Raña-Garibay R, Salgado-Nesme N, Carmona-Sánchez R, Remes-Troche J M, Aguilera-Carrera J, Alonso-Sánchez L, Arnaud-Carreño C, Charúa-Guindic L, Coss-Adame E, de la Torre-Bravo A, Espinosa-Medina D, Esquivel-Ayanegui F, Roesch-Dietlen F, López-Colombo A, Muñoz-Torres J I, Noble-Lugo A, Rojas-Mendoza F, Suazo-Barahona J, Stoopen-Rometti M, Torres-Flores E, Vallejo-Soto M, Vergara-Fernández O
Hospital Español, Ciudad de México, México.
División de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México.
Rev Gastroenterol Mex (Engl Ed). 2019 Apr-Jun;84(2):220-240. doi: 10.1016/j.rgmx.2019.01.002. Epub 2019 Apr 20.
Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.
自墨西哥胃肠病学协会发布2008年《结肠憩室病诊断与治疗指南》以来，在该疾病的认知方面取得了重大进展。对2008年1月至2018年7月医学文献中发表的文章进行了系统综述，以修订和更新2008年指南并提供新的循证建议。纳入了该时间段内发表的所有高质量西班牙语和英语文章。采用德尔菲法，撰写了三轮投票中接受的43项声明的最终版本，并利用GRADE系统为每项声明确定了证据质量和建议强度。本共识包含了关于结肠憩室病的定义、分类、流行病学、病理生理学和危险因素的新数据。特别强调了计算机断层扫描和结肠镜检查的实用性，以及控制出血的内镜方法。讨论了非复杂性憩室炎的门诊治疗，以及利福昔明和美沙拉嗪在复杂性急性憩室炎管理中的作用。描述了其微创替代方法和手术选择，强调了它们的适应症、局限性和禁忌症。新声明提供了基于最新科学证据的指南。对每项声明进行了讨论，并给出了其证据质量和建议强度。
