Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 31 May 2016

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Recent changes in treatment guidelines for sigmoid diverticulitis

A study published in this week's issue of the Journal of the American Medical Association reviews the etiology and natural history of diverticulitis and recent changes in treatment guidelines.

News image

Diverticulitis is a common disease.

Recent changes in understanding its natural history have substantially modified treatment paradigms.

Dr Arden Morris and colleagues from Michigan, USA reviewed the etiology and natural history of diverticulitis and recent changes in treatment guidelines.

The team searched the MEDLINE and Cochrane databases for English-language articles pertaining to diagnosis and management of diverticulitis published between 2000 and 2013.

Search terms applied to 4 thematic topics: pathophysiology, natural history, medical management, and indications for surgery.

The research team excluded small case series and articles based on data accrued prior to 2000.

13% of patients had a recurrence
Journal of the American Medical Association

The team hand searched the bibliographies of included studies, yielding a total of 186 articles for full review.

The researchers graded the level of evidence and classified recommendations by size of treatment effect, according to the guidelines from the American Heart Association Task Force on Practice Guidelines.

The team identified 80 articles that met criteria for analysis.

The pathophysiology of diverticulitis is associated with altered gut motility, increased luminal pressure, and a disordered colonic microenvironment.

Several studies examined histologic commonalities with inflammatory bowel disease and irritable bowel syndrome but were focused on associative rather than causal pathways.

The natural history of uncomplicated diverticulitis is often benign. For example, in a cohort study of 2366 of 3165 patients hospitalized for acute diverticulitis and followed up for 9 years, only 13% of patients had a recurrence and 4%, a second recurrence.

In contrast to what was previously thought, the risk of septic peritonitis is reduced and not increased with each recurrence.

Patient-reported outcomes studies show 20% to 35% of patients managed nonoperatively progress to chronic abdominal pain compared with 5% to 25% of patients treated operatively.

Randomized trials and cohort studies have shown that antibiotics and fiber were not as beneficial as previously thought and that mesalamine might be useful.

The team observed that surgical therapy for chronic disease is not always warranted.

Dr Morris' team comments, "Recent studies demonstrate a lesser role for aggressive antibiotic or surgical intervention for chronic or recurrent diverticulitis than was previously thought necessary."

JAMA 2014; 311(3): 287-297
16 January 2014

Go to top of page Email this page Email this page to a colleague

 31 May 2016 
Biomarker predicts post ERCP pancreatitis
 31 May 2016 
Markers as a reflection of inflammatory burden in ulcerative colitis
 31 May 2016 
Predicting Crohn's diseases before diagnosis
 30 May 2016 
Challenges for direct-acting antivirals in Hep C
 30 May 2016 
Endoscopic indices for disease activity in ulcerative colitis
 30 May 2016 
Colonoscopy reimbursement reduction in practice
 27 May 2016 
Obstructive sleep apnea and NASH
 27 May 2016 
Risk stratification in acute upper GI bleeding
 27 May 2016 
Hepatocellular carcinoma in chronic Hep B patients
 26 May 2016 
Education booklet for colonoscopy bowel preparation
 26 May 2016 
Uncomplicated diverticulitis in outpatients
 26 May 2016 
Direct-acting antivirals in Hep C cirrhosis
 25 May 2016 
Preventing NSAID-associated GI toxicity
 25 May 2016 
Recurrence of Barrett’s after successful endoscopic therapy
 25 May 2016 
PPIs and NSAID-induced small bowel injury
 24 May 2016 
Fecal inflammatory markers in Crohn's
 24 May 2016 
Depression and IBD recurrence
 24 May 2016 
New therapies for NASH
 23 May 2016 
Risk factors for peptic ulcer bleeding outcomes
 23 May 2016 
Liver transplantation for hepatocellular carcinoma
 23 May 2016 
Cancer after colectomy in IBD
 20 May 2016 
Biomarker for colorectal cancer diagnosis
 20 May 2016 
Prognostic score for hepatic venous outflow obstruction
 20 May 2016 
Treatment for uncomplicated acute diverticulitis
 19 May 2016 
Probiotics and H. pylori eradication
 19 May 2016 
Impaired skeletal health in atrophic gastritis
 19 May 2016 
Predicting outcome in ulcerative colitis
 18 May 2016 
Erectile dysfunction in IBD
 18 May 2016 
Acute GERD and esophageal histologic changes
 18 May 2016 
Surgical fundoplication for GERD 
 17 May 2016 
Mucosal dysbiosis in Crohn's disease
 17 May 2016 
Vitamin D level and clinical status in IBD 
 17 May 2016 
Inpatient costs for IBD and acute pancreatitis
 16 May 2016 
Outcomes of postcolonoscopy colorectal cancers
 16 May 2016 
Therapy for Crohn's in a Medicaid population
 16 May 2016 
C. difficile in ulcerative colitis patients
 13 May 2016 
Parkinson's disease and IBD
 13 May 2016 
Inactivated oral cholera vaccine
 13 May 2016 
Non-traditional heart disease risk factors in NAFLD
 12 May 2016 
Gestational diabetes mellitus and NAFLD
 12 May 2016 
Impact of Crohn's in the USA
 12 May 2016 
Ozanimod induction and ulcerative colitis
 11 May 2016 
Anti-TNF discontinuation in IBD
 11 May 2016 
Age and disease presentation with Crohn's disease
 11 May 2016 
Prognosis after colorectal cancer resection
 10 May 2016 
Noninvasive test for IBD
 10 May 2016 
Gluten-free diet in patients with IBS-diarrhea
 10 May 2016 
Digital health for gastroenterology
 09 May 2016 
Diarrheal infections in adults
 09 May 2016 
Quality improvement initiative and readmission for cirrhosis
 09 May 2016 
Coffee or tea and the risk of Barrett's
 06 May 2016 
Risk factors in peptic ulcer bleeding
 06 May 2016 
Recurrent pancreatitis after acute pancreatitis
 06 May 2016 
Managing acute lower GI bleeding
 05 May 2016 
Chemoradiotherapy vs chemotherapy for pancreatic cancer
 05 May 2016 
Genetics in early-early-onset IBD
 05 May 2016 
Reductions in quality of screening colonoscopies
 04 May 2016 
Anti-TNF therapy for IBD
 04 May 2016 
Bismuth and H. pylori eradication
 04 May 2016 
Chromoendoscopy vs colonoscopy for dysplasia in colitis

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2016 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us