Management Of Diverticular Disease Research Articles

From diverticulosis to complicated diverticular disease: Progression of myogenic alterations and oxidative imbalance.

The natural history and pathophysiology of diverticular disease (DD) are still uncertain. An ex-vivo human complicated DD (cDD) model has recently shown a predominant transmural oxidative imbalance. The present study aims to evaluate whether the previously described alterations may precede the symptomatic form of the disease. Colonic surgical samples obtained from patients with asymptomatic diverticulosis (DIV), complicated DD, and controls were systematically and detailed morphologically and molecularly analyzed. Therefore, histologic, histomorphometric, immunohistochemical evaluation, and gene and protein expression analysis were performed to characterize colonic muscle changes and evaluate chronic inflammation, oxidative imbalance, and hypoxia. Functional muscle activity was tested on strips and isolated cells in response to contractile and relaxant agents. Compared with controls, DD showed a marketed increase in muscle layer thickness, smooth muscle cell syncytium disarray, and increased interstitial fibrosis; moreover, the observed features were more evident in the cDD group. These changes mainly affected longitudinal muscle and were associated with altered contraction-relaxation dynamics and fibrogenic switch of smooth muscle cells. Chronic lymphoplasmacytic inflammation was primarily evident in the mucosa and spared the muscle. A transmural increase in carbonylated and nitrated proteins, with loss of antioxidant molecules, characterized both stages of DD, suggesting early oxidative stress probably triggered by recurrent ischemic events, more pronounced in cDD, where HIF-1 was detected in both muscle and mucosa. The different DD clinical scenarios are part of a progressive process, with oxidative imbalance representing a new target in the management of DD.

Effectiveness of NOTES versus traditional techniques on surgical outcomes in adults with diverticulitis: a systematic review protocol.

This review will evaluate the effectiveness of natural orifice transluminal endoscopic surgery (NOTES)/hybrid NOTES versus traditional surgical techniques in the management of diverticular disease. Diverticular disease can have a significant impact on a patient's quality of life, especially the changes affecting bowel function. Recurrent/severe symptoms may require surgery. Resections are invasive and can have significant operative complications. There has been a shift from an open resection to a more minimally invasive technique such as laparoscopy. Furthermore, the use of natural orifice transluminal endoscopic resection, using a transanal/transvaginal approach, has begun to be used in colorectal resections. Eligible studies will include patients who underwent surgical resection for diverticular disease or diverticulitis. The review will consider studies that evaluate NOTES in the management of diverticular disease or diverticulitis. This will include hybrid procedures involving both NOTES and natural orifice specimen extraction (NOSE), with the aid of laparoscopy/endoscopy/robotic equipment. Studies on participants under 18 years of age and presenting with non-diverticular pathologies will be excluded. This review will follow the JBI methodology for systematic reviews of effectiveness and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Databases to be searched will include PubMed, MEDLINE (Ovid), CINAHL (EBSCOhost), Cochrane Library, Web of Science, Scopus, ProQuest, ClinicalTrials.gov, and ANZCTR, with no language limitations. The reference lists of included studies will be screened for additional studies. This review will preferentially consider experimental and quasi-experimental study designs. Two reviewers will conduct critical appraisal and data extraction. Studies will, where possible, be pooled in statistical meta-analyses. PROSPERO CRD42023420771.

Towards a tailored approach for patients with acute diverticulitis and abscess formation. The DivAbsc2023 multicentre case–control study

BackgroundThis multicentre case–control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses.MethodsThis study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed.ResultsFailure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI − 0.66;3.70, P = 0.23).ConclusionsNon-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.Graphical abstract

Unmet needs in treatment of symptomatic uncomplicated diverticular disease and prevention of recurrent acute diverticulitis: a scoping review.

