Uncomplicated Diverticular Disease Research Articles

Site and duration of abdominal pain discriminate symptomatic uncomplicated diverticular disease from previous diverticulitis patients.

Abdominal pain in patients with diverticular disease (DD) can be challenging in clinical practice. Patients with symptomatic uncomplicated diverticular disease (SUDD) and patients with a previous acute diverticulitis (PD) may share a similar clinical pattern, difficult to differentiate from irritable bowel syndrome (IBS). We used standardized questionnaires for DD (short and long lasting abdominal pain) and IBS (following Rome III Criteria) to assess clinical features of abdominal pain, in terms of presence, severity and length, in SUDD and PD patients. One hundred and forty-eight SUDD and 118 PD patients completed all questionnaires. Short-lasting pain was more frequent in SUDD than PD patients (p = 0.007). Number of long-lasting pain episodes was higher in SUDD (6.6 ± 11.9) compared to PD patients (3.4 ± 6.9) (p < 0.001). PD patients reported long-lasting pain more frequently in the lower left abdomen (p < 0.001), while in SUDD it was more frequently diffuse (p = 0.002) or localized in the lower right quadrant (p = 0.009). Features associated with long-lasting pain (fever, confinement to bed, consultations, antibiotic therapy, hospitalization) were more often reported in PD patients. IBS criteria were reported in 28.2% of patients and were more frequent in SUDD than PD patients (37.2% vs 17.1%, p < 0.001). SUDD and PD patients presented different pattern of abdominal pain (length, number of long lasting episodes, site and associated features), with a third reporting overlap with IBS. Further observational studies are needed to better characterize abdominal symptoms in DD patients, especially in those not fulfilling IBS criteria.Trial registration: The REMAD Registry is registered as an observational study in ClinicalTrial.gov (ID: NCT03325829).

The value and advanced features of pre- and metabiotics in the treatment of symptomatic uncomplicated diverticular colon disease

Background. Symptomatic uncomplicated diverticular colon disease (SNDCD) is a common condition that significantly affects the quality of life of patients. One of the main therapeutic targets in SNDCD is the microbiota.&#x0D; Aim. To evaluate the efficacy and safety of microbiocenosis-based therapy (prebiotic Mucofalk + metabiotic Zakofalk) in relieving symptoms of SNDCD and maintaining asymptomatic remission.&#x0D; Materials and methods. The study included 60 patients with clinically apparent SNDCD. For 3 months, they were treated with Mukofalk and Zakofalk and then followed up for another 3 months. Parameters such as treatment efficacy, satisfaction and compliance were evaluated, as well as change of short-chain fatty acids in feces using gas-liquid chromatography was measured.&#x0D; Results. A statistically significant improvement of all assessed symptoms (abdominal pain, constipation, diarrhea, flatulence, tenesmus) was observed after 3 months of therapy. Relapse of abdominal pain and bowel movement disorders (constipation) after completion of therapy were observed in 7 (11.6%) subjects. The compliance study showed that more than 80% of the required number of sachets/tablets was taken by more than 80% of patients. At the end of follow-up, 49 (81.7%) patients rated their outcomes as "excellent" and 11 (18.3%) as "good". During treatment, there was a significant tendency to increase the absolute content of butyric acid in feces.&#x0D; Conclusion. Microbiocenosis-based therapy with the prebiotic Mukofalk and the metabiotic Zakofalk is effective and safe for treating SNDCD and preventing the recurrence of symptoms and disease complications. The therapy is associated with excellent and good satisfaction and a high compliance to treatment. Therapy with Mukofalk and Zakofalk resulted in the normalization of the intestinal microbiota.

Non-distinctive abdominal pain: is it diverticular disease or not?

Acute abdominal pain may relate to specific organ systems and needs an interdisciplinary approach with close collaboration between internal and surgical disciplines. Main objective is to shorten the diagnostic work-up between the beginning of the symptoms and their therapy. After clarifying of the five w-questions: when, how, how long, why, and where, abdominal ultrasound, ECG, laboratory diagnostics and early application of computed tomography should be performed.For the most part, chronic abdominal pain is caused by disorders of the gut-brain-axis such as the irritable bowel syndrome. Because of the synaptic plasticity, the processing of pain is dynamic and cannot be related to a single organ system. This problem is obvious in patients with irritable bowel syndrome and colonic diverticula, which may be interpreted as symptomatic uncomplicated diverticular disease (SUDD, type 3a). However, a reliable clinical differentiation between both groups is not possible. The establishment of SUDD (type 3a) considerable widened the application area of mesalazine.

