p < 0.001).
LIMITATIONS
Significant variability in design and methodology of the individual studies contributed to the heterogeneity of this study, but these were addressed by using the random-effects model analysis.
CONCLUSIONS
Colonic evaluation is worth considering for patients with diverticulitis because of the small but serious risk of underlying malignancy. The risk of malignancy is higher for patients of advanced age and with complicated diverticulitis.
Topics: Colonoscopy; Colorectal Neoplasms; Diverticulitis, Colonic; Humans; Tomography, X-Ray Computed
PubMed: 32271220
DOI: 10.1097/DCR.0000000000001664 -
Diseases of the Colon and Rectum Dec 2019Despite low-quality and conflicting evidence, the Association of Coloproctology of Great Britain and Ireland recommends the routine use of antibiotics in the treatment... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Despite low-quality and conflicting evidence, the Association of Coloproctology of Great Britain and Ireland recommends the routine use of antibiotics in the treatment of uncomplicated acute diverticulitis. Recent studies have shown that treatment without antibiotics did not prolong recovery. Some new guidelines currently recommend selective use of antibiotics.
OBJECTIVE
The purpose of this study was to compare the safety, effectiveness, and outcomes in treating uncomplicated acute diverticulitis without antibiotics with treatment with antibiotics.
DATA SOURCES
PubMed, Embase, Clinicaltrials.gov, and the Cochrane Library were searched with the key words antibiotics and diverticulitis.
STUDY SELECTION
All studies published in English on treating uncomplicated acute diverticulitis without antibiotics and containing >20 individuals were included.
INTERVENTION
Treatment without antibiotics versus treatment with antibiotics were compared.
MAIN OUTCOME MEASURES
The primary outcome was the percentage of patients requiring additional treatment or intervention to settle during the initial episode. The secondary outcomes were duration of hospital stay, rate of readmission or deferred admission, need for surgical or radiological intervention, recurrence, and complication.
RESULTS
Search yielded 1164 studies. Nine studies were eligible and included in the meta-analysis, composed of 2505 patients, including 1663 treated without antibiotics and 842 treated with an antibiotic. The no-antibiotics group had a significantly shorter hospital stay (mean difference = -0.68; p = 0.04). There was no significant difference in the percentage of patients requiring additional treatment or intervention to settle during the initial episode (5.3% vs 3.6%; risk ratio = 1.48; p = 0.28), rate of readmission or deferred admission (risk ratio = 1.17; p = 0.26), need for surgical or radiological intervention (risk ratio = 0.61; p = 0.34), recurrence (risk ratio = 0.83; p = 0.21), and complications (risk ratio = 0.70-1.18; p = 0.67-0.91).
LIMITATIONS
Only a limited number of studies were available, and they were of variable qualities.
CONCLUSIONS
Treatment of uncomplicated acute diverticulitis without antibiotics is associated with a significantly shorter hospital stay. There is no significant difference in the percentage of patients requiring additional treatment or intervention to settle in the initial episode, rate of readmission or deferred admission, need for surgical or radiological intervention, recurrence, or complications.
Topics: Anti-Bacterial Agents; Disease Management; Diverticulitis; Fluid Therapy; Humans; Length of Stay; Patient Readmission; Recurrence; Treatment Outcome
PubMed: 30663999
DOI: 10.1097/DCR.0000000000001330 -
The Surgeon : Journal of the Royal... Dec 2018The surgical interventions of diverticulitis vary according to its grade and severity. There is a controversy about the best of these different surgical procedures. We... (Meta-Analysis)
Meta-Analysis
PURPOSE
The surgical interventions of diverticulitis vary according to its grade and severity. There is a controversy about the best of these different surgical procedures. We aimed to systematically review and meta-analyze randomized controlled trials (RCTs) comparing outcomes and complications between different surgical approaches for acute diverticulitis and its complications.
METHODS
Nine electronic databases including PubMed, Scopus, and Web of Science were searched for RCTs comparing different surgical procedures for different grades of diverticulitis. The risk of bias was assessed using the Cochrane Collaboration tool. The protocol was registered in PROSPERO (CRD42015032290).
RESULTS
Outcome data were analyzed from five RCTs comparing laparoscopic sigmoid resection (LSR) (n = 247) versus open sigmoid resection (OSR) (n = 237) for treatment of acute complicated diverticulitis with minimal heterogeneity. There was no significant difference in short-term postoperative overall morbidity (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.61-1.31; P = 0.56) and long-term postoperative major morbidity (RR 0.78, 95% CI 0.46-1.31, P = 0.34). In other six RCTs compared laparoscopic lavage with resection for treatment of perforated diverticulitis with peritonitis, the postoperative mortality rate was non-significant in both short-term (RR 1.55, 95% CI 0.79-3.04; P = 0.21) and long-term (RR 0.67, 95% CI 0.29-1.58; P = 0.36) follow up.
