Diverticular disease

Diverticular disease 3. Increased AEA levels in colon strips from patients with diverticular disease participate in alterations of neural control of colon motility 3. None tested... 

A laxative is most often prescribed for the short-term relief or prevention of constipation. Certain stimulant, emollient, and saline laxatives are used to evacuate the colon for rectal and bowel examinations. Fecal softeners or mineral oil are used prophylactically in patients who should not strain during defecation, such as after anorectal surgery or a myocardial infarction. Psyllium may be used in patients with irritable bowel syndrome and diverticular disease. Fblycarbophil may be prescribed for constipation or diarrhea associated with irritable bowel syndrome and diverticulosis. Mineral oil is... 

Approximately 8% to 20% of patients with UC and 7% to 26% of patients with CD are elderly at initial diagnosis.42 In general, IBD presents similarly in elderly patients compared to younger individuals. Elderly patients may have more comor-bid diseases, some of which may make the diagnosis of IBD more difficult. Such conditions include ischemic colitis, diverticular disease, and microscopic colitis. Increased age is also associated with a higher incidence of adenomatous polyps, but the onset of IBD at an advanced age does not appear to increase the risk of developing colorectal cancer. Elderly patients may also use more medications, particularly NSAIDs, which may induce or exacerbate colitis. 

Rifaximin Rifamycin Antibiotic Gut bacteria Enteric infection Diarrhea, infectious Hepatic encephalopathy Small intestine bacterial overgrowth Inflammatory bowel disease Colonic diverticular disease Irritable bowel syndrome Constipation Clostridium difficile infection Helicobacter pylori infection Colorectal surgery Bowel decontamination, selective Pancreatitis, acute Bacterial peritonitis, spontaneous Nonsteroidal anti-inflammatory drug enteropathy... 

A large number of human studies [71, 77-80] performed in patients with infectious diarrhea or other GI diseases (e.g. hepatic encephalopathy, small bowel bacterial overgrowth, IBD, colonic diverticular disease) have confirmed the antibacterial activity of rifaximin demonstrated in vitro and in laboratory animals. 

Nevertheless, a rapid disappearance of resistant bacteria was observed after stopping the antibiotic treatment (fig. 5). Different kinetics of disappearance were, however, observed. The aerobic species showed a more rapid return to the baseline sensitive status whereas the anaerobic bacteria, especially the Gram-negative rods, regained sensitivity to rifaximin more slowly. In any case, 3 months after the end of treatment resistant strains were no longer detectable in the feces [82], These results support the cyclic use of rifaximin that has been adopted by the investigators in the treatment of hepatic encephalopathy [77] and colonic diverticular disease [79]. 

Rifaximin is available in Europe for the treatment of acute intestinal bacterial infections, hepatic encephalopathy, bacterial overgrowth syndrome, diverticular disease of the colon, and for the prevention of infections after colorectal surgery [3, 4]. Rifaximin is also licensed in Mexico, Asia and Northern Africa and has recently been approved in USA for the treatment of traveler s diarrhea. 

Papi C, Ciacco A, Koch M, Capurso L Efficacy of rifaximin on symptoms of uncomplicated diverticular disease of the colon. A pilot multicentre open trial. Diverticular Disease Study Group. Ital J Gastroenterol 1992,24 452—456. 

Management of Diverticular Disease Is There Room for Rifaximin ... 

Treatment of symptomatic diverticular disease of the colon is aimed at the relief of symptoms and the prevention of major complications. The efficacy of fiber supplementation and of anticholinergic and spasmolytic agents remains controversial. Antibiotics are commonly used in the treatment of inflammatory complications of diverticular disease. Data from open labelled and randomized controlled trials do suggest the efficacy of rifaximin in obtaining symptomatic relief in patients with diverticular disease. Approximately 30% therapeutic gain compared to fiber supplementation only can be expected after one year of intermittent treatment with rifaximin. Considering the safety and tolerability of rifaximin, this drug can be recommended for patients with symptomatic uncomplicated diverticular disease. 

Diverticular disease of the colon is extremely common in developed countries and its prevalence is correlated with advancing age [1], Estimates based on necroscopy or... 

The majority of patients harboring colonic diverticula remain asymptomatic throughout their life (asymptomatic diverticular disease) only 20% will develop symptoms and signs of illness [15]. Symptomatic diverticular disease is further subdivided into painful diverticular disease (symptomatic diverticular disease with no inflammation) and diverticulitis (symptomatic diverticular disease with inflammation). Diverticulitis is further subdivided into uncomplicated and complicated diverticulitis [16]. 