Changes in indicators of local and systemic inflammation in patients with uncomplicated diverticular disease in combination with obesity

Changes in indicators of local and systemic inflammation in patients with uncomplicated diverticular disease in combination with obesity

A SYSTEMATIC MAPPING REVIEW OF IN-VITRO AND IN-VIVO EVIDENCES EXPLORING THE ROLE OF STRAIN-SPECIFIC PROBIOTIC BIFIDOBACTERIUM LONGUM W11

The gut microbiome has a significant role in overall well-being. Various probiotics are currently used for the improvement of the gut microbiome; the current scoping review aimed to critically examine the effectiveness of Bifidobacterium longum W11 in healthy and disease states. A thorough search of the literature was done in three scientific databases (PubMed, ScienceDirect, and Google Scholar) to identify and retrieve in-vitro, pre-clinical, and clinical evidence that evaluated the effect of B. longum W11 probiotic. Two independent reviewers identified and screened articles, published from 2000 to 2023 from the databases. Data from eligible studies were extracted, compiled, critically evaluated for scientific strength, and presented in this scoping review. Initially, 663 articles were identified and after a complete screening and evaluation process, twenty-one articles (eight in-vitro and animal studies; thirteen clinical studies) were included. Pre-clinical data suggest that B. longum W11 can withstand the severe gastrointestinal environment and colonize the intestinal epithelial cells to a significant degree. Due to the presence of a specific EPS cluster gene, B. longum W11 is capable of producing unique exopolysaccharides that might be responsible for the adhesion and functional capabilities of B. longum W11. Additionally, the specific mutation in the rpoB gene confers the B. longum W11 resistance to all rifamycin derivatives (including rifaximin). Clinical studies involving individuals with constipation and irritable bowel syndrome have shown that B. longum W11 supplementation significantly improves the overall quality of life and reduces the severity of symptoms. Furthermore, B. longum W11 was found to be effective in minimal hepatic encephalopathy and active celiac disease conditions. Due to the antibiotic resistance, the simultaneous use of rifaximin and B. longum W11 in patients with uncomplicated diverticular disease condition resulted in greater improvement in various symptoms compared to rifaximin supplementation alone. These data suggest that B. longum W11 is a potential probiotic that can be administered along with antibiotics in various gastrointestinal disease conditions. This evidence suggests that B. longum W11 is a promising probiotic with potential applications in various functional and inflammatory GI-related complications. Further clinical studies and stringent systematic reviews are needed to strengthen the outcomes of the current study.

P992 Nutraceutical treatment based on a multi-compound formulation composed of Hericium erinaceus, berberine, quercetin, niacin, and biotin could improve the oral 5-ASA effectiveness in mild-to-moderate ulcerative colitis: Results from a two-arm multicentric retrospective observational study

