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Digestive Diseases (Basel, Switzerland) 2013Appendicitis and diverticulitis are very common entities that show some similarities in diagnosis and course of disease. Both are widely believed to be simple clinical... (Review)
Review
Appendicitis and diverticulitis are very common entities that show some similarities in diagnosis and course of disease. Both are widely believed to be simple clinical diagnoses, which is in contrast to scientific evidence. An accurate diagnosis has to describe not only the initial detection, but particularly the severity of the disease. It is based mainly on cross-sectional imaging by ultrasound (US) and computed tomography (CT). Appendectomy is the standard treatment for acute appendicitis and is mandatory in complicated cases. Antibiotic therapy is similarly effective in uncomplicated appendicitis, but long-term results are not sufficiently known. Treatment of diverticulitis is related to the disease status. Complications such as perforation and bleeding require intervention. Uncomplicated diverticulitis as graded by US or CT are subject to conservative management, in the form of outpatient or hospital care. It is an unresolved debate as to whether antibiotic treatment offers benefits. Mesalazine seems at least to improve pain. The real challenge is treatment of recurrent diverticulitis. Lifestyle measures such as nutritional habits and physical activity are found to influence diverticular disease. Besides immunosuppression, obesity is a significant risk factor for complicated diverticulitis. Whether any medication such as chronic antibiotics, probiotics or mesalazine offers benefits is unclear. The indication for sigmoid resection has changed; it is no longer given by the number of attacks, but rather by structural changes as depicted by cross-sectional imaging.
Topics: Appendicitis; Chronic Disease; Diverticulitis; Humans; Recurrence; Ultrasonography
PubMed: 23797126
DOI: 10.1159/000347185 -
American Family Physician May 2013
Topics: Diverticulitis; Humans
PubMed: 23668530
DOI: No ID Found -
BMJ (Clinical Research Ed.) Feb 2006
Review
Topics: Dietary Fiber; Dietary Supplements; Diverticulitis; Humans; Intestinal Perforation; Tomography, X-Ray Computed
PubMed: 16455722
DOI: 10.1136/bmj.332.7536.271 -
Journal of Gastroenterology and... Aug 2013For years, the natural course of diverticulitis in the young has been debatable in terms of its severity and recurrence rate, and no consensus has been reached regarding... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIM
For years, the natural course of diverticulitis in the young has been debatable in terms of its severity and recurrence rate, and no consensus has been reached regarding its treatment and timing of surgery. Thus, the study aims to evaluate by meta-analysis the natural course of acute diverticulitis in the young.
METHODS
Data were obtained from electronic databases and manual search of studies comparing the course of diverticulitis in young versus elderly patients. The age cut-off was selected to be 40-50 years, and only studies using computed tomography as the sole modality for diagnosis were included. Primary outcomes were surgery during hospitalization and disease recurrence. Relative risks (RRs) with 95% confidence intervals (CIs) are reported.
RESULTS
One thousand eighty publications were found, 12 of which were included. The total number of patients was 4982. Most young patients were males (RR 1.70, 95% CI 1.31-2.21), without tendency toward a more complicated disease at admission (RR 0.95, 95% CI 0.46-1.97). While there was no significant difference in the rate of surgery during hospitalization (RR 0.69, 95% CI 0.46-1.06), young patients underwent more elective surgeries (RR 2.39, 95% CI 1.82-3.15). No mortality was recorded among young patients. The disease recurrence rate was significantly higher than that of elderly patients (RR 1.70, 95% CI 1.31-2.21); however, no study specified the mean follow-up period for each group.
CONCLUSIONS
The course of diverticulitis in the young is not more severe than that in elderly patients; however, the disease tends to recur more often. Therefore, while choosing a therapeutic regimen, factors other than age should also be considered.
Topics: Acute Disease; Adult; Age Factors; Aged; Diverticulitis; Female; Follow-Up Studies; Hospitalization; Humans; MEDLINE; Male; Middle Aged; Prognosis; Recurrence; Risk; Severity of Illness Index; Sex Factors; Tomography, X-Ray Computed
PubMed: 23701446
DOI: 10.1111/jgh.12274 -
Khirurgiia 2021The authors reviewed the main researches devoted to pathophysiological mechanisms and international classification of diverticulitis, analyzed multiple-center... (Review)
Review
The authors reviewed the main researches devoted to pathophysiological mechanisms and international classification of diverticulitis, analyzed multiple-center retrospective and randomized prospective studies. Modern diagnostic and therapeutic approaches, certain unsolved problems in indications for surgeries and their technique, as well as the role of surgical interventions in prevention of recurrences and severe complications of diverticulitis are demonstrated.
Topics: Diverticulitis; Humans; Randomized Controlled Trials as Topic; Retrospective Studies; Secondary Prevention
PubMed: 33710833
DOI: 10.17116/hirurgia202103183 -
Diseases of the Colon and Rectum Dec 2010The clinical course of diverticular disease in immunosuppressed patients is widely believed to be more severe than in the general population. In this study we... (Review)
Review
BACKGROUND
The clinical course of diverticular disease in immunosuppressed patients is widely believed to be more severe than in the general population. In this study we systematically reviewed the literature regarding the epidemiology and clinical course of diverticulitis in immunosuppressed patients. Our goal was to develop recommendations regarding the care of this group of patients.
