Acute diverticulitis of the colon--current medical therapeutic management

Diverticular disease of the colon is very common in developed countries with its prevalence increasing with age, varying from < 10% in those < 40 years of age, to an estimated 50-66% of patients > 80 years of age. Diverticulitis, defined as inflammation and/or infection associated with diverticula, is the most common clinical complication of this disorder, affecting an estimated 10-25% of patients with colonic diverticula. The therapeutic measures aim at putting the intestine 'at rest', thus resolving the infection, the consequences of the inflammation and preventing or limiting complications. For patients with severe and complicated diverticulitis, ampicillin, gentamicin, metronidazole, piperacillin and tazobactam are the antibiotics successfully used in clinical practice, whereas ciprofloxacin, metronidazole and more recently, rifaximin, have been successfully used in the treatment of uncomplicated diverticular disease. Mesalazine (alone or in association with antibiotics) and probiotics are the two latest therapies for the treatment of diverticulitis which have been developed in the last few years. In fact, the combination of mesalazine and an antibiotic showed significant superiority in improving the severity of symptoms, bowel habits and in preventing symptomatic recurrence of diverticulitis than antibiotics alone, but probiotics also seem to be effective in preventing recurrence of the disease. In light of the excellent results obtained in the treatment of inflammatory bowel disease and irritable bowel syndrome, it is probable that probiotics may be the future best treatment also for mild-to-moderate uncomplicated attacks of acute diverticulitis, especially if used with salycilates.