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Gastroenterology Apr 2019Diverticulitis is a prevalent gastrointestinal disorder that is associated with significant morbidity and health care costs. Approximately 20% of patients with incident... (Review)
Review
Diverticulitis is a prevalent gastrointestinal disorder that is associated with significant morbidity and health care costs. Approximately 20% of patients with incident diverticulitis have at least 1 recurrence. Complications of diverticulitis, such as abdominal sepsis, are less likely to occur with subsequent events. Several risk factors, many of which are modifiable, have been identified including obesity, diet, and physical inactivity. Diet and lifestyle factors could affect risk of diverticulitis through their effects on the intestinal microbiome and inflammation. Preliminary studies have found that the composition and function of the gut microbiome differ between individuals with vs without diverticulitis. Genetic factors, as well as alterations in colonic neuromusculature, can also contribute to the development of diverticulitis. Less-aggressive and more-nuanced treatment strategies have been developed. Two multicenter, randomized trials of patients with uncomplicated diverticulitis found that antibiotics did not speed recovery or prevent subsequent complications. Elective surgical resection is no longer recommended solely based on number of recurrent events or young patient age and might not be necessary for some patients with diverticulitis complicated by abscess. Randomized trials of hemodynamically stable patients who require urgent surgery for acute, complicated diverticulitis that has not improved with antibiotics provide evidence to support primary anastomosis vs sigmoid colectomy with end colostomy. Despite these advances, more research is needed to increase our understanding of the pathogenesis of diverticulitis and to clarify treatment algorithms.
Topics: Diverticulitis, Colonic; Humans; Risk Factors; Treatment Outcome
PubMed: 30660732
DOI: 10.1053/j.gastro.2018.12.033 -
World Journal of Gastroenterology Mar 2021Diverticular disease and diverticulitis are the most common non-cancerous pathology of the colon. It has traditionally been considered a disease of the elderly and... (Review)
Review
Diverticular disease and diverticulitis are the most common non-cancerous pathology of the colon. It has traditionally been considered a disease of the elderly and associated with cultural and dietary habits. There has been a growing evolution in our understanding and the treatment guidelines for this disease. To provide an updated review of the epidemiology, pathogenesis, classification and highlight changes in the medical and surgical management of diverticulitis. Diverticulitis is increasingly being seen in young patients (< 50 years). Genetic contributions to diverticulitis may be larger than previously thought. Potential similarities and overlap with inflammatory bowel disease and irritable bowel syndrome exist. Computed tomography imaging represents the standard to classify the severity of diverticulitis. Modifications to the traditional Hinchey classification might serve to better delineate mild and intermediate forms as well as better classify chronic presentations of diverticulitis. Non-operative management is primarily based on antibiotics and supportive measures, but antibiotics may be omitted in mild cases. Interval colonoscopy remains advisable after an acute attack, particularly after a complicated form. Acute surgery is needed for the most severe as well as refractory cases, whereas elective resections are individualized and should be considered for chronic, smoldering, or recurrent forms and respective complications (stricture, fistula, etc) and for patients with factors highly predictive of recurrent attacks. Diverticulitis is no longer a disease of the elderly. Our evolving understanding of diverticulitis as a clinical entity has led into a more nuanced approach in both the medical and surgical management of this common disease. Non-surgical management remains the appropriate treatment for greater than 70% of patients. In individuals with non-relenting, persistent, or recurrent symptoms and those with complicated disease and sequelae, a segmental colectomy remains the most effective surgical treatment in the acute, chronic, or elective-prophylactic setting.
Topics: Aged; Colectomy; Colon, Sigmoid; Diverticulitis; Diverticulitis, Colonic; Elective Surgical Procedures; Humans; Laparoscopy
PubMed: 33727769
DOI: 10.3748/wjg.v27.i9.760 -
Critical Care Nursing Clinics of North... Mar 2018Diverticular disease accounts for approximately 300,000 hospitalizations per year in the United States, resulting in 1.5 million days of inpatient care. Diverticulitis... (Review)
Review
Diverticular disease accounts for approximately 300,000 hospitalizations per year in the United States, resulting in 1.5 million days of inpatient care. Diverticulitis is defined as an inflammation of the diverticulum, which can be asymptomatic or symptomatic. This disease is the third most common gastrointestinal illness that requires hospitalization and the leading indication for elective colon resection. Abdominal pain is the most common complaint in patients with acute diverticulitis. The pain can be described as cramping, constant, and persistent for several days. Medical management is most often provided with antibiotics and clear liquid diet.
Topics: Acute Disease; Anti-Bacterial Agents; Diverticulitis; Hospitalization; Humans; Inflammation; United States
PubMed: 29413216
DOI: 10.1016/j.cnc.2017.10.006 -
Surgical Endoscopy Sep 2019Acute diverticulitis (AD) presents a unique diagnostic and therapeutic challenge for general surgeons. This collaborative project between EAES and SAGES aimed to...