Diverticular disease (DD) represents a common gastrointestinal condition that poses a heavy burden on healthcare systems worldwide. A high degree of uncertainty surrounds the therapeutic approaches for the control of symptoms in patients with symptomatic uncomplicated diverticular disease (SUDD) and primary and secondary prevention of diverticulitis and its consequences. To review the current knowledge and discuss the unmet needs regarding the management of SUDD and the prevention of acute diverticulitis. Randomized trials, observational studies, and systematic reviews on lifestyle/dietary interventions and medical treatment (rifaximin, mesalazine, and probiotics) of SUDD or prevention of acute diverticulitis. The literature search was performed from inception to April 2023, without language restriction, following the modified Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) reporting guidelines. References of the papers selected were checked to identify additional papers of potential interest. The final list of references was evaluated by a panel of experts, who were asked to check for any lack of relevant studies. Information on patient population, study design, intervention, control group, duration of the observation, and outcomes assessed was collected by two authors independently. The review shows a high degree of uncertainty about therapeutic interventions, both dietary/lifestyle and pharmacological, in patients with SUDD, because of the scarcity and weakness of existing evidence. Available studies are generally of low quality, heterogeneous, and outdated, precluding the possibility to draw robust conclusions. Similarly, acute diverticulitis prevention has been seldom investigated, and there is a substantial lack of evidence supporting the role of dietary/lifestyle or pharmacological approaches to reduce the risk of diverticulitis. The lack of robust evidence regarding therapeutic options for gastrointestinal symptoms in SUDD patients and for primary and secondary prevention of acute diverticulitis remains an important unmet need in the management of DD.

Esophageal diverticula: from diagnosis to therapeutic management-narrative review.

Esophageal diverticulum (ED) is a relatively rare condition, characterized by high etio- and pathophysiological versatility, with an uncommon clinical impact, consequently requiring a complete and complex diagnostic evaluation, so that the therapeutic decision is "appropriate" to a specific case. The aim of the paper is, therefore, a reassessment of the diagnostic possibilities underlying the establishment of the therapeutic protocol and the available therapeutic resources, making a review of the literature, and a non-statistical retrospective analysis of cases hospitalized and operated in a tertiary center. Thus, classical investigations (upper digestive endoscopy, barium swallow) need to be correlated with complex, manometric, and imaging evaluations with direct implications in therapeutic management. Moreover, in the absence of a precise etiology, the operative indication needs to be established sparingly, with the imposition of the identification and interception of the pathophysiological mechanisms through the therapeutic gesture. The identification of the pathophysiological mechanisms is mandatory for the management of diverticular disease, the result obtained-restoring swallowing and comfort/good quality of life in the postoperative period-is directly related to the chosen therapeutic procedure. In addition, management appears to be a difficult goal in the context of the low incidence of ED but also of the results that emphasize important differences in the reports in the medical literature. Although ED is a benign condition, surgical techniques are demanding, impacted by significant morbidity and mortality. The causes of these results are multiple: possible localizations anywhere in the esophagus, diverticulum size/volume from a few millimeters to an impressive one, over 10-12 cm, metabolic impact in direct relation to the alteration swallowing, numerous diverticular complications but, perhaps most importantly, alteration of the quality of the diverticular wall by inflammatory phenomena, with an impact on the quality of the suture. The accumulation of cases in a tertiary profile center, with volume/hospital, respectively volume/surgeon + gastroenterologist could be a solution in improving the results. One consequence would be the identification of alternative solutions to open surgical techniques, a series of minimally invasive or endoscopic variants can refine these results.

Combined Overview on Diverticular Assessment:a new score for the management of diverticular disease

Abstract Background Diverticulosis is increasing worldwide as a public health problem. The Combined Overview on Diverticular Assessment (CODA) score, merging Diverticular Inflammation and Complication Assessment (DICA) and few clinical parameters, may reliably predict the occurrence of acute diverticulitis and surgery due to complications. Thus, the aim of the study is to confirm the value of DICA classification and to develop and validate the CODA endoscopic-clinical score. Methods A number of 2198 patients, at the first diagnosis of diverticulosis/diverticular disease were enrolled in a multicentre, prospective, international cohort study. Participants were scored according to DICA classifications. A 3-year follow-up was performed. Survival methods for censored observation were used to develop and validate the CODA score for predicting diverticulitis and surgery. Results The 3-year cumulative probability of diverticulitis and surgery was ≤4%, and ≤0.7% in CODA A; &amp;lt;10%and &amp;lt;2.5% in CODA B; &amp;gt;10%and &amp;gt;2.5% in CODA C, respectively. The 3-year cumulative probability of diverticulitis and surgery was of 3.3% (95% CI 2.5% to 4.5%) in DICA 1, 11.6% (95% CI 9.2% to 14.5%) in DICA 2 and 22.0% (95% CI 17.2% to 28.0%) in DICA 3 (p &amp;lt; 0.001), and 0.15% (95% CI 0.04% to 0.59%) in DICA 1, 3.0% (95% CI 1.9% to 4.7%) in DICA 2 and 11.0% (95% CI 7.5% to 16.0%) in DICA 3 (p &amp;lt; 0.001), respectively. The CODA score showed optimal discrimination capacity in predicting the risk of surgery in the development (cstatistic: 0.829; 95%CI 0.811 to 0.846) and validation cohort (c-statistic: 0.943; 95% CI 0.905 to 0.981). Conclusions DICA endoscopic classification was confirmed to have a significant predictive value in terms of acute diverticulitis occurence/recurrence and risk of surgery. CODA score could provide a new risk stratification tool useful for everyday clinical practice and also with a significant public health impact in terms of treatment effectiveness and decision making. Key messages • DICA endoscopic classification of diverticular disease is a clear predictor of the outcome of diverticulosis/diverticular disease. • The CODA score, combining DICA and few clinical parameters, may reliably predict the occurence of acute diverticulitis and surgery due to complications.

