[Diverticular disease: towards 2020. An evidence-based approach]

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Epidemiology

Background:

• Diverticular disease (DD) presents a growing burden on healthcare systems, marked by increased hospital admissions, mortality, and surgery rates.
• Prevalence rises with age, yet most diverticulosis cases remain asymptomatic; only 4% develop diverticulitis, but recurrence and complications are significant concerns.

Purpose of the Study:

• To provide an overview of the clinical history of diverticular disease.
• To explore current and potential therapeutic strategies for managing DD and preventing relapses.

Main Methods:

• Review of clinical history, diagnostic methods (clinical evaluation, lab tests, imaging like ultrasonography and CAT scans).
• Analysis of evidence for relapse prevention, including mesalazine and non-absorbable antibiotics like rifaximin.
• Examination of risk factors for relapse and future research directions.

Main Results:

• Diagnostic accuracy for diverticulitis is high with imaging (sensitivity 92-99%), while clinical diagnosis has lower sensitivity (68%).
• Evidence for mesalazine in preventing relapse is lacking (GRADE 3).
• Rifaximin shows some evidence of efficacy in preventing relapses (GRADE 1) based on RCT and observational data, reducing relapse risk by 9-14 patients per 100 over 5 years.

Conclusions:

• Current evidence for preventing diverticular disease relapse is limited.
• Rifaximin demonstrates potential for reducing diverticulitis recurrence, warranting further investigation.
• Future research should focus on identifying relapse risk factors and evaluating interventions like probiotics.