Pathophysiology, Symptoms and Evolving Treatment for Colonic Diverticular Disease: A Review
,
Abstract
The review on diverticulitis disease, is the most prevalent non-cancerous pathology of the colon is diverticular disease and diverticulitis. It has long been thought to be a disease of the elderly, linked to cultural and dietary patterns. Our understanding of this condition, as well as the therapy protocols, has progressed. To give an updated assessment of the epidemiology, pathophysiology, and classification of diverticulitis, as well as to highlight developments in medicinal and surgical management. Treatment of Diverticular Disease represented an important challenge in clinical practice, especially concerning the management of symptomatic uncomplicated diverticular disease (SUDD) and the primary and secondary prevention of acute diverticular disease (AD). Antibiotics and supportive treatments are the mainstays of non-operative treatment, while antibiotics may be skipped in moderate cases. Acute surgery is required for the most severe and refractory cases, whereas elective resections should be considered for chronic, smoldering, or recurrent forms, as well as their associated complications (stricture, fistula, etc.) and patients with factors that are highly predictive of recurrent attacks. Diverticulitis isn't just a condition that affects the elderly. Our growing understanding of diverticulitis as a clinical entity has resulted in a more nuanced approach to its medicinal and surgical therapy. For more than 70% of patients, non-surgical care is still the best option. In the acute, chronic, or elective-prophylactic environment, a segmental colectomy remains the most effective surgical treatment for those with non-relenting, persistent, or recurrent symptoms, as well as those with severe disease and sequelae.
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2.Strate LL, Morris AM. Epidemiology, pathophysiology and treatment of diverticulitis. Gastroenterology. 2019; 156(5): 1282-98.
3.Tursi A, Elisei W. Role of inflammation in the pathogenesis of diverticular disease. Mediators Inflamm. 2019; 2019: 8328490.
4.Zullo A, Gatta L, Vassallo R, et al. Paradigm shift: The Copernican revolution in diverticular disease. Ann Gastroenterol. 2019; 32(6): 541-53.
5.Lambrichts DPV, Bolkenstein HE, et al. Multicenter study of non-surgical management of diverticulitis with abscess formation. Br J Surg. 2019; 106(4): 458-66.
6.Carabotti M, Annibale B. Treatment of diverticular disease: an update on latest evidence and clinical implications. Drugs Context. 2018; 7: 212526.
7.Young-Fadock TM, Solomon CG. Diverticulitis. N Engl J Med. 2018; 379 (17): 1635-42.
8.Rezapour M, Stollman N. Antibiotics in uncomplicated acute diverticulitis: to give or not to give? Inflamm Intest Dis. 2018; 3: 75-79.
9.Slim K, Joris J, Bayer-Berjot L. The end of antibiotics in the management of uncomplicated acute diverticulitis. J Visc Surg. 2019; 156: 373-375.
10.Rottier SJ, van Dijk ST, Unlu C, et al. Complicated disease course in initially computed tomography- proven uncomplicated acute diverticulitis. Surg Infect. 2019; 20(6): 453-9.
11.Bolkenstein HE, Esther CJC, Job VP, et al. Long-term outcome of surgery versus conservative management for recurrent and ongoing complaints after an episode of diverticulitis: 5- year follow-up results of a multicenter randomized controlled trial (DIRECT-trial). Ann Surg. 2019; 269(4): 612-20.
12.Ticinesi A. Diverticular disease: a gut microbiota perspective. J Gastrointestin Liver Dis. 2019; 28(3): 327-37.
13.Hanna MH, Kaiser AM. Update on the management of sigmoid diverticulitis. World J Gastroenterol. 2021; 27(9): 760-81.
14.Hassan AH, Abhilash JP, Samer D, Irshad S. Recurrent Acute Diverticulitis: When to Operate? Inflamm Intest Dis. 2018(3); 3: 91-9.
15.Lopez DE, Brown CVR. Diverticulitis: The most common colon emergency for the acute surgeon. Scandinavian J Surg. 2010; 99(2): 86-9.
16.Tursi A, Papagrigoriadis S. The current and evolving treatment of colonic diverticular disease. Aliment Pharmacol Ther. 2009; 30(6): 532-46.
17.Antonio T, Carmelo S, Lisa LS, et al. Colonic diverticular disease. Nat Rev Dis Primers. 2020; 6(1): 20.
18.Hayley Y, Amy S, Michelle LC, et al. The management of diverticulitis: a review of the Guidelines. Med J Aust. 2020;212(9):434-434.e1.
19.Tonia M, Young-Fadok BM. Diverticulitis. New Engl J Med. 2018; 379(17): 1635-42.