CONCLUSIONS
LSR is not superior over OSR regarding postoperative morbidity and mortality for acute symptomatic diverticulitis. Furthermore, laparoscopic lavage was proved to be as safe as resection for perforated diverticulitis with peritonitis. Further RCTs are still needed to make an accurate decision regarding these and other procedures.
Topics: Colectomy; Colon, Sigmoid; Diverticulitis; Humans; Laparoscopy; Peritonitis; Postoperative Complications; Therapeutic Irrigation
PubMed: 30033140
DOI: 10.1016/j.surge.2018.03.011 -
Scandinavian Journal of Gastroenterology Jul 2024Recurrences or persistent symptoms after an initial episode of diverticulitis are common, yet surgical treatment is rarely performed. Current guidelines lack clear... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recurrences or persistent symptoms after an initial episode of diverticulitis are common, yet surgical treatment is rarely performed. Current guidelines lack clear recommendations on whether or not to operate, even though recent studies suggest an improved quality of life following surgery. The aim of this study is therefore to compare quality of life in patients with recurrent or ongoing diverticulitis treated conservatively versus surgically, giving a more definitive answer to the question of whether or not to operate on these patients.
METHODS
A systematic literature search was conducted in EMBASE, MEDLINE and Cochrane. Only comparative studies reporting on quality of life were included. Statistical analysis included calculation of weighted mean differences and pooled odds ratios.
RESULTS
Five studies were included; two RCT's and three retrospective observational studies. Compared to conservative treatment, the SF-36 scores were higher in the surgically treated group at each follow-up moment but only the difference in SF-36 physical scores at six months follow-up was statistically significant (MD 6.02, 95%CI 2.62-9.42). GIQLI scores were also higher in the surgical group with a MD of 14.01 (95%CI 8.15-19.87) at six months follow-up and 7.42 (95%CI 1.23-12.85) at last available follow-up. Also, at last available follow-up, significantly fewer recurrences occurred in the surgery group (OR 0.10, 95%CI 0.05-0.23, < 0.001).
CONCLUSION
Although surgery for recurrent diverticulitis is not without risk, it might improve long-term quality of life in patients suffering from recurrent- or ongoing diverticulitis when compared to conservative treatment. Therefore, it should be considered in this patient group.
Topics: Humans; Quality of Life; Recurrence; Conservative Treatment; Diverticulitis; Diverticulitis, Colonic; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 38613245
DOI: 10.1080/00365521.2024.2337833 -
Diseases of the Colon and Rectum Mar 2020Acute diverticulitis is a common disease with public health significance. Many studies with a high level of evidence have been published recently on the surgical...
BACKGROUND
Acute diverticulitis is a common disease with public health significance. Many studies with a high level of evidence have been published recently on the surgical management of acute diverticulitis.
OBJECTIVE
The aim of this systematic review was to define the accurate surgical management of acute diverticulitis.
DATA SOURCES
Medline, Embase, and the Cochrane Library were sources used.
STUDY SELECTION
One reviewer conducted a systematic study with combinations of key words for the disease and the surgical procedure. Additional studies were searched in the reference lists of all included articles. The results of the systematic review were submitted to a working group composed of 13 practitioners. All of the conclusions were obtained by full consensus and validated by an external committee.
INTERVENTIONS
The interventions assessed were laparoscopic peritoneal lavage, primary resection with anastomosis with or without ileostomy, and the Hartmann procedure, with either a laparoscopic or an open approach.
MAIN OUTCOME MEASURES
Morbidity, mortality, long-term stoma rates, and quality of life were measured.
RESULTS
Seventy-one articles were included. Five guidelines were retrieved, along with 4 meta-analyses, 14 systematic reviews, and 5 randomized controlled trials that generated 8 publications, all with a low risk of bias, except for blinding. Laparoscopic peritoneal lavage showed concerning results of deep abscesses and unplanned reoperations. Studies on Hinchey III/IV diverticulitis showed similar morbidity and mortality. A reduced length of stay with Hartmann procedure compared with primary resection with anastomosis was reported in the short term, and in the long term, more definite stoma along with poorer quality of life was reported with Hartmann procedure. No high-quality data were found to support the laparoscopic approach.
LIMITATIONS
Trials specifically assessing Hinchey IV diverticulitis have not yet been completed.
CONCLUSIONS
High-quality studies showed that laparoscopic peritoneal lavage was associated with an increased morbidity and that Hartmann procedure was associated with poorer long-term outcomes than primary resection with anastomosis with ileostomy, but Hartmann procedure is still acceptable, especially in high-risk patients.
