Cuomo Rosario, Cargiolli Martina, Andreozzi Paolo, Zito Francesco P, Sarnelli Giovanni
Unit of Gastroenterology, Department of Clinical Medicine and Surgery, "Federico II" School of Medicine, Naples, Italy -
Unit of Gastroenterology, Department of Clinical Medicine and Surgery, "Federico II" School of Medicine, Naples, Italy.
Minerva Gastroenterol Dietol. 2017 Jun;63(2):130-142. doi: 10.23736/S1121-421X.16.02357-6. Epub 2016 Dec 14.
Symptomatic uncomplicated diverticular disease (SUDD) is one of the possible clinical manifestations of diverticular disease. It is a common disorder characterized by chronic abdominal symptoms ranging from lower left abdominal pain to alteration of bowel habit, that significantly reduce quality of life of subject affected. The present article aims to review the current data for medical management of SUDD.
We analyzed the existing literature on the factors involved in the pathogenesis of SUDD and we highlighted the possible target for treatment. Treatment for SUDD should be direct to relieve chronic symptoms and prevent diverticulitis and its complications. In particular we focused on the role of probiotics, fiber-diet, mesalazine and rifaximin on these two aspects. In this setting, we conducted a PubMed search for guidelines, systematic reviews and meta-analyses and updated information to October 2016.
Each topic was evaluated according to the best evidences available. Best results seemed to be obtained with combined therapies and in particular with rifaximin associated to high fiber-diet. This regimen seems to guarantee better symptoms control compared to fiber alone and it is more effective in preventing acute diverticulitis. On the contrary, no clear evidences about the efficacy of mesalazine and probiotics are available.
The results of the studies available in literature are controversial and debatable, for this reason a clear and defined algorithm for treatment of SUDD has not yet been defined. Further randomized, double-blind, placebo controlled study are necessary.
症状性单纯性憩室病（SUDD）是憩室病可能的临床表现之一。它是一种常见疾病，其特征为慢性腹部症状，范围从左下腹疼痛到排便习惯改变，这会显著降低受影响患者的生活质量。本文旨在综述SUDD药物治疗的现有数据。
我们分析了关于SUDD发病机制相关因素的现有文献，并强调了可能的治疗靶点。SUDD的治疗应直接针对缓解慢性症状并预防憩室炎及其并发症。我们特别关注了益生菌、高纤维饮食、美沙拉嗪和利福昔明在这两个方面的作用。在此背景下，我们在PubMed上搜索了指南、系统评价和荟萃分析以及截至2016年10月的最新信息。
根据现有最佳证据对每个主题进行了评估。联合治疗似乎能取得最佳效果，特别是利福昔明与高纤维饮食联合使用。与单独使用纤维相比，这种方案似乎能更好地控制症状，并且在预防急性憩室炎方面更有效。相反，关于美沙拉嗪和益生菌疗效的明确证据尚不充分。
文献中现有研究结果存在争议且有待商榷，因此尚未确定明确的SUDD治疗方案。有必要进一步开展随机、双盲、安慰剂对照研究。
