Böhm S, Kruis W
Spital Bülach, Spitalstr. 24, 8180, Bülach, Schweiz.
Evangelisches Krankenhaus Köln-Kalk, Köln, Deutschland.
Internist (Berl). 2017 Jul;58(7):745-752. doi: 10.1007/s00108-017-0266-4.
Increasing interest in diverticular disease by the scientific community in the last 10-15 years has resulted in an increased number of publications. Among other things, nonevidence-based therapeutic paradigms were tested in randomized, controlled therapy studies. The importance of surgery in the therapy of diverticulitis has diminished in recent years; in particular, it has no role in the treatment of diverticulitis types 1a, 1b, and 2a according to the Classification of Diverticular Disease (CDD) treated successfully by conservative means. Surgery has only a subordinate role in recurrent type 3b diverticulitis according to the CDD. Diverticulitis is therefore increasingly treated using conservative or drug therapy. However, only the classic, established antibiotics are currently available as effective drugs for the treatment of diverticular disease. However, these are also decreasing in significance. Over 90% of patients with type 1a/1b diverticulitis can be safely treated according to current data without the use of antibiotics. It is possible that type 2a diverticulitis will also be successfully treated without antibiotics in the future. Substances such as rifaximin, mesalazine, or probiotics, which were tested above all in patients with chronic recurrent forms (CDD type 3a/3b), have not yet been established.
在过去10至15年里，科学界对憩室病的兴趣与日俱增，这导致了相关出版物数量的增加。除其他方面外，非循证治疗模式在随机对照治疗研究中得到了检验。近年来，手术在憩室炎治疗中的重要性有所降低；特别是，对于根据憩室病分类（CDD）的1a、1b和2a型憩室炎，通过保守方法成功治疗的患者，手术在其治疗中并无作用。根据CDD，手术在复发性3b型憩室炎中仅起次要作用。因此，憩室炎越来越多地采用保守或药物治疗。然而，目前只有经典的、已确立的抗生素可作为治疗憩室病的有效药物。然而，这些药物的重要性也在下降。根据目前的数据，超过90%的1a/1b型憩室炎患者无需使用抗生素即可安全治疗。未来，2a型憩室炎也有可能在不使用抗生素的情况下成功治疗。诸如利福昔明、美沙拉嗪或益生菌等物质，主要在慢性复发性形式（CDD 3a/3b型）患者中进行了测试，但尚未确立其地位。
