Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Int J Colorectal Dis. 2023 Apr 14;38(1):97. doi: 10.1007/s00384-023-04389-7.
Antibiotics have long been recommended as a form of conservative therapy in patients with acute uncomplicated diverticulitis despite no supporting evidence. This meta-analysis aims to assess the difference in outcomes between observational therapy and antibiotics regime in patients with acute uncomplicated diverticulitis.
Medline and Embase electronic databases were reviewed. A comparative meta-analysis in odds ratios (ORs) or mean difference (MD) was conducted using a random effects model for dichotomous and continuous outcomes, respectively. Randomized controlled trials comparing outcomes in patients with acute uncomplicated diverticulitis on observational therapy compared to antibiotics regime were selected. Outcomes of interest included all-cause mortality, complications, emergency surgery rates, length of stay, and recurrence.
A total of 7 articles looking at 5 different randomized controlled trials were included. A total of 2959 patients with acute uncomplicated diverticulitis comprising of 1485 patients on antibiotics therapy and 1474 patients on observational therapy were included in the comparison. We found that there was no statistically significant difference in all-cause mortality (OR = 0.98; 95% CI 0.53;1.81; p = 0.68), complications (OR = 1.04; 95% CI 0.36;3.02; p = 0.51), emergency surgery (OR = 1.24; 95% CI 0.70;2.19, p = 0.92), length of stay (M.D: -0.14, 95% CI -0.50;0.23, p < 0.001), and recurrent diverticulitis (OR 1.01; 95% CI 0.83;1.22, p < 0.91) between the two arms.
This systemic review and meta-analysis found that there is no statistically significant difference in outcomes between patients with acute uncomplicated diverticulitis who were put on observational therapy compared to the antibiotics regime. This suggests that observational therapy is an equally safe and effective therapy as compared to antibiotics therapy.
尽管缺乏支持证据，抗生素长期以来一直被推荐为急性单纯性憩室炎患者的保守治疗形式。本荟萃分析旨在评估急性单纯性憩室炎患者接受观察治疗与抗生素治疗方案之间结局的差异。
检索了 Medline 和 Embase 电子数据库。使用随机效应模型分别对二分类和连续结局进行比值比 (OR) 或均数差 (MD) 的比较荟萃分析。选择了比较急性单纯性憩室炎患者接受观察治疗与抗生素治疗方案的结局的随机对照试验。感兴趣的结局包括全因死亡率、并发症、急诊手术率、住院时间和复发。
共纳入 7 篇观察性研究的文章，共纳入 5 项不同的随机对照试验，共有 2959 例急性单纯性憩室炎患者，其中 1485 例接受抗生素治疗，1474 例接受观察治疗。我们发现，全因死亡率（OR=0.98；95%CI 0.53；1.81；p=0.68）、并发症（OR=1.04；95%CI 0.36；3.02；p=0.51）、急诊手术（OR=1.24；95%CI 0.70；2.19；p=0.92）、住院时间（MD：-0.14，95%CI-0.50；0.23，p<0.001）和复发性憩室炎（OR 1.01；95%CI 0.83；1.22，p<0.91）在两组之间无统计学差异。
本系统评价和荟萃分析发现，接受观察治疗的急性单纯性憩室炎患者与接受抗生素治疗方案的患者之间的结局无统计学差异。这表明与抗生素治疗相比，观察治疗同样安全有效。