Topics: Acute Disease; Anastomosis, Surgical; Digestive System Surgical Procedures; Diverticulitis; Emergencies; Humans; Laparoscopy; Peritoneal Lavage
PubMed: 30694823
DOI: 10.1097/DCR.0000000000001327 -
Nutrients Jan 2018In practice, nutrition recommendations vary widely for inpatient and discharge management of acute, uncomplicated diverticulitis. This systematic review aims to review... (Review)
Review
In practice, nutrition recommendations vary widely for inpatient and discharge management of acute, uncomplicated diverticulitis. This systematic review aims to review the evidence and develop recommendations for dietary fibre modifications, either alone or alongside probiotics or antibiotics, versus any comparator in adults in any setting with or recently recovered from acute, uncomplicated diverticulitis. Intervention and observational studies in any language were located using four databases until March 2017. The Cochrane Risk of Bias tool and GRADE were used to evaluate the overall quality of the evidence and to develop recommendations. Eight studies were included. There was "very low" quality evidence for comparing a liberalised and restricted fibre diet for inpatient management to improve hospital length of stay, recovery, gastrointestinal symptoms and reoccurrence. There was "very low" quality of evidence for using a high dietary fibre diet as opposed to a standard or low dietary fibre diet following resolution of an acute episode, to improve reoccurrence and gastrointestinal symptoms. The results of this systematic review and GRADE assessment conditionally recommend the use of liberalised diets as opposed to dietary restrictions for adults with acute, uncomplicated diverticulitis. It also strongly recommends a high dietary fibre diet aligning with dietary guidelines, with or without dietary fibre supplementation, after the acute episode has resolved.
Topics: Acute Disease; Anti-Bacterial Agents; Diet; Dietary Fiber; Diverticulitis; Evidence-Based Medicine; Humans; Meta-Analysis as Topic; Observational Studies as Topic; Probiotics; Randomized Controlled Trials as Topic; Recurrence; Risk Factors
PubMed: 29382074
DOI: 10.3390/nu10020137 -
Colorectal Disease : the Official... Jan 2018Acute uncomplicated diverticulitis (AUD) is common and antibiotics are the cornerstone of traditional conservative management. This approach lacks clear evidence base... (Review)
Review
BACKGROUND
Acute uncomplicated diverticulitis (AUD) is common and antibiotics are the cornerstone of traditional conservative management. This approach lacks clear evidence base and studies have recently suggested that avoidance of antibiotics is a safe and efficacious way to manage AUD. The aim of this systematic review is to determine the safety and efficacy of treating AUD without antibiotics.
METHODS
A systematic search of Embase, Cochrane library, MEDLINE, Science Citation Index Expanded, and ClinicalTrials. gov was performed. Studies comparing antibiotics versus no antibiotics in the treatment of AUD were included. Meta-analysis was performed using the random effects model with the primary outcome measure being diverticulitis-associated complications. Secondary outcomes were readmission rate, diverticulitis recurrence, mean hospital stay, requirement for surgery and requirement for percutaneous drainage.
RESULTS
Eight studies were included involving 2469 patients; 1626 in the non-antibiotic group (NAb) and 843 in the antibiotic group (Ab). There was a higher complication rate in the Ab group however this was not significant (1.9% versus 2.6%) with a combined risk ratio (RR) of 0.63 (95% CI, 0.25 to 1.57, p=0.32). There was a shorter mean length of hospital stay in the Nab group (standard mean difference of -1.18 (95% CI, -2.34 to -0.03 p= 0.04). There was no significant difference in readmission, recurrence and surgical intervention rate or requirement for percutaneous drainage.
CONCLUSION
Treatment of AUD without antibiotics may be feasible with outcomes that are comparable to antibiotic treatment and with potential benefits for patients and the NHS. Large scale randomised multicentre studies are needed. This article is protected by copyright. All rights reserved.
PubMed: 29323778
DOI: 10.1111/codi.14013 -
Presse Medicale (Paris, France : 1983) Nov 2015Acute diverticulitis is a common disease with increasing incidence. In most of cases, diagnosis is made at an uncomplicated stage offering a curative attempt under... (Review)
Review
Acute diverticulitis is a common disease with increasing incidence. In most of cases, diagnosis is made at an uncomplicated stage offering a curative attempt under medical treatment and use of antibiotics. There is a risk of diverticulitis recurrence. Uncomplicated diverticulitis is opposed to complicated forms (perforation, abscess or fistula). Recent insights in the pathophysiology of diverticulitis, the natural history, and treatments have permitted to identify new treatment strategies. For example, the use of antibiotics tends to decrease; surgery is now less invasive, percutaneous drainage is preferred, peritoneal lavage is encouraged. Treatments of the diverticulitis are constantly evolving. In this review, we remind the pathophysiology and natural history, and summarize new recommendations for the medical and surgical treatment of acute diverticulitis.
Topics: Abscess; Acute Disease; Age Factors; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Comorbidity; Dietary Fiber; Disease Management; Disease Progression; Diverticulitis; Drainage; Elective Surgical Procedures; Hospitalization; Humans; Intestinal Perforation; Laparoscopy; Multicenter Studies as Topic; Peritonitis; Probiotics; Randomized Controlled Trials as Topic; Recurrence; Rifamycins; Rifaximin; Therapeutic Irrigation
PubMed: 26358668
DOI: 10.1016/j.lpm.2015.08.004