METHODS
Using PubMed and Web of Knowledge we systematically reviewed all studies published between 1970 and 2009 that analyzed the epidemiology, clinical manifestation, or outcomes of treatment of diverticulitis in immunosuppressed patients. Keywords of "transplantation," "corticosteroid," "HIV," "AIDS," and "chemotherapy" were used.
RESULTS
Twenty-five studies met our inclusion criteria. All of these studies focused on the impact of diverticulitis in patients with transplants or on chronic corticosteroid therapy. The reported incidence of acute diverticulitis in these patients was approximately 1% (variable follow-up periods). Among patients with known diverticular disease the incidence was 8%. Mortality from acute diverticulitis in these patients was 23% when treated surgically and 56% when treated medically. Overall mortality was 25%.
CONCLUSIONS
Our study summarizes evidence that patients with transplants or patients on chronic corticosteroid therapy 1) have a rate of acute diverticulitis that is higher than the baseline population and 2) a mortality rate with acute diverticulitis that is high. Further research is needed to define whether these risks constitute a mandate for screening and prophylactic sigmoid colectomy.
Topics: Adrenal Cortex Hormones; Diverticulitis; Humans; Immunocompromised Host; Incidence; Organ Transplantation; Risk Factors
PubMed: 21178867
DOI: 10.1007/DCR.0b013e3181f5643c -
Journal of Primary Care & Community... Jan 2015Colonic diverticulitis is relatively uncommon in young patients, especially those younger than 40 years. We compared demographic data, clinical presentation, management,... (Comparative Study)
Comparative Study
BACKGROUND
Colonic diverticulitis is relatively uncommon in young patients, especially those younger than 40 years. We compared demographic data, clinical presentation, management, and clinical course of diverticulitis in patients ≤40 years old compared with patients >40 years old.
METHODS
This study included all patients who presented to the emergency department with a diagnosis of diverticulitis between October 1, 2009 and September 30, 2010. Patients were divided into 2 groups: group 1 (≤40 years old) and group 2 (>40 years old). Demographic characteristics, clinical presentation and management, and short-term outcomes were compared.
RESULTS
Ninety-four patients were included in the study (37 patients in group 1 and 57 patients in group 2). A higher percentage of obese and Hispanic men was found in group 1 (P > .05). The rate of discharge from the emergency department was significantly higher in group 1 (56.8% in group 1 vs 7.0% in group 2, P < .01). Group 2 patients had a shorter median length of stay than group 1 patients (3.1 vs 5.7 days, P = .16). There were no differences in vital signs, laboratory data (including complete blood count and basic metabolic panel), and in-hospital mortality rates between the 2 groups.
CONCLUSIONS
This study demonstrates that young Hispanic men develop diverticulitis and that this diagnosis needs to be considered when they present to emergency rooms with abdominal symptoms. A longitudinal study is needed to determine the long-term outcomes in these patients and to investigate the pathogenesis.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Diverticulitis; Emergency Service, Hospital; Female; Hispanic or Latino; Humans; Length of Stay; Male; Middle Aged; Obesity; Prevalence; Sex Factors; Young Adult
PubMed: 25178276
DOI: 10.1177/2150131914548512 -
Gastroenterologia Y Hepatologia 2022
Topics: Diverticulitis; Diverticulitis, Colonic; Humans; Polyps
PubMed: 33253772
DOI: 10.1016/j.gastrohep.2020.10.011 -
Diseases of the Colon and Rectum Nov 2020
Topics: Diverticulitis; Diverticulitis, Colonic; Humans
PubMed: 33044301
DOI: 10.1097/DCR.0000000000001802 -
Journal of Digestive Diseases Feb 2022There is no consensus on the optimal treatment for patients with complicated diverticulitis. In this systematic review and meta-analysis we aimed to determine the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
There is no consensus on the optimal treatment for patients with complicated diverticulitis. In this systematic review and meta-analysis we aimed to determine the indications for elective surgery in complicated diverticulitis by comparing conservative treatment with elective surgery.
METHODS
A meta-analysis of recurrence, morbidity and stoma rates was performed using a random effects model. Patient-reported quality of life (QoL) and cost-effectiveness outcomes were synthesized qualitatively.
RESULTS
Eleven randomized controlled trials and non-randomized studies with a total of 7415 patients were included. In statistical terms, the recurrence of diverticulitis was significantly higher in the conservatively treated group than in the elective surgery group (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.12-0.51). The stoma rate (OR 2.34, 95% CI 1.88-2.92) and the morbidity rate (OR 4.29, 95% CI 2.24-8.23) were significantly higher in the elective surgery group than in the conservatively treated group. There was some evidence for a significant increase in QoL and long-term cost-effectiveness in the elective surgery group than in the conservatively treated group.
CONCLUSIONS
Indications for elective surgery should not include the prevention of emergency colostomy or complications. Elective surgical resection may be considered in patients with complicated diverticulitis with the goal of improving their QoL and long-term cost-effectiveness.
Topics: Conservative Treatment; Diverticulitis; Elective Surgical Procedures; Humans; Quality of Life; Randomized Controlled Trials as Topic; Recurrence
PubMed: 34965017
DOI: 10.1111/1751-2980.13076