Abstract Background The use of nutraceuticals as adjunctive therapy for ulcerative colitis (UC) is increasingly emerging. HBQ-Complex® (a compound consisting of Hericium erinaceus, berberine, and quercetin), when added to biotin and niacin (a compound called Enteroflegin®), has already shown promising results in ex vivo models of UC as well as in other gastrointestinal disorders such as symptomatic uncomplicated diverticular disease. This multicentric observational retrospective study aimed to weigh the effectiveness and safety of Enteroflegin® in mild-to-moderate UC as adjunctive therapy to oral 5-aminosalicylic acid (5-ASA). Methods Mild-to-moderate UC patients [i.e., with a partial Mayo score (PMS) between 2 and 7] on exclusive therapy with oral 5-ASA (i.e., without taking steroids, biologics, small molecules or other prebiotics/symbiotics/antibiotics) were divided into two groups and evaluated at baseline (T0), after three months (T1) and after six months (T2). One group of patients (G1) took 5-ASA plus two Enteroflegin® tablets for six months, while the other control group underwent only 5-ASA treatment (G2). PMS, faecal calprotectin and 5-ASA dose were collected at each time. Clinical response at T1 and T2 (i.e., reduction in PMS ≥ 2 from baseline) and clinical remission at T1 and T2 (i.e., PMS &amp;lt; 2) were the main outcomes of the study, including compound safety. Results One hundred thirty patients [median age 39.5 (30 - 55), BMI 24.4 (22.8 - 26.4) Kg/m2, median years since UC diagnosis 10 (3.2 - 18.4)] were retrospectively included. In the sample, 51.5% were male, 47.7% had left colitis, 55.4% had proctitis, and 5.4% had pancolitis. 96.2% were on mesalazine therapy. 40.8% of patients had a PMS consistent with moderate activity. The clinical response rate at T2 (69.4% vs 47.5%, p=0.01) and clinical remission at T1 (17.9% vs 4.2%, p=0.029) and T2 (38.9% vs 19.1%, p=0.03) were higher in G1 than in G2 group (Figure A, p &amp;lt; 0.05). The trend in calprotectin reduction was also more favourable for G1 throughout the study (Figure B, p &amp;lt; 0.05). A dosage of 5-ASA &amp;gt; 3.6 g (OR 4.269, 95% CI 1.322 - 13.79; p=0.015) per day, as well as the use of Enteroflegin® (OR 3.303, 95% CI 1.232 - 8.857; p=0.018), resulted as clinical remission at T2 (i.e., six months) predictors. No adverse events were reported. Conclusion The nutraceutical compound Enteroflegin®, when added to standard therapy with oral 5-ASA treatment in patients with mild-to-moderate UC, increased its real-life effectiveness without safety concerns.

Diverticular disease and risk of dementia: a Danish population-based cohort study.

Patients with diverticular disease (DD) have ongoing chronic inflammation associated with changes in the gut microbiome, which might contribute to the development of dementia. Using Danish medical and administrative registries from 1980 to 2013, we conducted a nationwide population-based cohort study including all DD patients and a matched (5:1) general population comparison cohort without DD. A nested case-control analysis was then conducted using a risk set sampling, matching four DD controls without dementia to each DD patient with dementia. Clinical severity was categorized as uncomplicated DD (outpatient), conservatively treated DD (inpatient), and surgically treated DD. 149 527 DD patients and 747 635 general population comparators were identified. The 30-year cumulative incidence of dementia among DD patients and general population comparators were 12.4 (95% confidence interval [CI] 12.1-12.7) and 13.73% (95% CI 13.6-13.9), respectively. This corresponded to a 30-year hazard ratio (HR) of 1.10 (95% CI 1.1-1.1). The highest HRs were found in the conservatively treated DD group (1.15 95% CI 1.1-1.2) and the group with young onset of DD (1.52 95% CI 1.2-2.0). In the nested case-control analysis, we identified 8875 dementia cases and 35 491 matched controls. The adjusted odds ratio (OR) for conservatively treated DD was increased (1.08, 95% CI; 1.0-1.2) compared to the reference of uncomplicated DD. We observed a slight increased risk of dementia in patients with young onset DD and conservatively treated DD. Findings suggest an association between disease duration, perhaps reflecting the duration of gut inflammation, and the risk of developing dementia.

Diverticulitis: A Review of Current and Emerging Practice-Changing Evidence

AbstractAcute diverticulitis represents a common colorectal emergency seen in the Western world. Over time, management of this condition has evolved. This review aims to highlight recent evidence and update current recommendations. Notable evidence has emerged in certain aspects of diverticulitis. This includes disease pathogenesis, as emerging data suggest a potentially greater role for the microbiome and genetic predisposition than previously thought. Acute management has also seen major shifts, where traditional antibiotic treatment may no longer be necessary for acute uncomplicated diverticulitis. Following successful medical management of acute diverticulitis, indications for elective sigmoidectomy have decreased. The benefit of emergency surgery remains for peritonitis, sepsis, obstruction, and acute diverticulitis in certain immunocompromised patients. Routine colonoscopy, once recommended after all acute diverticulitis episodes, has been shown to be beneficial for cancer exclusion in a distinct patient population. Despite advances in research, certain entities remain poorly understood, such as smoldering diverticulitis and symptomatic uncomplicated diverticular disease. As research in the field expands, paradigm shifts will shape our understanding of diverticulitis, influencing how clinicians approach management and educate patients.