SP9.1.6 Save the scope - a 3-year analysis of follow-up methods for acute diverticulitis and the incidence of colorectal malignancy

Abstract Aims Previously, guidelines for the management of diverticular disease have recommended endoscopic evaluation following acute diverticulitis to exclude colorectal cancer (CRC). However, 2021 ACPGBI consensus guidelines recognised the sensitivity of modern CT scanning and low incidence of CRC, and suggested no routine re-imaging in CT-proven uncomplicated disease. Methods Patient were identified presenting between 2017–2019 at a single centre. Records were retrospectively reviewed to evaluate the incidence of CRC at a minimum of 18-month follow up in this patient group. Secondary outcomes included the imaging method requested, operative management, and complications following endoscopy. Results Of 486 admissions in 461 patients, 168 (35%) had CT-proven complicated disease, 225 (46%) had uncomplicated, and 93 (19%) had no imaging. 281 (59%) had follow-up investigations requested; 126 CT colonoscopy (CTC) and 150 endoscopic. 133 investigations were performed in patients with uncomplicated diverticulitis. Only 6 patients (1%) were diagnosed with CRC; 2 at endoscopy, and 4 by histology from colorectal resections during emergency admission; all had CT-proven complicated diverticulitis. No malignancy was identified in patients with uncomplicated diverticulitis. Secondary outcomes identified that 26 (24%) flexible sigmoidoscopies were poorly tolerated, necessitating further imaging. Conclusions At our centre, there was little consensus on whether patients had follow-up imaging following acute diverticulitis, and what modality was used. We identified no CRC in patients with CT-proven uncomplicated disease, with 133 potentially unnecessary investigations performed in this group. We recommend use of CTC or endoscopy following acute CT-proven complicated diverticulitis in line with ACPGBI guidelines, avoiding follow-up in uncomplicated disease.

EP-608 Robotic surgery in Inflammatory Bowel Disease: single centre experience

Abstract Aims Minimally invasive surgical approach has been shown to be beneficial especially with its utilization in the rectal dissection for the management of malignant disease. There has been growing interest in robotic approach in the surgical management of diverticular disease and inflammatory bowel disease (IBD). The aim of this study is to present our local institutional experience following implementation of a robotic service for surgical management of benign colorectal disease. Methods Data on patient demographics, intraoperative details, length of hospital stay (LOS), and postoperative complications were collected prospectively with a 30 day follow up. Patients included those who underwent robotic ileocaecal resection, subtotal colectomy, anterior resection, panproctocolectomy or proctectomy between April and December 2021, for benign disease including diverticular disease, IBD, or chronic constipation. Results Seventeen patients were included. 35% were male, median (IQR) age was 38 (22) years and BMI was 23 (2). Procedure duration was 181 (125) minutes, and one patient underwent conversion to open surgery. LOS was 9 (6) days and one patient required admission to HDU for one day. N=3 (18%) had ileus, and n=1 (6%) had an anastomotic leak, acute renal failure, or a chest infection. Two patients had collection requiring percutaneous drainage. No return to theatre or deaths were recorded. Conclusions Our early experience demonstrates encouraging outcomes as well as feasibility and safety of robotic approach in managing benign colorectal disease. Future studies with larger samples will allow to draw more definitive conclusions.

Racial Disparity in the Surgical Management of Diverticular Disease.