20.Mehmet RO, Erhan A, Ali DK, et al. Diverticulitis: a comprehensive review with usual and unusual complications. Insights Imaging. 2017; 8(1): 19-27.
21.Massimo S, Dieter GW, Yoram K, et al. 2020 Update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020; 15(32): 2-18.
22.Nicolas DR, Leidy DR, Lizeth G, et al. Review of Hinchey’s (diverticulitis) classification and its therapeutic implications. Rev Argent Radiol. 2020; 84: 123-9.
23.Anne FP, Aasma S, Lisa LS. AGA Clinical Practice Update on Medical management of Colonic Diverticulitis: expert review. Gastroenterol.2021; 160(3): 906-11.
24.Mariana MC, Paulina MV. Diverticular Disease of the colon- Recent Knowledge of Physiopathology, Endoscopic Approaches, Clinical and Surgical Treatments provides a comprehensive overview of diverticular disease. Published February 2nd, 2022; ISBN 978-1-83968-579-8.
25.Michael C, Robert SS, Anne FP. Etiopathogenetic Mechanisms in Diverticular Disease of Colon. Cell Mol Gasroenterol Hepatol. 2020; 9(1): 15-32.
26.Amir Q, Itziar EI, Jennifer SL, Nick F, et al. Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline from the American College of Physicians. Ann Intern Med. 2022;175(3):399-415.
27.Amy ET. Diverticulosis and Diverticulitis. JAMA. 2016; 316(10): 1124.
28.Joel AB, Rafael ACC. Colonic Diverticulosis MSD Manual, Oct 2020.
29.Janson H, Karin H, Sang L, Amy L, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum. 2020; 63(6): 728-47.
30.Thad W, Katherine E, Ruth G. Diagnosis and management of acute diverticulitis. Am Fam Physician. 2013; 87(9): 612-20.
31.Riccardo V, Niccolo F, Matteo B, et al. Role of CT colonography in differentiating sigmoid cancer chronic diverticular disease. Japa J Radio. 2022; 40(1): 48-55.
32.Betul TBS. Computed Tomographic Evaluation of Colonic Diverticulum Complication. Curr Med Imag. 2021; 17(9): 1054-8.
33.Nina C, Carl F, Victor S. Gut wrenching: cases of missed gastrointestinal tumors and their mimics on computed tomography. Emerg Radio. 2021; 28(2): 389-99.
34.Kristopher BP, Olivier M. Diverticulitis of the appendix- case report and literature review. J Surg Case Rep. 2021; 2021(10): 1-3.
35.Morris CR, Harvey IM, Stebbings WSL, et al. Epidemiology of perforated colonic diverticular disease. Postgrad Med J. 2002; 78(925): 654-9.
36.Ahmed FR, Mohamed HK, Khalid A, et al. Small Intestinal Diverticulosis: A rare cause of Intestinal Perforation Revisited. Case Rep Sur. 2020; 2020: 1-6.
37.Elliot CD, Suzanne TC, James HE, et al. Recurrence of Colonic Diverticulitis: Identifying Predictive CT Findings- Retrospective Cohort Study. Radiology. 2017; 285(3): 850-8.
38.VanDijk ST, Daniels L, de Korte N. Quality of life and persistent symptoms after Uncomplicated Acute Diverticulitis. Dis Colon Rectum. 2019; 62(5): 608-14.
39.Jaung R, Nisbet S, Gosselink MP. Antibiotics do not reduce length of Hospital stay for Uncomplicated Diverticulitis in Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2021;19(3):503-10.
40.Kim JY, Park SG, Kang HJ. Prospective randomized trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics. Inter J Colorec Dis. 2019; 34(8): 1413-20.
41.Lambrichts DPV, Bolkenstein HE, et al. Multicenter study of non-surgical management of diverticulitis with abscess formation. Brit J Surg. 2019; 106(4): 458-66.
42.Mali J, Mentula P, Leppaniemi A. Determinants of treatment and outcomes of diverticular abscesses. World J Emerg Surg. 2019; 14:31.
43.Seoane UA, Zaffalon D, Pera RM. Routine lower gastrointestinal endoscopy for radiographically confirmed acute diverticulitis. In whom and when is it indicated? Rev Esp Enferm Dig. 2018; 110(9): 571-6.
44.Carabotti M, Annibale B. Treatment of diverticular disease: an update on latest evidence and clinical implications. Drugs in Context. 2018; 7: 212526.
45.Studniarek A, Koehar K, Warner C. Findings on Colonoscopy after Diverticulitis: A Multicenter Review. American Surgeon. 2019; 85(12): 1381-85.
