Division of Gastroenterology, California Pacific Medical Center, San Francisco, CA, USA.
Department of Internal Medicine, California Pacific Medical Center, San Francisco, CA, USA.
Gut Liver. 2018 Mar 15;12(2):125-132. doi: 10.5009/gnl16552.
Diverticular disease is one of the most common conditions in the Western world and one of the most common findings identified at colonoscopy. Recently, there has been a significant paradigm shift in our understanding of diverticular disease and its management. The pathogenesis of diverticular disease is thought to be multifactorial and include both environmental and genetic factors in addition to the historically accepted etiology of dietary fiber deficiency. Symptomatic uncomplicated diverticular disease (SUDD) is currently considered a type of chronic diverticulosis that is perhaps akin to irritable bowel syndrome. Mesalamine, rifaximin and probiotics may achieve symptomatic relief in some patients with SUDD, although their role(s) in preventing complications remain unclear. Antibiotic use for acute diverticulitis and elective prophylactic resection surgery are considered more individualized treatment modalities that take into account the clinical status, comorbidities and lifestyle of the patient. Our understanding of the pathogenesis of diverticular disease continues to evolve and is likely to be diverse and multifactorial. Paradigm shifts in several areas of the pathogenesis and management of diverticular disease are explored in this review.
憩室病是西方世界最常见的疾病之一，也是结肠镜检查中最常见的发现之一。最近，我们对憩室病及其治疗的理解发生了重大转变。憩室病的发病机制被认为是多因素的，除了历史上公认的膳食纤维缺乏病因外，还包括环境和遗传因素。有症状的单纯性憩室病（SUDD）目前被认为是一种慢性憩室病，可能类似于肠易激综合征。美沙拉嗪、利福昔明和益生菌可能会使一些 SUDD 患者的症状得到缓解，但它们在预防并发症方面的作用尚不清楚。对于急性憩室炎和择期预防性切除手术，抗生素的使用被认为是更个体化的治疗方法，需要考虑患者的临床状况、合并症和生活方式。我们对憩室病发病机制的理解还在不断发展，可能是多样化和多因素的。本文综述了憩室病发病机制和治疗的几个领域的范式转变。
