Abstract
In uncomplicated diverticular disease, treatment is aimed at relieving symptoms. The aim of the present study was to evaluate the efficacy of mesalazine for symptomatic relief of uncomplicated diverticular disease of the colon. Two hundred sixty-eight consecutive eligible outpatients (122 male, 146 female; age, 66.1 years; range, 31–81 years) were enrolled in four treatment schedules in a randomized fashion: Group R1 (66 patients), rifaximin, 200 mg bid; Group R2 (69 patients), rifaximin, 400 mg bid; Group M1 (67 patients), mesalazine, 400 mg bid; and Group M2 (66 patients), mesalazine, 800 mg bid. Treatments were administered for 10 days every month for 12 months. Clinical evaluations were performed at admission and at 3-month intervals for 12 months considering 12 clinical variables (upper and lower abdominal pain/discomfort, tenesmus, diarrhea, abdominal tenderness, fever, bloating, general illness, nausea, emesis, dysuria, bleeding) graded as 0 = no symptoms, 1 = mild, 2 = moderate, and 3 = severe. The Global Symptomatic Score (GSS) was calculated using the sum of each symptom score. Two hundred forty-four patients completed the 12- month study; 24 were discontinued (14 treated with rifaximin and 10 treated with mesalazine) either as voluntary dropouts or because they developed side effects and/or complications. Group M2 demonstrated a lower frequency of many symptoms after 6 and 12 months of treatment; the mean GSS was significantly lower in Group M2 after 6 and 12 months of therapy by both intention-to-treat and per-protocol analyses. Patients treated with mesalazine (Groups M1+M2) had a lower GSS than subjects treated with rifaximin (Groups R1+R2) during the 12-month follow-up period. We conclude that cyclic administration of mesalazine is effective for symptomatic relief of uncomplicated diverticular disease of the colon. Some symptoms showed greater improvement with mesalazine, 800 mg bid, than with the other treatment schedules.
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Stollman NH, Baskin JB, for and on behalf of the Ad Hoc Practice Parameters Committee of the American College of Gastroenterology (1999) Diagnosis and management of diverticular disease of the colon in adults. Practice guidelines. Am J Gastroenterol 94(11):3110–3121
Salzman H, Dustin L (2005) Diverticular disease: diagnosis and treatment. Am Fam Phys 72(7):1230–1234
Almy TP, Howell DA (1980) Diverticular disease of the colon. N Engl J Med 302:324–331
Kohler L, Sauerland S, Neugebauer E, for the Scientific Committee of the European Association for Endoscopic Surgery (1999) Diagnosis and treatment of diverticular disease. Results of a consensus development conference. Surg Endosc 13:430–436
Schwartz JT, Graham DY (1998) Diverticular disease of the large intestine. In: Diseases of the colon, rectum and anal canal. Kirsner J, Shorter R (eds). Williams & Wilkins, Baltimore, pp 519–536
Naitove A, Smith RE (1993) Diverticular disease of the colon. In: Gastrointestinal disease, 5th ed. Sleisenger MH, Fordtran TS (eds). Saunders, Philadelphia, pp 1347–1363
Aldoori WH, Giovannucci EL, Rockett HR, et al. (1998) A prospective study of dietary fiber types and symptomatic diverticular disease in men. J Nutr 128:714–719
Brodribb AJ (1977) Treatment of symptomatic diverticular disease with a high-fibre diet. Lancet 1(8013):664–666
Ewerth S, Ahlberg J, Holmstrom B, Persson U, Uden R (1980) Influence on symptoms and transit time of Vi SiblinR in diverticular disease. Acta Chir Scand 500:40–59
Solotoft J, Gudmand-Hoyer E, Krag B, Kristensen E, Wulff HR (1976) A double blind trial of wheat bran on symptoms of irritable bowel syndrome. Lancet 1(7954):270–272
