Wensaas Knut-Arne, Hungin Amrit Pali
*Research Unit for General Practice, Uni Research Health, Bergen, Norway †School of Medicine, Pharmacy and Health, Durham University, Durham, UK.
J Clin Gastroenterol. 2016 Oct;50 Suppl 1:S86-8. doi: 10.1097/MCG.0000000000000596.
Diverticular disease is a chronic and common condition, and yet the impact of diverticular disease in primary care is largely unknown. The diagnosis of diverticular disease relies on the demonstration of diverticula in the colon, and the necessary investigations are often not available in primary care. The specificity and sensitivity of symptoms, clinical signs and laboratory tests alone are generally low and consequently the diagnostic process will be characterized by uncertainty. Also, the criteria for symptomatic uncomplicated diverticular disease in the absence of macroscopic inflammation are not clearly defined. Therefore both the prevalence of diverticular disease and the incidence of diverticulitis in primary care are unknown. Current recommendations for treatment and follow-up of patients with acute diverticulitis are based on studies where the diagnosis has been verified by computerized tomography. The results cannot be directly transferred to primary care where the diagnosis has to rely on the interpretation of symptoms and signs. Therefore, one must allow for greater diagnostic uncertainty, and safety netting in the event of unexpected development of the condition is an important aspect of the management of diverticulitis in primary care. The highest prevalence of diverticular disease is found among older patients, where multimorbidity and polypharmacy is common. The challenge is to remember the possible contribution of diverticular disease to the patient's overall condition and to foresee its implications in terms of advice and treatment in relation to other diseases.
憩室病是一种慢性常见疾病，然而其在初级保健中的影响在很大程度上尚不明确。憩室病的诊断依赖于结肠憩室的显示，而初级保健中往往无法进行必要的检查。仅症状、临床体征和实验室检查的特异性和敏感性通常较低，因此诊断过程将具有不确定性。此外，在无宏观炎症的情况下，有症状的非复杂性憩室病的标准也未明确界定。因此，初级保健中憩室病的患病率和憩室炎的发病率均不清楚。目前针对急性憩室炎患者的治疗和随访建议是基于经计算机断层扫描证实诊断的研究。这些结果不能直接应用于初级保健，因为在初级保健中诊断必须依赖于症状和体征的判断。因此，必须考虑到更大的诊断不确定性，并且在病情意外发展时进行安全防护是初级保健中憩室炎管理的一个重要方面。憩室病在老年患者中患病率最高，而多重疾病和多种药物治疗在这部分人群中很常见。挑战在于要记住憩室病可能对患者整体状况产生的影响，并预见其在针对其他疾病的建议和治疗方面的影响。
