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Systematic review of medical therapy to prevent recurrent diverticulitis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim and background

One of today’s controversies remains the prevention of recurrent diverticulitis. Current guidelines advise a conservative approach, based on studies showing low recurrence rates and a high operative morbidity and mortality. Conservative measures in prevention recurrence are dietary advises and medical therapies, including probiotics and 5-aminosalicylic acid.

Objectives

The aim of this systematic review is to assess whether medical or dietary therapies can prevent recurrent diverticulitis after a primary episode of acute diverticulitis.

Method and search strategy

We searched different databases for papers published between January 1966 and January 2011.

Study selection

Clinical studies were eligible for inclusion if they assessed the prevention of recurrent diverticulitis with a medical or dietary therapy. Exclusion criteria were studies without a control group.

Results

Three randomized controlled trials (RCT), all with a Jadad quality score of 2 out of 5, were included in this systematic review. Mesalazine results in significantly less disease recurrence and fewer symptoms after an acute episode. The use of probiotics decreases symptoms but does not reduce recurrence. No difference in effect is seen when Balsalazide is added to probiotics compared to probiotics only. No relevant studies on dietary therapy/advices or antibiotics for prevention of recurrent diverticulitis were found.

Conclusion

The evidence that supports medical therapy to prevent recurrent diverticulitis is of poor quality. Treatment with 5-aminosalicylic acid seems promising. Based on current data, no recommendation of any non-operative relapse prevention therapy for diverticular disease can be made.

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Systematic review

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Authors and Affiliations

  1. Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands

    Çagdas Ünlü, Lidewine Daniels & Marja A. Boermeester

  2. Department of Surgery, Sint Lucas Andreas Hospital, Amsterdam, the Netherlands

    Bart C. Vrouenraets

Authors
  1. Çagdas Ünlü
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  2. Lidewine Daniels
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  3. Bart C. Vrouenraets
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  4. Marja A. Boermeester
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Corresponding author

Correspondence to Çagdas Ünlü.

Additional information

CU: literature search, data interpretation and writing, LD: literature search and writing, BCV: data interpretation and writing, MAB: Data interpretation and writing.

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Ünlü, Ç., Daniels, L., Vrouenraets, B.C. et al. Systematic review of medical therapy to prevent recurrent diverticulitis. Int J Colorectal Dis 27, 1131–1136 (2012). https://doi.org/10.1007/s00384-012-1486-7

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  • DOI: https://doi.org/10.1007/s00384-012-1486-7

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