Diverticulitis sigmoide: una revisión sistemática de los resultados de las pruebas
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Arden M Morris1, Scott E Regenbogen1, Karin M Hardiman1
1Division of Colorectal Surgery, Department of Surgery, University of Michigan, Ann Arbor.
JAMA
|January 17, 2014
Resumen
La diverticulitis a menudo tiene una historia natural benigna, con menores riesgos de recurrencia de lo que se creía anteriormente. Los tratamientos quirúrgicos o antibióticos agresivos pueden no ser necesarios para los casos crónicos o recurrentes.
Área de la Ciencia:
- Gastroenterología y Gastroenterología.
- Cirugía colorrectal cirugía colorrectal.
- Medicina interna es la medicina interna de las enfermedades.
Sus antecedentes:
- La diverticulitis es una afección gastrointestinal prevalente.
- Comprender su historia natural y fisiopatología es crucial para un manejo eficaz.
- Los paradigmas de tratamiento están evolucionando en base a nuevas evidencias.
Objetivo del estudio:
- Revisar la comprensión actual de la etiología y la historia natural de la diverticulitis.
- Para analizar los cambios recientes en las pautas de tratamiento para la diverticulitis.
- Evaluar la evidencia para las intervenciones médicas y quirúrgicas.
Principales métodos:
- Revisión sistemática de las bases de datos MEDLINE y Cochrane (2000-2013).
- Inclusión de artículos en inglés sobre diagnóstico y manejo.
- Exclusión de pequeñas series de casos y datos anteriores a 2000; clasificación de la evidencia.
Principales resultados:
- La fisiopatología involucra la alteración de la motilidad intestinal, el aumento de la presión y los cambios en el microambiente.
- La diverticulitis sin complicaciones generalmente sigue una historia natural benigna con bajas tasas de recurrencia.
- Los antibióticos y la fibra muestran un beneficio limitado; la mesalamina puede ser útil; la cirugía no siempre está indicada.
Conclusiones:
- La evidencia actual sugiere un papel reducido para los antibióticos agresivos o las intervenciones quirúrgicas.
- El manejo de la diverticulitis crónica o recurrente debe ser individualizado.
- La investigación adicional puede refinar las estrategias de tratamiento basadas en los resultados del paciente.
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