Although minimally invasive surgery (MIS) has clearly been associated with improved colorectal surgery outcomes, not all populations benefit from this approach. Using a national database, we analyzed both, the trend in the utilization of MIS for diverticulitis and differences in utilization by race. Colon-targeted participant user files (PUFs) from 2012 to 18 were linked to respective PUFs in National Surgical Quality Improvement Project. Patients undergoing colectomy for acute diverticulitis or chronic diverticular disease were included. Surgical approach was stratified by race and year. To adjust for confounding and estimate the association of covariates with approach, data were fit using multivariable binary logistic regression main effects model. Using a joint effects model, we evaluated whether the odds of a particular approach over time was differentially affected by race. Of the 46 713 patients meeting inclusion criteria, 83% were white, with 7% black and 10% other. Over the study period, there was a decrease in the rate of open colectomy of about 5% P < .001, and increase in the rate of utilization of laparoscopic and robotic approaches (RC) P < .0001. After adjusting for confounders, black race was associated with open surgery P < .0001. There is disparity in the utilization of MIS for diverticulitis. Further research into the reasons for this disparity is critical to ensure known benefits of MIC are realized across all races.

Updates in the understanding and management of diverticular disease.

Diverticulosis leads to significant morbidity and mortality and is increasing in prevalence worldwide. In this paper, we review the clinical features, diagnosis, and management of diverticular disorders, followed by a discussion of recent updates and changes in the clinical approach to diverticular disease. Recent literature suggests that antibiotics are likely not necessary for low-risk patients with acute uncomplicated diverticulitis, and not all patients with recurrent diverticulitis require colectomy. Dietary restrictions do not prevent recurrent diverticulitis. Visceral hypersensitivity is increasingly being recognized as a cause of persistent abdominal pain after acute diverticulitis and should be considered along with chronic smoldering diverticulitis, segmental colitis associated with diverticula, and symptomatic uncomplicated diverticular disease. Clinicians should be aware that traditionally held assumptions regarding the prevention and management of diverticular disorders have recently been called into question and should adjust their clinical practice accordingly.

Microbiota and Probiotics: The Role of Limosilactobacillus Reuteri in Diverticulitis.

The microbiota is the set of commensal microorganisms, residing in the organism, helping proper functioning of organs and systems. The role that the microbiota plays in maintaining the health of vertebrates is widely accepted, particularly in the gastrointestinal system, where it is fundamental for immunity, development, and conversion of nutrients. Dysbiosis is an alteration of the microbiota which refers to a disturbed balance, which can cause a number of pathologies. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. In particular, Lactobacilli are a group of Gram-positive bacteria, which are able to produce lactic acid through glucose metabolism. They are present in different microenvironments, ranging from the vagina, to the mouth, to different tracts of the small intestine. In the present review, we will discuss the use of Limosilactobacillus in human health in general and more specifically in diverticulitis. In particular we analyze the role of Limosilactobacillus reuteri and its anti-inflammatory action. For this review, articles were identified using the electronic PubMed database through a comprehensive search, conducted by combining key terms such as “diverticulitis”, “Limosilactobacillus reuteri”, “human health and disease”, “probiotics”. We selected all the articles published in the last 10 years and screened 1017 papers. Articles referenced in the screened papers were evaluated if considered interesting for our topic. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. The importance of probiotics in treating diverticular disease and acute diverticulitis can be further understood if taking into consideration some pathophysiological aspects, associated to the microbiota. L. reuteri plays an important role in human health and disease. The effectiveness of L. reuteri in stimulating a correct bowl motility partly explains its effectiveness in treating diverticulitis. The most important action of L. reuteri is probably its immunomodulating activity. Levels of IL-6, IL-8, and Tumor necrosis factor (TNF-alpha) are reduced after supplementation with different strands of Lactobacilli, while T-regulatory cells increase in number and activity. Anyway, new mechanisms of action of probiotics come to light from the many investigations currently taking place in numerous centres around the world and to improve how exactly probiotic administration could make the difference in the management of diverticular disease and acute diverticulitis.

Appraisal of the current guidelines for the management of diverticular disease using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument.

