Colonic diverticular disease: medical treatments for acute diverticulitis

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

Top

General background

Colonic diverticular disease is a common condition, and its complications cause significant morbidity, mortality, and health care costs. The treatment of its most commonly occurring complication, acute diverticulitis, is changing as evidence from RCTs has started to be published.

Top

Focus of the review

For this update we have focused on the issue of medical treatment (either mesalazine or antibiotics) for acute diverticulitis.

Top

Comments on evidence

We found four systematic reviews, which identified one RCT of relevance on the use of antibiotics.

Top

Search and appraisal summary

The update literature search for this overview was carried out from the date of the last search, May 2010, to August 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 193 studies. After deduplication and removal of conference abstracts, 75 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 37 studies and the further review of 38 full publications. Of the 38 full articles evaluated, four systematic reviews and one RCT were added at this update.

Top

Substantive changes at this update

Medical treatment (mesalazine, antibiotics [any] only) versus placebo or no treatment for acute diverticulitis New option. Four systematic reviews were added,[26][27][28][29] which identified one RCT.[30] Categorised as 'unknown effectiveness'.

Abstract

INTRODUCTION: Diverticula (mucosal outpouchings through the wall of the colon) are rare before the age of 40 years, after which prevalence increases steadily and reaches over 25% by 60 years. However, only 10% to 25% of affected people will develop symptoms such as lower abdominal pain. Recurrent symptoms are common, and 5% of people with diverticula eventually develop complications such as perforation, obstruction, haemorrhage, fistulae, or abscesses. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of medical treatments for acute diverticulitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2014 (BMJ Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 193 studies. After deduplication and removal of conference abstracts, 75 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 37 studies and the further review of 38 full publications. Of the 38 full articles evaluated, four systematic reviews and one RCT were added at this update. We performed a GRADE evaluation for two PICO combinations CONCLUSIONS: In this systematic overview, we categorised the efficacy for one comparison based on information about the effectiveness and safety of medical treatment (mesalazine, antibiotics [any] only) versus placebo or no treatment.

Cite as

Humes D, Spiller RC. Colonic diverticular disease: medical treatments for acute diverticulitis. Systematic review 405. BMJ Clinical Evidence. . 2016 February. Accessed [date].

Latest citations

Laparoscopic Lavage in the Management of Hinchey Grade III Diverticulitis: A Systematic Review. ( 10 January 2017 )

Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. ( 10 January 2017 )