The Prevalence and Characteristics of Symptomatic Uncomplicated Diverticular Disease Among Asian Patients With Unexplained Abdominal Symptoms.

The precise incidence of symptomatic uncomplicated diverticular disease (SUDD) and its effects on the quality of life (QOL) remain unclear, particularly in Asian patients with right-sided SUDD. We assess the prevalence of SUDD and its impact on QOL in a real-world population. Five institutional cohorts of patients who received outpatient treatment for unexplained abdominal symptoms from January 15, 2020 to March 31, 2022, were included. All patients underwent colonoscopy. SUDD was defined as the presence of recurrent abdominal symptoms, particularly pain in the lower right or left quadrant lasting > 24 hours in patients with diverticulosis at the site of pain. The 36-item short-form health survey was used to assess QOL. Diverticula were identified in 108 of 361 patients. Among these 108 patients, 31% had SUDD, which was right-sided in 39% of cases. Of the 50 patients with right-sided diverticula, 36% had SUDD, as did 15 of 35 patients with left-sided diverticula (43%). Among the 33 patients with SUDD, diverticula were right-sided, left-sided, and bilateral in 39%, 45%, and 15% of patients, respectively. Diarrhea was more frequent in the SUDD group than in the non-SUDD group. Patients with SUDD had significantly lower physical, mental, and role/social component scores than those without SUDD. It is important to recognize that patients with SUDD account for as high as 31% of outpatients with unexplained abdominal symptoms; these patients have diarrhea and a low QOL. The presence of right-sided SUDD was characteristic of Asian patients.

Diagnostic delay in symptomatic uncomplicated diverticular disease: an Italian tertiary referral centre study

The magnitude of the diagnostic delay of symptomatic uncomplicated diverticular disease (SUDD) is unknown; we aimed to evaluate SUDD diagnostic delay and its risk factors. SUDD patients diagnosed at a tertiary referral centre were retrospectively enrolled (2010–2022). Demographic and clinical data were retrieved. Overall, patient-, and physician-dependant diagnostic delays were assessed. Univariate and multivariate analyses were fitted to identify risk factors for diagnostic delay. Overall, 70 SUDD patients (median age 65 years, IQR 52–74; F:M ratio = 1.6:1) were assessed. The median overall diagnostic delay was 7 months (IQR 2–24), patient-dependant delay was 3 months (IQR 0–15), and physician-dependant delay was 1 month (IQR 0–6). Further, 25% of patients were misdiagnosed with irritable bowel syndrome (IBS). At multivariate analysis, previous misdiagnosis was a significant risk factor for overall and physician-dependant diagnostic delay (OR 9.99, p = 0.01, and OR 6.46, p = 0.02, respectively). Also, a high educational level (> 13 years) was associated with a greater overall diagnostic delay (OR 8.74 p = 0.02), while previous abdominal surgery was significantly associated to reduced physician-dependant diagnostic delay (OR 0.19 p = 0.04). To conclude, SUDD may be diagnosed late, IBS being the most frequent misdiagnosis. Timely diagnosis is crucial to tackle the burden of SUDD on patients and healthcare.

One-year cyclic therapy with rifaximin-α is effective in the treatment of SUDD (Symptomatic Uncomplicated Diverticular Disease) also in patients with a history of complicated diverticulitis