46.Qaseem A, Crandall CJ, Mustafa RA. Screening for Colorectal Cancer in Asymptomatic Average- Risk Adults: A Guidance Statement from the American College of Physicians. Ann Intern Med. 2019; 171(9): 643-54.
47.Mizuki A, Tatemichi M, Nakazawa A. Effects of Burdock tea on recurrence of colonic diverticulitis and diverticular bleeding: An open-labelled randomized clinical trial. Sci Rep. 2019; 9: 6793.
2.Strate LL, Morris AM. Epidemiology, pathophysiology and treatment of diverticulitis. Gastroenterology. 2019; 156(5): 1282-98.
3.Tursi A, Elisei W. Role of inflammation in the pathogenesis of diverticular disease. Mediators Inflamm. 2019; 2019: 8328490.
4.Zullo A, Gatta L, Vassallo R, et al. Paradigm shift: The Copernican revolution in diverticular disease. Ann Gastroenterol. 2019; 32(6): 541-53.
5.Lambrichts DPV, Bolkenstein HE, et al. Multicenter study of non-surgical management of diverticulitis with abscess formation. Br J Surg. 2019; 106(4): 458-66.
6.Carabotti M, Annibale B. Treatment of diverticular disease: an update on latest evidence and clinical implications. Drugs Context. 2018; 7: 212526.
7.Young-Fadock TM, Solomon CG. Diverticulitis. N Engl J Med. 2018; 379 (17): 1635-42.
8.Rezapour M, Stollman N. Antibiotics in uncomplicated acute diverticulitis: to give or not to give? Inflamm Intest Dis. 2018; 3: 75-79.
9.Slim K, Joris J, Bayer-Berjot L. The end of antibiotics in the management of uncomplicated acute diverticulitis. J Visc Surg. 2019; 156: 373-375.
10.Rottier SJ, van Dijk ST, Unlu C, et al. Complicated disease course in initially computed tomography- proven uncomplicated acute diverticulitis. Surg Infect. 2019; 20(6): 453-9.
11.Bolkenstein HE, Esther CJC, Job VP, et al. Long-term outcome of surgery versus conservative management for recurrent and ongoing complaints after an episode of diverticulitis: 5- year follow-up results of a multicenter randomized controlled trial (DIRECT-trial). Ann Surg. 2019; 269(4): 612-20.
12.Ticinesi A. Diverticular disease: a gut microbiota perspective. J Gastrointestin Liver Dis. 2019; 28(3): 327-37.
13.Hanna MH, Kaiser AM. Update on the management of sigmoid diverticulitis. World J Gastroenterol. 2021; 27(9): 760-81.
14.Hassan AH, Abhilash JP, Samer D, Irshad S. Recurrent Acute Diverticulitis: When to Operate? Inflamm Intest Dis. 2018(3); 3: 91-9.
15.Lopez DE, Brown CVR. Diverticulitis: The most common colon emergency for the acute surgeon. Scandinavian J Surg. 2010; 99(2): 86-9.
16.Tursi A, Papagrigoriadis S. The current and evolving treatment of colonic diverticular disease. Aliment Pharmacol Ther. 2009; 30(6): 532-46.
17.Antonio T, Carmelo S, Lisa LS, et al. Colonic diverticular disease. Nat Rev Dis Primers. 2020; 6(1): 20.
18.Hayley Y, Amy S, Michelle LC, et al. The management of diverticulitis: a review of the Guidelines. Med J Aust. 2020;212(9):434-434.e1.
19.Tonia M, Young-Fadok BM. Diverticulitis. New Engl J Med. 2018; 379(17): 1635-42.
20.Mehmet RO, Erhan A, Ali DK, et al. Diverticulitis: a comprehensive review with usual and unusual complications. Insights Imaging. 2017; 8(1): 19-27.
21.Massimo S, Dieter GW, Yoram K, et al. 2020 Update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020; 15(32): 2-18.
22.Nicolas DR, Leidy DR, Lizeth G, et al. Review of Hinchey’s (diverticulitis) classification and its therapeutic implications. Rev Argent Radiol. 2020; 84: 123-9.
23.Anne FP, Aasma S, Lisa LS. AGA Clinical Practice Update on Medical management of Colonic Diverticulitis: expert review. Gastroenterol.2021; 160(3): 906-11.
24.Mariana MC, Paulina MV. Diverticular Disease of the colon- Recent Knowledge of Physiopathology, Endoscopic Approaches, Clinical and Surgical Treatments provides a comprehensive overview of diverticular disease. Published February 2nd, 2022; ISBN 978-1-83968-579-8.