Fric P, Zavoral M (2003) The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon. Eur J Gastroenterol Hepatol 15(3):313–315
Papi C, Ciaco A, Koch M, et al. (1995) Efficacy of rifaximine in the treatmentof symptomatic diverticular disease of the colon. A multicentre double-blind placebo-controlled trial. Aliment Pharmacol Ther 9:33–39
Latella G, Pimpo MT, Sottili S, et al. (2003) Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon. Int J Colorectal Dis 18:55–62
Stollman N, Raskin JB (2004) Diverticular disease of the colon. Lancet 363:631–639
Bassotti G, Chistolini F, Morelli A (2003) Pathophysiological aspects of diverticular disease of colon and role of large bowel motilità. World J Gastroenterol 9(10):2140–2142
Simpson J, Scholefield JH, Spiller RC (2002) Pathogenesis of colonic diverticula. Br J Surgery 89:546–554
Bode MK, Karttunen TJ, Makela J, et al. (2000) Type I and III collagens in human colon cancer and diverticulosis. Scand J Gastroenterol 35:747–752
Painter NS, Burkitt DP (1975) Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 4:3–21
Ghorai S, Ulbright TM, Douglas K, et al. (2003) Endoscopic findings of diverticular inflammation in colonscopy patients with clinical acute diverticulitis: prevalence and endoscopic spectrum. Am J Gastroenterol 98(4):76–84
Makapugay LM, Dean PJ (1996) Diverticular disease-associated chronic colitis. Am J Surg Pathol 20(1):94–102
Peppercorn MA (2004) The overlap of inflammatory bowel disease and diverticular disease. J Clin Gastroenterol 38 (Suppl 1):S8–S10
Sheperd NA (1996) Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades. Gut 38:801–802
Tursi A (2005) Mesalazine for diverticular disease of the colon-a new role for an old drug. Expert Opin Pharmacother 6(1):69–74
Eliakim R, Rachmilewitz D (1992) Potenzial mediators in inflammatory bowel disease. Gastroenterol Int 5:48–56
Grisham MB (1994) Oxidants and free radicals in inflammatory bowel disease. Lancet 344:859–861
Wood AJJ (1996) Inflammatory bowel disease. N Engl J Med 334:841–848
Goncalves E, Almeida LM, Dinis TC (1998) Antioxidant activity of 5-aminosalicylic acid against peroxidation of phosphatidylcholine liposomes in the presence of alpha-tocopherol: A synergistic interaction? Free Rad Res 29:53–66
Gore S, Sheperd NA, Wilkinson SP (1992) Endoscopic crescentic fold disease of the sigmoid colon: the clinical and hystopathological spectrum of a distinctive endoscopic appearance. Int J Colorect Dis 7:76–81
Tursi A (2004) Diverticular disease of the colon. Lancet 363:1397–1398
Peppercorn MA (1992) Drug-responsive chronic segmental colitis associated with diverticula: a clinical syndrome in the elderly. Am J Gastroenterol 87:609–612
Trespi E, Colla C, Panizza P, Polino MG, Venturini A, Bottani G, De Vecchi P, Matti C (1999) Ruolo terapeutico e profilattico della mesalazina (5-ASA) nella malattia diverticolare sintomatica del crasso. Minerva Gastroenterol Dietol 45:245–252
Tursi A, Brandimarte G, Daffinà R (2002) Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon. Dig Liver Dis 34:510–515
Di Mario F, Aragona G, Leandro G, et al. (2005) Efficacy of mesalazine in the treatment of symptomatic diverticular disease. Dig Dis Sci 50:581–586
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This work was conducted under the auspices of the Roberto Farini Foundation for Gastroenterological Research.
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Comparato, G., Fanigliulo, L., Cavallaro, L.G. et al. Prevention of Complications and Symptomatic Recurrences in Diverticular Disease with Mesalazine: A 12-Month Follow-up. Dig Dis Sci 52, 2934–2941 (2007). https://doi.org/10.1007/s10620-007-9766-8
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DOI: https://doi.org/10.1007/s10620-007-9766-8