Introduction: The treatment of diverticulosis symptoms in patients with a history of diverticulitis is a challenge in everyday clinical practice. Aim: Efficacy assessment of a cyclic, year-long treatment with rifaximin-α in patients with symptomatic uncomplicated diverticular disease (SUDD) and a history of past diverticulitis. Material and methods: This study is a multicenter, retrospective, observational study involving 48 centers. The study group included patients who reported to the outpatient clinic within a month with SUDD symptoms, who had a history of diverticulitis, and who were given a cyclic rifaximin-α treatment of 2 x 400 mg/day for 7 days and then once a month for 12 months. Epidemiological and demographic data, the course of diverticulosis, the number of inflammation episodes and their diagnoses, complications, symptoms of SUDD, and its treatment were evaluated. The efficacy of rifaximin-α therapy was assessed on a 4-point scale (0 – no symptoms, 3 – severe symptoms) every 3 months, and analyzed: pain, tenderness, bloating, bowel movements, and recurrence of inflammation during the 12-month treatment. Results: 178 patients (67% women, median age 65 years [34–92]) were included in the study. The average duration of diverticulosis was 6.4 years (3–20), and 59% of patients had more than one episode of diverticulitis during this period. In total, 87% of patients had symptoms of SUDD after or between episodes of diverticulitis. Abdominal pain was the most common symptom (92%). An inflammation episode was diagnosed using imaging in 50.5% of cases, and the rest – based on typical clinical symptoms. As many as 46.2% of patients required hospitalization, and complications were diagnosed in 44% of cases. One hundred and seventy (95%) patients completed the 12-month rifaximin-α therapy. Changes in the severity of pain, abdominal tenderness, diarrhea, constipation, and bloating were assessed every 3 months. After 12 months of treatment with rifaximin-α, there was a statistically significant reduction in the severity of symptoms overall (median from 1.5 [0–3 points] to 0.2; P&lt;0.001) and each symptom evaluated individually. Regardless of the previous diagnostic method of diverticulitis (imaging or typical clinical presentation) or its complications (e.g. perforation, abscess), treatment with rifaximin-α was equally effective. Conclusions: Cyclic therapy with rifaximin-α is effective in treating SUDD symptoms and in preventing the recurrence of symptoms, also in patients with a history of diverticulitis – regardless of how the diagnosis was made and disease complications. The extended treatment regimen leads to a gradual resolution of symptoms during 12 months of observation. Cyclic use of rifaximin-α is necessary to maintain symptom remission.

Opinions of gastroenterologists about intestinal microbiota modulating agents: results of the survey in focus groups

Aim. To study the opinions of gastroenterologists about drugs affecting the intestinal microflora.&#x0D; Materials and methods. A qualitative survey was conducted in focus groups to study the patterns of prescribing drugs that regulate intestinal microflora in chronic gastrointestinal diseases. The survey included only outpatient gastroenterologists who managed patients with irritable bowel syndrome, an uncomplicated diverticular disease with clinical manifestations and excessive bacterial growth in the small intestine for at least 3 years.&#x0D; Results. Physicians perceive the non-absorbable antibiotic rifaximin alpha as the drug of choice for treating these diseases; they are aware of its low bioavailability and suitability for repeated use. However, with severe clinical symptoms, some doctors tend to use systemic antibiotics before infectious or inflammatory complications are confirmed. It is due to the erroneous perception of systemic antibiotics as obviously more effective drugs than non-absorbable antibiotics. When choosing a drug, it is essential to consider the risk of antibiotic-associated diarrhea, adverse changes in the microflora, and the patient's comorbidities.&#x0D; Conclusion. Surveyed gastroenterologists consider rifaximin alfa (Alfa Normix) the most suitable drug that helps in routine practice achieve the desired result with a minimum risk of adverse events. Many study participants are skeptical about the effect of probiotics due to the lack of evidence but emphasize their safety and the request for probiotics from patients. Not all doctors are aware of metabiotics. Prebiotics and dietary fibers are perceived as agents that affect both the intestinal microflora and the stool frequency. Some healthcare professionals are concerned about prebiotics and probiotics registered as dietary supplements, which can cause patient misunderstandings. Identified opinions about such agents can be used in training gastroenterologists and developing clinical guidelines.

