Gargallo Puyuelo Carla J, Sopeña Federico, Lanas Arbeloa Angel
Digestive Diseases Service, University Clinic Hospital Lozano Blesa, Zaragoza, Spain; Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain.
Digestive Diseases Service, University Clinic Hospital Lozano Blesa, Zaragoza, Spain; Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain; University of Zaragoza, Spain; CIBERehd, Zaragoza, Spain.
Gastroenterol Hepatol. 2015 Dec;38(10):590-9. doi: 10.1016/j.gastrohep.2015.03.010. Epub 2015 May 12.
Diverticular disease represents the most common disease affecting the colon in the Western world. Most cases remain asymptomatic, but some others will have symptoms or develop complications. The aims of treatment in symptomatic uncomplicated diverticular disease are to prevent complications and reduce the frequency and intensity of symptoms. Fibre, probiotics, mesalazine, rifaximin and their combinations seem to be usually an effective therapy. In the uncomplicated diverticulitis, outpatient management is considered the optimal approach in the majority of patients, and oral antibiotics remain the mainstay of treatment. Admission to hospital and intravenous antibiotic are recommended only when the patient is unable to intake food orally, affected by severe comorbidity or does not improve. However, inpatient management and intravenous antibiotics are necessary in complicated diverticulitis. The role of surgery is also changing. Most diverticulitis-associated abscesses can be treated with antibiotics and/or percutaneous drainage and emergency surgery is considered only in patients with acute peritonitis. Finally, patient related factors, and not the number of recurrences, play the most important role in selecting recipients of elective surgery to avoid recurrences.
憩室病是西方世界影响结肠的最常见疾病。大多数病例无症状，但其他一些病例会出现症状或发生并发症。有症状的非复杂性憩室病的治疗目标是预防并发症并减少症状的频率和严重程度。纤维、益生菌、美沙拉嗪、利福昔明及其联合使用通常似乎是有效的治疗方法。在非复杂性憩室炎中，大多数患者的门诊管理被认为是最佳方法，口服抗生素仍然是主要治疗手段。仅当患者无法经口进食、受严重合并症影响或病情无改善时，才建议住院并静脉使用抗生素。然而，复杂性憩室炎需要住院管理和静脉使用抗生素。手术的作用也在发生变化。大多数与憩室炎相关的脓肿可以用抗生素和/或经皮引流治疗，仅在急性腹膜炎患者中考虑急诊手术。最后，在选择择期手术的受术者以避免复发时，与患者相关的因素而非复发次数起最重要作用。