Diverticular disease is one of the most frequent reasons for attending emergency departments and surgical causes of hospital admission. In the past decade, many surgical and gastroenterological societies have published guidelines for the management of diverticular disease. The aim of the present study was to appraise the methodological quality of these guidelines using the Appraisal of Guidelines Research and Evaluation II (AGREE II) tool. PubMed, Embase, Cochrane Library and Google Scholar databases were searched systematically. The methodological quality of the guidelines was appraised independently by five appraisers using the AGREE II instrument. A systematic search of the literature identified 12 guidelines. The median overall score of all guidelines was 68%. Across all guidelines, the highest score of 85% was demonstrated in the domain 'Scope and purpose'. The domains 'Clarity and presentation' and 'Editorial independence' both scored a median of 72%. The lowest scores were demonstrated in the domains 'Stakeholder involvement' and 'Applicability' at 46% and 40%, respectively. Overall, the National Institute for Health and Care Excellence (NICE) guidelines performed consistently well, scoring 100% in five of six domains; NICE was one of the few guidelines that specifically reported stakeholder involvement, scoring 97%. Generally, the domain of 'Stakeholder involvement' ranked poorly with seven of twelve guidelines scoring below 50%, with the worst score in this domain demonstrated by Danish guidelines at 25%. Six of twelve guidelines (NICE, American Society of Colon & Rectal Surgeons (ASCRS), European Society of Coloproctology (ESCP), American Gastroenterological Association, German Society of Gastroenterology/German Society for General and Visceral Surgery (German), Netherlands Society of Surgery) scored above 70%. Only three, NICE, ASCRS and ESCP, scored above 75% and were voted unanimously by the appraisers for use as they are. Therefore, use of AGREE II may help improve the methodological quality of guidelines and their future updates.

AB130. SOH21AS022. Diverticular disease and diet: are we doing enough?

Background: Diverticular disease (DD) is a major burden on healthcare systems globally, especially in the western world. DD accounts for the second most common indication for elective colorectal resections, with each resection costing the National Health Service (NHS) a minimum of £5,000. Since dietary advice is an integral part of the management of DD, we aim to investigate the proportion of patients that receive documented dietary advice or guidance on their stay in hospital.

Trends in emergent diverticular disease management: a nationwide cohort study from 2009 to 2018.

Diverticular disease is a common disorder. Several guidelines report on its optimal management. The aim of this study was to describe the evolution of the prevalence of this disease, the treatment strategies, and the mortality rate on a national level. We conducted a retrospective study on prospective data using a nationwide database. All consecutive adult patients diagnosed with diverticular disease and admitted via the emergency department from 2009 to 2018 were included in the study. We performed a descriptive analysis for epidemiologic data, diagnosis, and treatment. During the data collection period, 233,386 patients were included in the study. The number of admissions for emergent diverticular disease increased by 65.8%, from 16,754 in 2009 to 27,781 in 2018, for both uncomplicated and complicated diverticular disease. Among these patients, 19,350 (8.3%) were operated on. The rate of surgical treatment progressively decreased from 9.7% in 2009 to 7.6% in 2018. The three main interventions were Hartmann's procedure (HP, n = 9111, 47.1%), resection with primary anastomosis (RPA, n = 4335, 22.4%), and peritoneal lavage (PL, n = 4836, 25%). We observed a progressive annual increase in HPs (n = 716 in 2009 and n = 1055 in 2018) as well as a decline in PLs since 2015, while the number of RPAs remained stable. Although admissions for emergent diverticular disease have increased during the study period, the rate of surgical treatment has decreased, suggesting an evolution toward more conservative management of this pathology.

Minimally Invasive Management of Diverticular Disease.

Traditionally, management of complicated diverticular disease has involved open damage control operations with large definitive resections and colostomies. Studies are now showing that in a subset of patients who would typically have undergone an open Hartmann's procedure for Hinchey III/IV diverticulitis, a laparoscopic approach is equally safe, and has better outcomes. Similar patients may be good candidates for primary anastomosis to avoid the morbidity and subsequent reversal of a colostomy. While most operations for diverticulitis across the country are still performed open, there has been an incremental shift in practice toward minimally invasive approaches in the elective setting. The most recent data from large trials, most notably the SIGMA trial, found laparoscopic sigmoid colectomy is associated with fewer short-term and long-term complications, decreased pain, improvement in length of stay, and maintains better cost-effectiveness than open resections. Some studies even demonstrate that robotic sigmoid resections can maintain a similar if not more reduction in morbidity as the laparoscopic approach while still remaining cost-effective. Intraoperative approaches also factor into improving outcomes. One of the most feared complications in colorectal surgery is anastomotic leak, and many studies have sought to find ways to minimize this risk. Factors to consider to minimize incidence of leak are the creation of tension-free anastomoses, amount of contamination, adequacy of blood supply, and a patient's use of steroids. Techniques supported by data that decrease anastomotic leaks include preoperative oral antibiotic and mechanical bowel prep, intraoperative splenic flexure mobilization, low-tie ligation of the inferior mesenteric artery, and use of indocyanine green immunofluorescence to assess perfusion. In summary, the management of benign diverticular disease is shifting from open, morbid operations for a very common disease to a minimally invasive approach. In this article, we review those approaches shown to have better outcomes, greater patient satisfaction, and fewer complications.