Characteristics of the microbiome in patients with symptomatic uncomplicated colonic diverticular disease in the central region of Ukraine

The aim of the study was to analyze the age structure, correlation with body mass index in patients with symptomatic uncomplicated diverticular disease (SUDD) in the central region of Ukraine. To reveal the prevalence of left-sided, right-sided or total diverticular lesions of the large intestine, to evaluate the microbiota composition, to identify peculiarities of the enterotype. Materials and methods. The study included 125 patients with SUDD aged 18 to 90 years who were at a Gastroenterology Hospital in the period from 2019 to 2022. All the patients were residents of the central region of Ukraine. Body mass index was calculated for all patients, total colonoscopy was performed, and fecal analysis was done using culturing and qRT-PCR methods. Results. The incidence of SUDD among patients in the central region of Ukraine increases with age and reaches its peak in the 71–80 age group. Almost all age groups are dominated by women. Left-sided localization of diverticula occurs in 84.8 % of patients, right-sided in 8.0 %, total in 7.2 %. The majority of patients with diverticular disease (87.2 %) are overweight or with varying degrees of obesity. Patients with SUDD are characterized by a decrease in the main representatives of obligate microflora, namely, Bifidobacterium, Lactobacillus, Escherichia coli. In 46.4 % of patients, representatives of opportunistic flora are detected, in 24.0 % – an increase in fungi from the genus Candida. Also, changes in enterotypes are detected, namely an increase in Firmicutes and Actinobacteria, with a decrease in Bacteroides. The number of Faecalibacterium prausnitzii tends to decrease, while the Akkermansia muciniphila count is unchanged. Conclusions. The incidence of SUDD increases with age among the population of the central region of Ukraine. Among patients with SUDD, women predominate in almost all age groups. 87.2 % of patients with SUDD are overweight or with various degrees of obesity. The left-sided localization of diverticula prevails among patients with SUDD in the central region of Ukraine – 84.8 %. Patients with SUDD in the central region of Ukraine are characterized by the decrease in the main representatives of obligate microflora, namely: Bifidobacterium, Lactobacillus, Escherichia coli. In 46.4 % of patients with SUDD, representatives of conditionally pathogenic flora are found, in 24.0 % – the increase in fungi from the genus Candida. Changes in enterotypes are detected, namely the increase in Firmicutes and Actinobacteria, with the decrease in Bacteroides. Faecalibacterium prausnitzii tends to decrease, while Akkermansia muciniphila are unchanged.

Do Colonic Mucosal Tumor Necrosis Factor Alpha Levels Play a Role in Diverticular Disease? A Systematic Review and Meta-Analysis.

Diverticular disease (DD) is the most frequent condition in the Western world that affects the colon. Although chronic mild inflammatory processes have recently been proposed as a central factor in DD, limited information is currently available regarding the role of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α). Therefore, we conducted a systematic review and meta-analysis aiming to assess the mucosal TNF-α levels in DD. We conducted a systematic literature search using PubMed, Embase, and Scopus to identify observational studies assessing the TNF-α levels in DD. Full-text articles that satisfied our inclusion and exclusion criteria were included, and a quality assessment was performed using the Newcastle-Ottawa Scale (NOS). The principal summary outcome was the mean difference (MD). The results were reported as MD (95% confidence interval (CI)). A total of 12 articles involving 883 subjects were included in the qualitative synthesis, out of which 6 studies were included in our quantitative synthesis. We did not observe statistical significance related to the mucosal TNF-α levels in symptomatic uncomplicated diverticular disease (SUDD) vs. the controls (0.517 (95% CI -1.148-2.182)), and symptomatic vs. asymptomatic DD patients (0.657 (95% CI -0.883-2.196)). However, the TNF-α levels were found to be significantly increased in DD compared to irritable bowel disease (IBS) patients (27.368 (95% CI 23.744-30.992)), and segmental colitis associated with diverticulosis (SCAD) vs. IBS patients (25.303 (95% CI 19.823-30.784)). Between SUDD and the controls, as well as symptomatic and asymptomatic DD, there were no significant differences in the mucosal TNF-α levels. However, the TNF-α levels were considerably higher in DD and SCAD patients than IBS patients. Our findings suggest that TNF-α may play a key role in the pathogenesis of DD in specific subgroups and could potentially be a target for future therapies.

The role of microbiota and its modulation in colonic diverticular disease.

