Management of Colonic Diverticular Disease

Vol. 73, Suppl. 1, 2006

Free Abstract Article (Fulltext) Article (PDF 154 KB)

Bacterial Flora in Digestive Disease.
Editor(s): Scarpignato, C. (Parma), Lanas, A. (Zaragoza)

Paper

Management of Colonic Diverticular Disease
Giuseppe Frieri^a, Maria Teresa Pimpo^a, Carmelo Scarpignato^b

^aGastroenterology Unit, School of Medicine and Dentistry, University of L'Aquila, L'Aquila, and
^bLaboratory of Clinical Pharmacology, Department of Anatomy, Pharmacology and Forensic Sciences, University of Parma, Parma, Italy

Address of Corresponding Author

Digestion 2006;73 (Suppl. 1):58-66 (DOI: 10.1159/000089780)

Key Words

Colonic diverticular disease
Diverticulitis, management
Diverticulitis recurrence, prevention
Fiber-rich diet
Rifaximin
Mesalazine

Abstract

Diverticular disease of the colon is a complex syndrome that includes several clinical conditions, each needing different therapeutic strategies. In patients with asymptomatic diverticulosis, only a fiber-rich diet can be recommended in an attempt to reduce intraluminal pressure and slow down the worsening of the disease. Fiber supplementation is also indicated in symptomatic diverticulosis in order to get symptom relief and prevent acute diverticulitis. In this regard, the best results have been obtained by combination of soluble fiber, like glucomannan, and poorly absorbed antibiotics, like rifaximin, given 7-10 days every month. For uncomplicated diverticulitis the standard therapy is liquid diet and oral antimicrobials, usually ciprofloxacin and metronidazole. Hospitalization, bowel rest, and intravenous antibacterial agents are mandatory for complicated diverticulitis. Haemorrhage is usually a self-limited event but may require endoscopic or surgical treatment. Once in remission, continuous fiber intake and intermittent course of rifaximin may improve symptoms and reduce diverticulitis recurrence. These preventive strategies will likely improve patients' quality of life and reduce management costs. A surgical approach in diverticular disease is needed in 15-30% of cases and consists of removing the intestinal segment affected by diverticula. It is indicated in diffuse peritonitis, abscesses, fistulas, stenosis and after the second to fourth attack of uncomplicated diverticulitis. Young people and immunocompromised patients are more likely to be operated.

Author Contacts

Giuseppe Frieri, MD
Gastroenterology Unit
Department of Internal Medicine and Public Health
Piazzale Tommasi, Coppito, IT-67100, L'Aquila (Italy)
Tel. +39 0862 368 796/324, E-Mail g.frieri@libero.it

Article Information

Published online: February 8, 2006
Number of Print Pages : 9
Number of Figures : 1, Number of Tables : 2, Number of References : 87

Medline Abstract (ID 16498253)

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