BACKGROUND
Acute diverticulitis (AD) presents a unique diagnostic and therapeutic challenge for general surgeons. This collaborative project between EAES and SAGES aimed to summarize recent evidence and draw statements of recommendation to guide our members on comprehensive AD management.
METHODS
Systematic reviews of the literature were conducted across six AD topics by an international steering group including experts from both societies. Topics encompassed the epidemiology, diagnosis, management of non-complicated and complicated AD as well as emergency and elective operative AD management. Consensus statements and recommendations were generated, and the quality of the evidence and recommendation strength rated with the GRADE system. Modified Delphi methodology was used to reach consensus among experts prior to surveying the EAES and SAGES membership on the recommendations and likelihood to impact their practice. Results were presented at both EAES and SAGES annual meetings with live re-voting carried out for recommendations with < 70% agreement.
RESULTS
A total of 51 consensus statements and 41 recommendations across all six topics were agreed upon by the experts and submitted for members' online voting. Based on 1004 complete surveys and over 300 live votes at the SAGES and EAES Diverticulitis Consensus Conference (DCC), consensus was achieved for 97.6% (40/41) of recommendations with 92% (38/41) agreement on the likelihood that these recommendations would change practice if not already applied. Areas of persistent disagreement included the selective use of imaging to guide AD diagnosis, recommendations against antibiotics in non-complicated AD, and routine colonic evaluation after resolution of non-complicated diverticulitis.
CONCLUSION
This joint EAES and SAGES consensus conference updates clinicians on the current evidence and provides a set of recommendations that can guide clinical AD management practice.
Topics: Acute Disease; Diverticulitis; Endoscopy, Gastrointestinal; Evidence-Based Practice; Humans; Patient Care Management; Patient Selection
PubMed: 31250244
DOI: 10.1007/s00464-019-06882-z -
The Korean Journal of Gastroenterology... Jun 2022Colonic diverticulosis is one of the most common conditions of the digestive system and patients generally remain asymptomatic. However, about 20% of patients develop... (Review)
Review
Colonic diverticulosis is one of the most common conditions of the digestive system and patients generally remain asymptomatic. However, about 20% of patients develop symptomatic diverticular disease such as acute diverticulitis or diverticular hemorrhage, and these have become a huge burden on healthcare systems worldwide. Recent understanding of the pathophysiology of diverticulosis and diverticular disease suggests the role of multiple factors including genetic and environment. Based on this understanding, a preventive strategy to reduce the risk factors of diverticulosis and diverticular disease is highly recommended. The diagnosis of the acute diverticulitis relies on imaging modalities such as an abdominal-pelvic CT scan together with symptoms and signs. Treatment of diverticular disease should be individualized and include modification of lifestyle, use of antibiotics, and surgery. Recent guidelines recommend pursuing less aggressive treatment for patients with acute diverticulitis. This review will provide an overview of both the existing and evolving understanding regarding colonic diverticulosis and diverticular disease and can help clinicians in the management of their patients with diverticular disease.
Topics: Diverticular Diseases; Diverticulitis; Diverticulitis, Colonic; Diverticulosis, Colonic; Diverticulum; Humans
PubMed: 35746837
DOI: 10.4166/kjg.2022.072 -
International Journal of Colorectal... May 2018The shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient treatment, potentially reducing the burden of one of the most common gastrointestinal diseases in the Western world.
PURPOSE
Assessing the safety and cost savings of outpatient treatment in acute colonic diverticulitis.
METHODS
PubMed and EMBASE were searched for studies on outpatient treatment of colonic diverticulitis, confirmed with computed tomography or ultrasound. Outcomes were readmission rate, need for emergency surgery or percutaneous abscess drainage, and healthcare costs.
RESULTS
A total of 19 studies with 2303 outpatient treated patients were included. These studies predominantly excluded patients with comorbidity or immunosuppression, inability to tolerate oral intake, or lack of an adequate social network. The pooled incidence rate of readmission for outpatient treatment was 7% (95%CI 6-9%, I 48%). Only 0.2% (2/1288) of patients underwent emergency surgery, and 0.2% (2/1082) of patients underwent percutaneous abscess drainage. Only two studies compared readmission rates outpatients that had similar characteristics as a control group of inpatients; 4.5% (3/66) and 6.3% (2/32) readmissions in outpatient groups versus 6.1% (4/66) and 0.0% (0/44) readmissions in inpatient groups (p = 0.619 and p = 0.174, respectively). Average healthcare cost savings for outpatient compared with inpatient treatment ranged between 42 and 82%.
CONCLUSION
Outpatient treatment of uncomplicated diverticulitis resulted in low readmission rates and very low rates of complications. Furthermore, healthcare cost savings were substantial. Therefore, outpatient treatment of uncomplicated diverticulitis seems to be a safe option for most patients.
Topics: Abscess; Acute Disease; Digestive System Surgical Procedures; Diverticulitis; Drainage; Emergencies; Humans; Inpatients; Outpatients; Patient Readmission
PubMed: 29532202
DOI: 10.1007/s00384-018-3015-9 -
Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review.Nutrients Apr 2021Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the...
Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the effect of dietary habits in the prevention of diverticula complications (i.e., acute diverticulitis and diverticula bleeding) in patients with diverticula disease. PubMed and Scopus databases were searched up to 19 January 2021, 330 records were identified, and 8 articles met the eligibility criteria and were subjected to data extraction. The quality of the studies was evaluated by the Newcastle-Ottawa quality assessment form. No study meets the criteria for being a high-quality study. A high intake of fiber was associated to a decreased risk of diverticulitis or hospitalization due to diverticular disease, with a protective effect for fruits and cereal fiber, but not for vegetable fiber; whereas, a high red meat consumption and a generally Western dietary pattern were associated with an increased risk of diverticulitis. Alcohol use seemed to be associated to diverticular bleeding, but not to recurrent diverticulitis or diverticular complications. Further high-quality studies are needed to better define these associations. It is mandatory to ascertain the role of dietary habits for the development of recurrent acute diverticulitis and diverticular bleeding.
Topics: Diet, Western; Dietary Fiber; Diverticulitis; Diverticulosis, Colonic; Edible Grain; Feeding Behavior; Fruit; Gastrointestinal Hemorrhage; Hospitalization; Humans; Meat; Recurrence; Vegetables
PubMed: 33919755
DOI: 10.3390/nu13041288 -
Journal of Laparoendoscopic & Advanced... Aug 2016Jejunal diverticulitis is a rare clinical entity often overlooked by physicians as a cause for abdominal pain. Although diagnostic capabilities improved in recent years,... (Review)
Review
BACKGROUND
Jejunal diverticulitis is a rare clinical entity often overlooked by physicians as a cause for abdominal pain. Although diagnostic capabilities improved in recent years, there is little data about diverticular disease in the proximal small bowel. The aim of this study is to present the clinical course and management in a series of eight cases of jejunal diverticulitis and possible therapeutic interventions.
METHODS
A cohort retrospective analysis of all patients admitted for acute jejunal diverticulitis between January 2010 and June 2015 was conducted. Patient demographics, clinical, and surgical outcome were recorded and analyzed.
RESULTS
Eight patients were admitted for acute jejunal diverticulitis with a mean age of 72.1 (range 55-87) years. Clinical presentation included six patients (75%) with a sealed perforation and only one patient demonstrated distant pneumoperitoneum. All patients were treated initially without surgery and only one patient required surgery because of diverticular complications. Recurrent episodes occurred in two patients (25%). Colonoscopy was performed in all patients after hospitalization that revealed large bowel diverticulosis in all patients (100%). Median follow-up was 8.2 months (3-15 months).
CONCLUSION
Jejunal diverticulitis can be initially treated conservatively but complicated disease should be considered for surgical management. Further study is required on the relationship between small and large bowel diverticulosis.
Topics: Abdominal Pain; Aged; Aged, 80 and over; Colonoscopy; Conservative Treatment; Diverticulitis; Diverticulosis, Colonic; Female; Humans; Intestinal Perforation; Jejunal Diseases; Male; Middle Aged; Pneumoperitoneum; Recurrence; Retrospective Studies
PubMed: 27182822
DOI: 10.1089/lap.2016.0066 -
Annals of Internal Medicine Mar 2024Acute colonic diverticulitis is a gastrointestinal condition that is frequently encountered by primary care and emergency department practitioners, hospitalists,... (Review)
Review
Acute colonic diverticulitis is a gastrointestinal condition that is frequently encountered by primary care and emergency department practitioners, hospitalists, surgeons, and gastroenterologists. Clinical presentation ranges from mild abdominal pain to peritonitis with sepsis. It is often diagnosed on the basis of clinical features alone, but imaging is necessary in more severe presentations to rule out such complications as abscess and perforation. Treatment depends on the severity of the presentation, the presence of complications, and underlying comorbid conditions. Medical and surgical treatment algorithms are evolving. This article provides an evidence-based, clinically relevant overview of the epidemiology, diagnosis, and treatment of acute diverticulitis.
Topics: Humans; Diverticulitis, Colonic; Diverticulitis; Tomography, X-Ray Computed; Peritonitis; Abdominal Pain; Acute Disease
PubMed: 38466995
DOI: 10.7326/AITC202403190 -
Journal of Medical Radiation Sciences Sep 2022Appendiceal diverticulitis, a frequently underdiagnosed entity, differs from typical appendicitis by the presence of an inflamed appendiceal diverticulum. Appendiceal...
Appendiceal diverticulitis, a frequently underdiagnosed entity, differs from typical appendicitis by the presence of an inflamed appendiceal diverticulum. Appendiceal diverticulitis is a surgical emergency which has an increased risk of perforation compared to typical appendicitis. We will discuss a surgically and pathologically confirmed case of complicated appendiceal diverticulitis and its management implications.
Topics: Appendicitis; Appendix; Diagnosis, Differential; Diverticulitis; Humans
PubMed: 35194966
DOI: 10.1002/jmrs.573