Diverticulitis medical therapy: Difference between revisions
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Outpatients should be advised to use diet consist of liquids only for 2-3 days, after which the diet can be resumed slowly. hospitalized patients can be treated with either liquids, or NPO with intravenous hydration depending on the severity. | Outpatients should be advised to use diet consist of liquids only for 2-3 days, after which the diet can be resumed slowly. hospitalized patients can be treated with either liquids, or NPO with intravenous hydration depending on the severity. | ||
There is no scientific evidence that | There is no scientific evidence suggests that avoidance of nuts and seeds prevents the progression of diverticulosis to an acute case of diverticulitis.<ref name="titlePatient Information: Diverticular disease - UpToDate">{{cite web |url=http://patients.uptodate.com/topic.asp?file=digestiv/6237#12| title=Patient information: Diverticular disease |publisher=[[UpToDate]] |accessdate=2008-02-12 |format= |work=}}</ref><ref name="pmid10215046">{{cite journal| author=Schechter S, Mulvey J, Eisenstat TE| title=Management of uncomplicated acute diverticulitis: results of a survey. | journal=Dis Colon Rectum | year= 1999 | volume= 42 | issue= 4 | pages= 470-5; discussion 475-6 | pmid=10215046 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10215046 }} </ref> Further, in a survey of fellows of The American Society of Colon and Rectal Surgeons, although the majority of the surgeons responding to the survey favored adherence to a [[low residue diet]], half of them still belief that there is no value in specifically avoiding seeds and nuts.<ref name="titleManagement of uncomplicated acute diverticulitis - Journal Article: Diseases of Colon & Rectum">{{cite journal | [[Diseases of the Colon & Rectum]] |url=http://www.springerlink.com/content/f385544687u6g224/ |title=Management of uncomplicated acute diverticulitis |accessdate=2008-02-12 |volume = 42 | issue = 4 | date = April 1999 | doi = 10.1007/BF02234169 | pages = 470-475 | authors = Steven Schechter, Joan Mulvey and Theodore E. Eisenstat}}</ref> | ||
Routine colonoscopy is recommended after the resolution of the attack, to exclude colonic neoplasia, or any other possible cause.<ref name="pmid21904141">{{cite journal| author=Lau KC, Spilsbury K, Farooque Y, Kariyawasam SB, Owen RG, Wallace MH et al.| title=Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded? | journal=Dis Colon Rectum | year= 2011 | volume= 54 | issue= 10 | pages= 1265-70 | pmid=21904141 | doi=10.1097/DCR.0b013e31822899a2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21904141 }} </ref> | Routine colonoscopy is recommended after the resolution of the attack, to exclude colonic neoplasia, or any other possible cause.<ref name="pmid21904141">{{cite journal| author=Lau KC, Spilsbury K, Farooque Y, Kariyawasam SB, Owen RG, Wallace MH et al.| title=Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded? | journal=Dis Colon Rectum | year= 2011 | volume= 54 | issue= 10 | pages= 1265-70 | pmid=21904141 | doi=10.1097/DCR.0b013e31822899a2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21904141 }} </ref> | ||
Revision as of 17:17, 13 February 2014
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Diverticulitis Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Mohamed Moubarak, M.D. [3]
Medical Therapy
Overview
An initial episode of acute diverticulitis is usually treated with conservative medical management, including bowel rest (ie, nothing by mouth), IV fluid resuscitation, and broad-spectrum antibiotics which cover anaerobic bacteria and gram-negative rods. However, recurring acute attacks or complications, such as peritonitis, abscess, or fistula may require surgery, either immediately or on an elective basis.
Upon discharge, patients may be placed on a low residue diet. This low-fiber diet gives the colon adequate time to heal without needing to be overworked. Later, patients are placed on a high-fiber diet. There is some evidence this lowers the recurrence rate.
Uncomplicated Diverticulitis
A 7-10 days of oral broad-spectrum antibiotic therapy is tried for acute uncomplicated diverticulitis.[1] The most common agents used in uncomplicated diverticulitis are:
- Quinolone-metronidazole or
- Amoxicillin-clavulanic acid or
- Trimethoprim-sulfamethoxazole with metronidazole
Admission to the hospital is indicated in all patients who are elderly, those with compromised immune systems, other comorbidities, cannot tolerate oral hydration, or fails to improve despite appropriate antibiotic therapy. The aim of hospital admission is bowel rest, nasogastric tube placement, and parenteral antibiotics.[2]
Outpatients should be advised to use diet consist of liquids only for 2-3 days, after which the diet can be resumed slowly. hospitalized patients can be treated with either liquids, or NPO with intravenous hydration depending on the severity.
There is no scientific evidence suggests that avoidance of nuts and seeds prevents the progression of diverticulosis to an acute case of diverticulitis.[3][4] Further, in a survey of fellows of The American Society of Colon and Rectal Surgeons, although the majority of the surgeons responding to the survey favored adherence to a low residue diet, half of them still belief that there is no value in specifically avoiding seeds and nuts.[5]
Routine colonoscopy is recommended after the resolution of the attack, to exclude colonic neoplasia, or any other possible cause.[6]
Complicated Diverticulitis
Surgical intervention is required for complicated acute diverticulitis which include:
- Peritonitis
- Failed percutaneous drainage of an abscess
- Enterocutaneous fistula formation
- Bowel obstruction
Empirical intravenous antibiotics that covers gram-negative and anaerobic pathogens are used.
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In some cases surgery may be required to remove the area of the colon with the diverticula. Patients suffering their first attack of diverticulitis are typically not encouraged to undergo the surgery, unless the case is severe. Patients suffering repeated episodes may benefit from the surgery. In such cases the risks of complications from the diverticulitis outweigh the risks of complications from surgery.
References
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
- ↑ "Patient information: Diverticular disease". UpToDate. Retrieved 2008-02-12.
- ↑ Schechter S, Mulvey J, Eisenstat TE (1999). "Management of uncomplicated acute diverticulitis: results of a survey". Dis Colon Rectum. 42 (4): 470–5, discussion 475-6. PMID 10215046.
- ↑ Steven Schechter, Joan Mulvey and Theodore E. Eisenstat (April 1999). "Management of uncomplicated acute diverticulitis". 42 (4): 470–475. doi:10.1007/BF02234169. Retrieved 2008-02-12. Text " Diseases of the Colon & Rectum " ignored (help)
- ↑ Lau KC, Spilsbury K, Farooque Y, Kariyawasam SB, Owen RG, Wallace MH; et al. (2011). "Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded?". Dis Colon Rectum. 54 (10): 1265–70. doi:10.1097/DCR.0b013e31822899a2. PMID 21904141.