Diverticular disease (DD) is a common condition in Western countries. The role of microbiota in the pathogenesis of DD and its related symptoms has been frequently postulated since most complications of this disease are bacteria-driven and most therapies rely on microbiota modulation. Preliminary data showed fecal microbial imbalance in patients with DD, particularly when symptomatic, with an increase of pro-inflammatory and potentially pathogenetic bacteria. In addition, bacterial metabolic markers can mirror specific pathways of the disease and may be even used for monitoring treatment effects. All treatments currently suggested for DD can affect microbiota structure and metabolome compositions. Sparse evidence is available linking gut microbiota perturbations, diverticular disease pathophysiology, and symptom development. We aimed to summarize the available knowledge on gut microbiota evaluation in diverticular disease, with a focus on symptomatic uncomplicated DD, and the relative treatment strategies.

Colonic diverticular disease: clinical presentation, diagnosis, treatment, and prevention Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientific Society of Russia, and the North- West Society of Gastroenterologists and Hepatologists

Clinical guidelines are intended for gastroenterologists, internists, and general practitioners and focus primarily on the management of patients with symptomatic uncomplicated diverticular disease, as well as on the primary and secondary prevention of acute diverticulitis and other complications of diverticular disease. Clinical guidelines were developed by the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientifi c Society of Russia, and the North-West Society of Gastroenterologists and Hepatologists. One of the reasons for creating new clinical guidelines is that the current guidelines on diverticular disease (2021) pay much more attention to complications of diverticular disease and surgical treatment of acute and chronic complications of the disease.

Health-Related Quality of Life and Stress-Related Disorders in Patients with Complicated Diverticular Disease under Conservative Management.

Diverticular disease is a common gastrointestinal disorder with increasing prevalence in advanced age. This study aimed to investigate the impact of age and complexity of diverticulitis on health-related quality of life (HRQoL) and stress-related disorders. A cross-sectional study was conducted on 180 patients, including adults (18-64 years) with complicated diverticular disease, the elderly (≥65 years) with complicated diverticular disease, and a control group with uncomplicated symptomatic diverticular disease. HRQoL and stress-related disorders were assessed using the SF-36, GIQLI, HADS, and PHQ-9 questionnaires at baseline and six months after the initial episode of diverticulitis. At diagnosis, the adult group had significantly lower mean physical and mental scores compared with the elderly and control groups (p < 0.001). At the 6-month follow-up, the mean physical score increased for all groups, but the difference between adults and the elderly remained significant (p = 0.028). The adult group had a significantly lower mean GIQLI score at diagnosis compared with the elderly and control groups (p < 0.001), although after 6 months it increased and the difference became insignificant. Anxiety scores at diagnosis were significantly higher in the adult group compared with the control group (p = 0.009). The complexity of diverticulitis and age significantly impacted HRQoL at diagnosis, with adults having lower physical and mental scores compared with elderly patients and controls. Although improvements were observed after 6 months, the difference between adults and the elderly remained significant for physical HRQoL scores. This highlights the need for tailored management strategies and psychosocial support to optimize patient outcomes across age groups and diverticulitis complexity.

Eubiotic effect of rifaximin is associated with decreasing abdominal pain in symptomatic uncomplicated diverticular disease: results from an observational cohort study

BackgroundRifaximin effectively treats symptomatic uncomplicated diverticular disease (SUDD) and has shown eubiotic potential (i.e., an increase in resident microbial elements with potential beneficial effects) in other diseases. This study investigated changes in the fecal microbiome of patients with SUDD after repeated monthly treatment with rifaximin and the association of these changes with the severity of abdominal pain.MethodsThis was a single-center, prospective, observational, uncontrolled cohort study. Patients received rifaximin 400 mg twice a day for 7 days per month for 6 months. Abdominal pain (assessed on a 4-point scale from 0 [no pain] to 3 [severe pain]) and fecal microbiome (assessed using 16 S rRNA gene sequencing) were assessed at inclusion (baseline) and 3 and 6 months. The Spearman’s rank test analyzed the relationship between changes in the gut microbiome and the severity of abdominal pain. A p-value ≤ 0.05 was considered statistically significant.ResultsOf the 23 patients enrolled, 12 patients completed the study and were included in the analysis. Baseline abdominal pain levels decreased significantly after 3 (p = 0.036) and 6 (p = 0.008) months of treatment with rifaximin. The abundance of Akkermansia in the fecal microbiome was significantly higher at 3 (p = 0.017) and 6 (p = 0.015) months versus baseline. The abundance of Ruminococcaceae (p = 0.034), Veillonellaceae (p = 0.028), and Dialister (p = 0.036) were significantly increased at 6 months versus baseline, whereas Anaerostipes (p = 0.049) was significantly decreased. The severity of abdominal pain was negatively correlated with the abundance of Akkermansia (r=-0.482; p = 0.003) and Ruminococcaceae (r=-0.371; p = 0.026) but not with Veillonellaceae, Dialister, or Anaerostipes. After 3 months of rifaximin, abdominal pain was significantly less in patients with Akkermansia in their fecal microbiome than in patients without Akkermansia (p = 0.022).ConclusionThe eubiotic effect of rifaximin was associated with decreased abdominal pain in patients with SUDD.

