Inflammation management in acute diverticulitis: current perspectives

Figures & data

Table 1 Acute diverticulitis classifications

Stage	Description
Modified Hinchey classification
0	Mild clinical diverticulitis
Ia	Confined pericolic inflammation or phlegmon
Ib	Confined pericolic abscess
II	Pelvic, distant intra-abdominal or retroperitoneal abscess
III	Generalized purulent peritonitis
Iv	Generalized fecal peritonitis
Ambrosetti’s classification
Mild	-wall thickening >5 mm
	-Pericolic fat stranding
Severe	-Abscess
	-extraluminal air
	-extraluminal contrast

Table 2 Randomized studies on mesalamine in SUDD

Study ID	Included patients	Study’s interventions	Number of patients	Endpoint	Follow-up	Results	Note
Kruis et al^Citation31	SUDD	Mesalamine 3 g/d vs placebo	56+61	Pain intensity reduction	1 month	No difference
Tursi et al^Citation34	SUDD	Mesalamine vs mesalamine + Lactobacillus casei vs L. casei vs placebo	51+55+54+50	Prevention of SUDD recurrence	12 months	Mesalamine and L. casei reduced recurrences; better in combination
Smith et al^Citation36	SUDD	Mesalamine vs placebo	18+14	Symptoms relief and inflammatory genes expression	3 months	Reduction with mesalamine	Study unpublished
Trepsi et al^Citation37	SUDD	Mesalamine vs placebo	81+85	Prevention of recurrence and complications	5 years	Significant reduction with mesalamine
Di Mario et al^Citation33	SUDD	Mesalamine 800 vs mesalamine 1600 vs rifaximin 400 vs rifaximin 800	39+43+40+48	Symptoms relief	3 months	Mesalamine similar to rifaximin	**Duplicate publication
Tursi et al^Citation35	SUDD	Mesalamine vs mesalamine + L. casei vs L. casei	27+29+29	Prevention of SUDD recurrence	12 months	Mesalamine + L. casei better than single agent
Comparato et al^Citation32	SUDD	Mesalamine 800 vs mesalamine 1600 vs rifaximin 400 vs rifaximin 800	66+69+67+66	Symptoms relief	12 months	Mesalamine similar to rifaximin	**Duplicate publication
Stollman et al^Citation28	Uncomplicated acute diverticulitis	Mesalamine vs mesalamine + Bifidobacterium infantis vs placebo	40+36+41	Symptoms relief at 3 months	12 months	No differences among groups
Parente et al^Citation29	Previous uncomplicated acute diverticulitis	Mesalamine vs placebo	45+47	Diverticulitis recurrence	24 months	No difference
Raskin et al^Citation30	Previous uncomplicated acute diverticulitis	Mesalamine 1,2 vs mesalamine 2,4 vs mesalamine 4,8 vs placebo	291+290+299+289	Diverticulitis recurrence	24 months	No differences

Note:

** Duplicate publication.

Abbreviation: SUDD, symptomatic uncomplicated diverticular disease.

KruisWMeierESchumacherMMickischOGreinwaldRMuellerRGerman SAG-20 Study GroupRandomised clinical trial: mesalazine (Salofalk granules) for uncomplicated diverticular disease of the colon–a placebo-controlled studyAliment Pharmacol Ther201337768069023414061

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TursiABrandimarteGEliseiWRandomised clinical trial: mesalazine and/or probiotics in maintaining remission of symptomatic uncomplicated diverticular disease–a double-blind, randomised, placebo-controlled studyAliment Pharmacol Ther201338774175123957734

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SmithJHumesDGarsedKMechanistic randomised control trial of mesalazine in symptomatic diverticular disease. Abstract OC-119 Table 1Gut201261Suppl 2A51A52

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TrepsiECollaCPanizzaPRuolo terapeutico e profilattico della mesalazina (5-ASA) nella malattia diverticolare sintomatica del colon: follow-up a 4 anni [Therapeutic and prophylactic role of mesalazine (5-ASA) in symptomatic diverticular disease of the large intestine. 4 year follow-up results]Minerva Gastroenterol Dietol1999454245252 Italian [with English abstract]16498335

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Di MarioFAragonaGLeandroGEfficacy of mesalazine in the treatment of symptomatic diverticular diseaseDig Dis Sci200550358158615810646

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TursiABrandimarteGGiorgettiGMEliseiWMesalazine and/or Lactobacillus casei in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomized, open-label studyJ Clin Gastroenterol200640431231616633103

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ComparatoGFanigliuloLCavallaroLGPrevention of complications and symptomatic recurrences in diverticular disease with mesalazine: a 12-month follow-upDig Dis Sci200752112934294117410435

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StollmanNMagowanSShanahanFQuigleyEMDIVA Investigator GroupA randomized controlled study of mesalamine after acute diverticulitis: results of the DIVA trialJ Clin Gastroenterol201347762162923426454

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ParenteFBargiggiaSPradaAGismi Study GroupIntermittent treatment with mesalazine in the prevention of diverticulitis recurrence: a randomised multicentre pilot double-blind placebo-controlled study of 24-month durationInt J Colorectal Dis201328101423143123754545

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RaskinJBKammMAJamalMMMesalamine did not prevent recurrent diverticulitis in phase 3 controlled trialsGastroenterology2014147479380225038431

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