25.Michael C, Robert SS, Anne FP. Etiopathogenetic Mechanisms in Diverticular Disease of Colon. Cell Mol Gasroenterol Hepatol. 2020; 9(1): 15-32.
26.Amir Q, Itziar EI, Jennifer SL, Nick F, et al. Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline from the American College of Physicians. Ann Intern Med. 2022;175(3):399-415.
27.Amy ET. Diverticulosis and Diverticulitis. JAMA. 2016; 316(10): 1124.
28.Joel AB, Rafael ACC. Colonic Diverticulosis MSD Manual, Oct 2020.
29.Janson H, Karin H, Sang L, Amy L, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum. 2020; 63(6): 728-47.
30.Thad W, Katherine E, Ruth G. Diagnosis and management of acute diverticulitis. Am Fam Physician. 2013; 87(9): 612-20.
31.Riccardo V, Niccolo F, Matteo B, et al. Role of CT colonography in differentiating sigmoid cancer chronic diverticular disease. Japa J Radio. 2022; 40(1): 48-55.
32.Betul TBS. Computed Tomographic Evaluation of Colonic Diverticulum Complication. Curr Med Imag. 2021; 17(9): 1054-8.
33.Nina C, Carl F, Victor S. Gut wrenching: cases of missed gastrointestinal tumors and their mimics on computed tomography. Emerg Radio. 2021; 28(2): 389-99.
34.Kristopher BP, Olivier M. Diverticulitis of the appendix- case report and literature review. J Surg Case Rep. 2021; 2021(10): 1-3.
35.Morris CR, Harvey IM, Stebbings WSL, et al. Epidemiology of perforated colonic diverticular disease. Postgrad Med J. 2002; 78(925): 654-9.
36.Ahmed FR, Mohamed HK, Khalid A, et al. Small Intestinal Diverticulosis: A rare cause of Intestinal Perforation Revisited. Case Rep Sur. 2020; 2020: 1-6.
37.Elliot CD, Suzanne TC, James HE, et al. Recurrence of Colonic Diverticulitis: Identifying Predictive CT Findings- Retrospective Cohort Study. Radiology. 2017; 285(3): 850-8.
38.VanDijk ST, Daniels L, de Korte N. Quality of life and persistent symptoms after Uncomplicated Acute Diverticulitis. Dis Colon Rectum. 2019; 62(5): 608-14.
39.Jaung R, Nisbet S, Gosselink MP. Antibiotics do not reduce length of Hospital stay for Uncomplicated Diverticulitis in Pragmatic Double-Blind Randomized Trial. Clin Gastroenterol Hepatol. 2021;19(3):503-10.
40.Kim JY, Park SG, Kang HJ. Prospective randomized trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics. Inter J Colorec Dis. 2019; 34(8): 1413-20.
41.Lambrichts DPV, Bolkenstein HE, et al. Multicenter study of non-surgical management of diverticulitis with abscess formation. Brit J Surg. 2019; 106(4): 458-66.
42.Mali J, Mentula P, Leppaniemi A. Determinants of treatment and outcomes of diverticular abscesses. World J Emerg Surg. 2019; 14:31.
43.Seoane UA, Zaffalon D, Pera RM. Routine lower gastrointestinal endoscopy for radiographically confirmed acute diverticulitis. In whom and when is it indicated? Rev Esp Enferm Dig. 2018; 110(9): 571-6.
44.Carabotti M, Annibale B. Treatment of diverticular disease: an update on latest evidence and clinical implications. Drugs in Context. 2018; 7: 212526.
45.Studniarek A, Koehar K, Warner C. Findings on Colonoscopy after Diverticulitis: A Multicenter Review. American Surgeon. 2019; 85(12): 1381-85.
46.Qaseem A, Crandall CJ, Mustafa RA. Screening for Colorectal Cancer in Asymptomatic Average- Risk Adults: A Guidance Statement from the American College of Physicians. Ann Intern Med. 2019; 171(9): 643-54.
47.Mizuki A, Tatemichi M, Nakazawa A. Effects of Burdock tea on recurrence of colonic diverticulitis and diverticular bleeding: An open-labelled randomized clinical trial. Sci Rep. 2019; 9: 6793.
| Files | ||
| Issue | Vol 10, No 3 (Summer 2022) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v10i3.10794 | |
| Keywords | ||
| Diverticulitis Inflammatory Bowel Disease Colectomy Antibiotics | ||
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How to Cite
1.
Kushwaha N, Kushwaha S. Pathophysiology, Symptoms and Evolving Treatment for Colonic Diverticular Disease: A Review. J Pharm Care. 2022;10(3):136-145.