Antibiotics are commonly used in the treatment of inflammatory complications of diverticular disease [3, 24]. In painful diverticular disease, when inflammation is excluded by definition, there is no rationale for using antibiotics. In a subset of patients with more severe symptoms, when an inflammatory component may be clinically suspected, a short course of antibiotics may be advisable [15],... 

Several clinical observations suggest a role of rifaximin in the management of symptomatic uncomplicated diverticular disease of the colon. 

Similar results were obtained in a large prospective open trial including 968 outpatients with symptomatic diverticular disease [44], Patients were randomly assigned to receive fiber supplementation (glucomannan 4 g/day) or fiber supplementation plus rifaximin (400 mg twice a day for 7 days every month) for 12 months. After 12 months, 56.5% of patients in the rifaximin group were symptom free compared to 29.2% of patients in the fiber supplementation only group (p < 0.001). 

Although there is some evidence for the efficacy of long-term treatment with rifaximin for symptomatic relief in patients with uncomplicated diverticular disease, an unresolved issue is whether rifaximin can prevent major inflammatory complications of diverticular disease. In the two prospective open trials discussed above, the occurrence rate of complications in 12 months was lower in patients treated with glucomannan plus rifaximin compared to patients treated with glucomannan only 2.7 versus 0.9% [43] and 3.2 versus 1.3% [44], This observation was not confirmed in the double-blind placebo-controlled trial [45] in which no difference in the 1-year complication rate was observed between the rifaximin and placebo groups. However, in all the studies, the number of patients suffering complications in a 12-month period was too small to detect any statistically significant... 

There is some evidence that long-term cyclic administration of rifaximin combined with fiber supplementation is effective for inducing symptomatic relief in patients with uncomplicated diverticular disease of the colon. A therapeutic gain of approximately 30% compared to fiber supplementation only can be expected. The drug is well tolerated and no relevant side effects have been reported. Symptoms attributed to diverticula (abdominal pain or discomfort, bloating, disturbance of bowel habits) are nonspecific symptoms and are also features of irritable bowel syndrome. It has been suggested that irritable bowel syndrome and diverticular disease of the colon may coexist in many people and when bowel symptoms occur with diverticulosis coli, they may be due to a coexistent irritable bowel rather to the diverticula themselves [47, 48]. This hypothesis is supported by the fact that many patients with symptomatic diverticular disease show co-... 

No definitive conclusions can be drawn concerning a possible role of rifaximin in preventing major complications of diverticular disease. Double-blind placebo-controlled trials with an adequate sample size are needed. However, such trials are difficult to perform considering the requirement of a large number of patients. Assuming a baseline risk of complications of diverticular disease of 5% per year [2], a randomized controlled trial able to detect a 50% risk reduction in complications should include 1,600 patients per treatment group considering a power of 80% (1 - (3) and an a error of 5%. 

Parks TG Natural history of diverticular disease of the colon. Clin Gastroenterol 1975,4 53-69. 

Naitove A, Almy TP Diverticular disease of the colon in Sleisenger MH, Fordtran JS (eds) Gastrointestinal Disease Pathophysiology, Diagnosis, Management, ed 4. Philadelphia, WB Saunders, 1989, pp 1419-1434. 

Roberts PL, Veidenheimer MC Diverticular disease of the colon in Bayless TM (ed) Current Therapy in Gastroenterology and Liver Disease. Toronto, BC Decker, 1990, vol 3, pp 416-419. 

Brodribb AJM, Humphreys DM Diverticular disease Three studies. I. Relation to other disorders and fibre intake. Br Med J 1976 i 424-430. 

Gear JSS, Ware A, Fursdon P, Mann JI, Nolan DJ, Brodribb AJ, Vessey MP Symptomless diverticular disease and intake of dietary fibre. Lancet 1979 i 511—514. 

Aldoori WH, Giovannucci EL, Rockett HRH, Sampson L, Rimm EB, Willet WC A prospective study of dietary fiber types and symptomatic diverticular disease in men. J Nutr 1998 128 717-719. 

Chia JG, Wilde CC, Ngoi SS, Goh PM, Ong CL Trends of diverticular disease of the large bowel in a newly developed country. Dis Colon Rectum 1991 34 498-501. 

Torsoli A, Inoue M, Manousos O, Smith A, Van Steensel CJ Diverticular disease of the colon Data relevant to treatment. Gastroenterol Int 1991 4 3-20. 

Farrell RJ, Farrell JJ, Morrin MM Diverticular disease in the elderly. Gastroenterol Clin North Am 2001 30 475-496. 

Brodribb AJM Treatment of symptomatic diverticular disease with a high-fibre diet. Lancet 1977 i 664—666. 

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