Lué Alberto, Laredo Viviana, Lanas Angel
*Digestive Diseases Service, University Clinic Hospital Lozano Blesa †Aragon Health Research Institute (IIS Aragón) ‡CIBERehd, University of Zaragoza, Zaragoza, Spain.
J Clin Gastroenterol. 2016 Oct;50 Suppl 1:S57-9. doi: 10.1097/MCG.0000000000000593.
Diverticular disease (DD) of the colon represents the most common disease affecting the large bowel in western countries. Its prevalence is increasing. Recent studies suggest that changes in gut microbiota could contribute to development of symptoms and complication. For this reason antibiotics play a key role in the management of both uncomplicated and complicated DD. Rifaximin has demonstrated to be effective in obtaining symptoms relief at 1 year in patients with uncomplicated DD and to improve symptoms and maintain periods of remission following acute colonic diverticulitis (AD). Despite absence of data that supports the routine use of antibiotic in uncomplicated AD, they are recommended in selected patients. In patients with AD that develop an abscess, conservative treatment with broad-spectrum antibiotics is successful in up to 70% of cases. In patients on conservative treatment where percutaneous drainage fails or peritonitis develops, surgery is considered the standard therapy. In conclusion antibiotics seem to remain the mainstay of treatment in symptomatic uncomplicated DD and AD. Inpatient management and intravenous antibiotics are necessary in complicated AD, while outpatient management is considered the best strategy in the majority of uncomplicated patients.
结肠憩室病（DD）是西方国家影响大肠的最常见疾病。其患病率正在上升。最近的研究表明，肠道微生物群的变化可能导致症状和并发症的发生。因此，抗生素在单纯性和复杂性DD的治疗中起着关键作用。利福昔明已被证明在单纯性DD患者中可有效缓解症状达1年，并可改善急性结肠憩室炎（AD）后的症状并维持缓解期。尽管缺乏支持在单纯性AD中常规使用抗生素的数据，但仍建议在特定患者中使用。在发生脓肿的AD患者中，使用广谱抗生素进行保守治疗在高达70%的病例中是成功的。在保守治疗的患者中，如果经皮引流失败或发生腹膜炎，则手术被认为是标准治疗方法。总之，抗生素似乎仍然是有症状的单纯性DD和AD治疗的主要手段。复杂性AD需要住院治疗和静脉使用抗生素，而在大多数单纯性患者中，门诊治疗被认为是最佳策略。
