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Management of acute colonic diverticulitis

The latest issue of the Alimentary Pharmacology & Therapeutics examines the pathogenesis and management of acute colonic diverticulitis.

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Acute diverticulitis, defined as acute inflammation associated with a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians.

There have been advances in both the medical and the surgical treatments offered to patients in recent years.

Drs Humes and Spiller from the United Kingdom reviewed the current understanding of the etiology and treatment of acute diverticulitis.

A search of PubMed and Medline databases was performed to identify articles relevant to the etiology, pathogenesis and management of acute diverticulitis.

There are 75 hospital admissions per year for acute diverticulitis per 100,000 of the population in the United States.

Recent reports suggest a 26% increase in admissions over a 7-year period
Alimentary Pharmacology & Therapeutics

Recent reports suggest a 26% increase in admissions over a 7-year period.

Factors predisposing to the development of acute diverticulitis include obesity, smoking, diet, lack of physical activity and medication use such as aspirin and non-steroidal anti-inflammatory drugs.

The research team found that the condition is associated with a low mortality of about 1% following medical therapy, rising to 4% in-hospital mortality in those requiring surgery.

The team observed limited evidence on the efficacy of individual antibiotic regimens, and antibiotic treatment may not be required in all patients.

The rates of recurrence reported for patients with acute diverticulitis following medical management vary from 13% to 36%.

The research team noted that surgical management of those patients who fail medical treatment has moved towards a laparoscopic non-resectional approach.

However, the evidence supporting this is limited.

Dr Humes and colleague comment, "Further high-quality randomised controlled trials are required of both medical and surgical treatments in patients with acute diverticulitis, if management is to be evidence-based."

Aliment Pharmacol Ther 2014: 39(4): 359–370
03 February 2014

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