Mayl Jonathan, Marchenko Mikhail, Frierson Emily
College of Medicine, University of Central Florida.
Cureus. 2017 May 15;9(5):e1250. doi: 10.7759/cureus.1250.
Diverticulitis is a common ailment that is prevalent in the developed world. As such, the management of diverticulitis places a substantial economic burden on healthcare. Research is ongoing to further elucidate both the pathogenesis of the disease, as well as ways to reduce associated expenditures. One of these emerging areas of research calls into question the use of antibiotics during treatment of acute uncomplicated diverticulitis. Current guidelines are largely based on expert opinion, with little evidence supporting the standard practice of antibiotic therapy. In this literature review, we have compiled and analyzed the latest collection of evidence in managing acute uncomplicated diverticulitis. There have been two randomized controlled trials (RCTs) performed that assessed the possibility of treating acute uncomplicated diverticulitis without antibiotics. Both the Antibiotika Vid Okomplicerad Divertikulit (AVOD) study and Daniels, et al. have found that an observational approach to acute uncomplicated diverticulitis is not inferior to antibiotic treatment and does not result in increased complication or recurrence rates. We also reviewed a single-center cohort study, a prospective observational study, and two retrospective case-controlled studies comparing observational management versus antibiotic treatment in patients with acute uncomplicated diverticulitis. We found the results were comparable; there was no difference in complication rates or recurrence in any study. The consensus among the studies reviewed challenges the current practice guidelines issued by the American Gastroenterological Association. However, given the geographical difference in diverticular disease and inherent bias found in these studies, we cannot recommend a modification of the guidelines. Based on this literature review, we feel compelled to suggest, and strongly recommend, further research be conducted in the United States in order to bolster the already significant evidence against antibiotic therapy in acute uncomplicated diverticulitis.
憩室炎是一种在发达国家普遍存在的常见疾病。因此，憩室炎的管理给医疗保健带来了沉重的经济负担。目前正在进行研究，以进一步阐明该疾病的发病机制以及降低相关费用的方法。这些新兴研究领域之一对急性单纯性憩室炎治疗期间使用抗生素提出了质疑。当前的指南很大程度上基于专家意见，几乎没有证据支持抗生素治疗的标准做法。在这篇文献综述中，我们收集并分析了管理急性单纯性憩室炎的最新证据。已经进行了两项随机对照试验（RCT），评估了不使用抗生素治疗急性单纯性憩室炎的可能性。抗生素治疗复杂性憩室炎（AVOD）研究以及丹尼尔斯等人的研究均发现，对急性单纯性憩室炎采用观察性方法并不逊色于抗生素治疗，也不会导致并发症或复发率增加。我们还回顾了一项单中心队列研究、一项前瞻性观察性研究以及两项回顾性病例对照研究，这些研究比较了急性单纯性憩室炎患者的观察性管理与抗生素治疗。我们发现结果具有可比性；在任何研究中，并发症发生率或复发率均无差异。所综述研究之间的共识对美国胃肠病学会发布的现行实践指南提出了挑战。然而，鉴于憩室病的地域差异以及这些研究中存在的固有偏差，我们不能建议修改指南。基于这篇文献综述，我们觉得有必要建议并强烈推荐在美国开展进一步研究，以加强已有的大量反对急性单纯性憩室炎抗生素治疗的证据。