Insights into Mesalazine Use in Clinical Practice of Young Gastroenterologists.

Mesalazine is among the medications most prescribed by gastroenterologists, with variable and controversial use in different settings. We aimed to explore the use of mesalazine in the clinical practice of young gastroenterologists. A web-based electronic survey was distributed to all participants of the National Meeting of the Italian Young Gastroenterologist and Endoscopist Association. A total of 101 participants took part in the survey, with a majority (54.4%) being aged >30 years, 63.4% of whom were trainees in academic hospitals, and 69.3% of whom were involved in the clinical management of inflammatory bowel disease (IBD). While both non-dedicated and IBD physicians generally agreed on the appropriate dose of mesalazine for mild ulcerative colitis (UC), significant differences were observed between the two groups for moderate-severe ulcerative colitis (UC). Additionally, in IBD patients who were starting immuno-modulators and/or biologics, 80% of IBD-dedicated physicians continued to prescribe mesalazine, compared to 45.2% of non-dedicated physicians (p = 0.002). Indeed, 48.4% of non-dedicated IBD physicians did not acknowledge mesalazine for colorectal cancer chemoprevention. With regards to Crohn's disease, it is mainly used by 30.1% of IBD physicians for preventing postoperative recurrence of Crohn's disease. Finally, 57.4% used mesalazine for symptomatic uncomplicated diverticular disease, and 84.2% did not recommend its use for irritable bowel syndrome. This survey showed heterogeneous behaviors in the daily use of mesalazine, mainly in the management of IBD. Educational programs and novel studies are needed to clarify its use.

Symptomatic Uncomplicated Diverticular Disease (SUDD): Practical Guidance and Challenges for Clinical Management.

Symptomatic Uncomplicated Diverticular Disease (SUDD) is a syndrome within the diverticular disease spectrum, characterized by local abdominal pain with bowel movement changes but without systemic inflammation. This narrative review reports current knowledge, delivers practical guidance, and reveals challenges for the clinical management of SUDD. A broad and common consensus on the definition of SUDD is still needed. However, it is mainly considered a chronic condition that impairs quality of life (QoL) and is characterized by persistent left lower quadrant abdominal pain with bowel movement changes (eg, diarrhea) and low-grade inflammation (eg, elevated calprotectin) but without systemic inflammation. Age, genetic predisposition, obesity, physical inactivity, low-fiber diet, and smoking are considered risk factors. The pathogenesis of SUDD is not entirely clarified. It seems to result from an interaction between fecal microbiota alterations, neuro-immune enteric interactions, and muscular system dysfunction associated with a low-grade and local inflammatory state. At diagnosis, it is essential to assess baseline clinical and Quality of Life (QoL) scores to evaluate treatment efficacy and, ideally, to enroll patients in cohort studies, clinical trials, or registries. SUDD treatments aim to improve symptoms and QoL, prevent recurrence, and avoid disease progression and complications. An overall healthy lifestyle - physical activity and a high-fiber diet, with a focus on whole grains, fruits, and vegetables - is encouraged. Probiotics could effectively reduce symptoms in patients with SUDD, but their utility is missing adequate evidence. Using Rifaximin plus fiber and Mesalazine offers potential in controlling symptoms in patients with SUDD and might prevent acute diverticulitis. Surgery could be considered in patients with medical treatment failure and persistently impaired QoL. Still, studies with well-defined diagnostic criteria for SUDD that evaluate the safety, QoL, effectiveness, and cost-effectiveness of these interventions using standard scores and comparable outcomes are needed.