Special Situations in the Management of Diverticular Disease.

Diverticular disease affects a large percentage of the US population, affecting over 30% among those older than 45 years old. It is responsible for ∼300,000 hospitalizations per year in the United States and can lead to serious complications such as hemorrhage, obstruction, abscess, fistulae, or bowel perforation. 2 It is an extremely common reason for emergency room and outpatient visits and evaluations by general and colorectal surgeons. In the US, patients usually present with sigmoid diverticulitis in the setting of a normal immune system so surgeons will follow well-established practice guidelines for treatment. However, there may be special circumstances in which the management of diverticulitis is not as straightforward. In this article, we will address patients who present with multifocal disease, giant colonic diverticulum, right-sided diverticulitis, and diverticulitis in the setting of immunosuppression and hopefully provide guidance for treatment in these special circumstances.

Diverticulitis.

Our understanding of the pathophysiology and management of diverticular disease of the colon continues to evolve at a rapid pace. The study of the natural history of diverticulitis has led to the understanding that this disease may have fundamentally different mechanisms than those proposed in previous generations. Genetics, the microbiome, and environmental risk factors are increasingly recognized as major contributors to the evolution of diverticulosis and subsequent progression to complicated diverticulitis.

Management of Diverticulosis

The paradigm in the management of diverticular disease is continuously changing. This review serves as an overview of the management of diverticular disease including modifiable risk factors and medical and surgical therapies. The treatment of acute uncomplicated diverticulitis has changed over time to a more conservative approach with the most recent trials showing that antibiotics neither accelerated recovery nor prevented complications of diverticulitis. Another paradigm shift has been in the surgical management of patients with acute diverticulitis with a more individualized approach favoring delay in surgery. Diverticulosis is the most common finding on colonoscopy with a prevalence that increases with age. The management of diverticular disease and its complications are ever evolving with a focus on more conservative approach to the management of uncomplicated disease.

Symptomatic uncomplicated diverticular disease management: an innovative food-grade formulation of Curcuma longa and Boswellia serrata extracts

BackgroundThe treatment of symptomatic uncomplicated colonic diverticular disease (SUDD) is still under debate, and new data show a pathogenic role of dysbiosis and low-grade inflammation in intestinal mucosa. Recent research has highlighted the anti-inflammatory effects of botanical extracts such as Curcuma longa L. and Boswellia serrata Roxb. ex Colebr. The aim of this work is to investigate the potential role of a new delivery formulation of the association of curcumin and boswellia phytosome extracts (CBP) in SUDD.MethodsIn a 30-day one-group longitudinal explanatory study, patients (men and women) were treated with an innovative association of CBP standardized extracts, 500 mg bid.ResultsTreatment of SUDD with the association of CBP was followed by a significant decrease in abdominal pain (p<0.0001). The study group showed that CBP supplementation was efficacious within 10 days and that efficacy was maintained almost constant until the 30th day of intervention.ConclusionA phytosome of curcumin and boswellia extracts may be useful for the relief of SUDD pain. However, controlled studies should be performed for final conclusions to be drawn.

Pregnancy and Healthy Childbirth in a 37 Year-Old Patient with Diverticular Disease

Aim.To describe a clinical case of pregnancy and healthy labour in a young female patient with uncomplicated diverticular disease (DD).Key points.In recent years, DD is more frequently observed in younger patients. A 37-yo woman manifested the symptoms of periodic intense abdominal pain and constant abdominal discomfort. Colonic DD was diagnosed with irrigoscopy. A high-fibre diet, rifaximin-α at 400 mg twice a day for one week, once a month for six months, and topical anti-inflammatory therapy were prescribed. Clinical symptoms were eradicated upon the treatment. Unaware of pregnancy, the patient had another course of rifaximin-α at the second week of gestation, after which the therapy was stopped. Rifaximin-α, which has a poor intestinal absorption, did not affect the foetal development. A caesarean childbirth was healthy, the newborn was delivered on term with no complications (Apgar score 8).Conclusion.DD should be included in differential diagnosis for patients with non-specific symptoms (abdominal pain, bloating and discomfort), regardless of young age. No protocols are currently accepted for the DD management during gestation. In the clinical case reported, a patient having diverticular disease and a rifaximin-α therapy at an early term of gestation proceeded without complications for herself and the foetus.