Skip to main content
Erschienen in: International Journal of Colorectal Disease 10/2013

01.10.2013 | Original Article

Intermittent treatment with mesalazine in the prevention of diverticulitis recurrence: a randomised multicentre pilot double-blind placebo-controlled study of 24-month duration

verfasst von: F. Parente, S. Bargiggia, A. Prada, A. Bortoli, A. Giacosa, B. Germanà, A. Ferrari, G. Casella, G. De Pretis, G. Miori, The “Gismi Study Group”

Erschienen in: International Journal of Colorectal Disease | Ausgabe 10/2013

Einloggen, um Zugang zu erhalten

Abstract

Background and aim

Recurrence of diverticulitis is frequent within 5 years from the uncomplicated first attack, and its prophylaxis is still unclear. We have undertaken a multicentre, randomised, double-blind, placebo-controlled pilot study in order to evaluate the role of mesalazine in preventing diverticulitis recurrence as well as its effects on symptoms associated to diverticular disease.

Methods

Ninety-six patients with the recent first episode of uncomplicated diverticulitis were randomised to receive mesalazine 800 mg twice daily for 10 days every month or placebo for 24 months. The primary efficacy end point was the diverticulitis recurrence at intention to treat analysis. Clinical evaluations were performed using the Therapy Impact Questionnaire (TIQ) for physical condition and quality of life at admission and at 3-month intervals. Treatment tolerability and routine biochemistry parameters as well as the use of additional drugs were also evaluated.

Results

Ninety-two patients (mean age, 61.5) completed the study, 45 of whom received mesalazine, and 47, placebo. Diverticulitis relapse incidence in mesalazine-treated group was 5/45 (11 %) at the 12th month and 6/45 (13 %) at the 24th month; in the placebo-treated group, the correspondent rates were 13 % (6/47) and 28 % (13/47), respectively. Mean values of TIQ at 24 months were significantly better in mesalazine-treated group than in placebo-treated group (p = 0.02); in addition, average additional drug consumption was significantly lower (−20.4 %, p < 0.03) in mesalazine than in placebo.

Conclusions

Diverticulitis recurrence occurred in as many as 28 % of patients under placebo within 24 months from the initial episode. Intermittent prophylaxis with mesalazine did not significantly reduce the risk of relapse but induced a significant improvement of patients' physical conditions and significantly lowered the additional consumption of other gastrointestinal drugs.
Literatur
1.
Zurück zum Zitat Painter NS, Burkitt DP (1975) Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 4:3–21PubMed Painter NS, Burkitt DP (1975) Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 4:3–21PubMed
2.
Zurück zum Zitat Roberts P, Abel M, Rosen L, Cirocco W, Fleshman J, Leff E et al (1995) Practice parameters for sigmoid diverticulitis. The Standards Task Force American Society of Colon and Rectal Surgeons. Dis Colon Rectum 38:125–132PubMedCrossRef Roberts P, Abel M, Rosen L, Cirocco W, Fleshman J, Leff E et al (1995) Practice parameters for sigmoid diverticulitis. The Standards Task Force American Society of Colon and Rectal Surgeons. Dis Colon Rectum 38:125–132PubMedCrossRef
3.
Zurück zum Zitat Stollman N, Raskin J (2004) Diverticular Dis Colon Lancet 363:631–639 Stollman N, Raskin J (2004) Diverticular Dis Colon Lancet 363:631–639
5.
Zurück zum Zitat Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4:53–69PubMed Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4:53–69PubMed
6.
Zurück zum Zitat Stollman NH, Raskin JB (1999) Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 94:3110–3121PubMedCrossRef Stollman NH, Raskin JB (1999) Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 94:3110–3121PubMedCrossRef
7.
Zurück zum Zitat Ibele A, Heise CP (2007) Diverticular disease: update. Curr Treat Options Gastroenterol 10:248–256PubMedCrossRef Ibele A, Heise CP (2007) Diverticular disease: update. Curr Treat Options Gastroenterol 10:248–256PubMedCrossRef
8.
Zurück zum Zitat Parra-Blanco A (2006) Colonic diverticular disease: pathophysiology and clinical picture. Digestion 73(Suppl 1):47–57PubMedCrossRef Parra-Blanco A (2006) Colonic diverticular disease: pathophysiology and clinical picture. Digestion 73(Suppl 1):47–57PubMedCrossRef
9.
Zurück zum Zitat Janes SE, Meagher A, Frizelle FA (2006) Clinical review. Management of diverticulitis. BMJ 332:271–275PubMedCrossRef Janes SE, Meagher A, Frizelle FA (2006) Clinical review. Management of diverticulitis. BMJ 332:271–275PubMedCrossRef
10.
Zurück zum Zitat Chabok A, Pahlman L, Hjern F, Haapaniemi S, Smedh K, AVOD Study Group (2012) Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 99:532–539PubMedCrossRef Chabok A, Pahlman L, Hjern F, Haapaniemi S, Smedh K, AVOD Study Group (2012) Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 99:532–539PubMedCrossRef
11.
Zurück zum Zitat Tursi A, Brandimarte G, Giorgetti G, Elisei W, Maiorano M, Aiello F (2008) The clinical picture of uncomplicated versus complicated diverticulitis of the colon. Dig Dis Sci 53:2474–2479PubMedCrossRef Tursi A, Brandimarte G, Giorgetti G, Elisei W, Maiorano M, Aiello F (2008) The clinical picture of uncomplicated versus complicated diverticulitis of the colon. Dig Dis Sci 53:2474–2479PubMedCrossRef
12.
Zurück zum Zitat Floch MH (2006) A hypothesis: is diverticulitis a type of inflammatory bowel disease? J Clin Gastroenterol 40(Suppl 3):S121–S125PubMedCrossRef Floch MH (2006) A hypothesis: is diverticulitis a type of inflammatory bowel disease? J Clin Gastroenterol 40(Suppl 3):S121–S125PubMedCrossRef
13.
Zurück zum Zitat Eglinton T, Nguyen T, Raniga S, Dixon L, Dobbs B, Frizelle FA (2010) Patterns of recurrence in patients with acute diverticulitis. Br J Surg 97:952–957PubMedCrossRef Eglinton T, Nguyen T, Raniga S, Dixon L, Dobbs B, Frizelle FA (2010) Patterns of recurrence in patients with acute diverticulitis. Br J Surg 97:952–957PubMedCrossRef
14.
Zurück zum Zitat Broderick-Villa G, Burchette RJ, Collins JC, Abbas MA, Haigh PI (2005) Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Arch Surg 140:576–581PubMedCrossRef Broderick-Villa G, Burchette RJ, Collins JC, Abbas MA, Haigh PI (2005) Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Arch Surg 140:576–581PubMedCrossRef
15.
Zurück zum Zitat Anaya DA, Flum DR (2005) Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg 140:681–685PubMedCrossRef Anaya DA, Flum DR (2005) Risk of emergency colectomy and colostomy in patients with diverticular disease. Arch Surg 140:681–685PubMedCrossRef
16.
Zurück zum Zitat Collins D, Winters DC (2008) Elective resection for diverticular disease: an evidence-based review. World J Surg 32:2429–2433PubMedCrossRef Collins D, Winters DC (2008) Elective resection for diverticular disease: an evidence-based review. World J Surg 32:2429–2433PubMedCrossRef
17.
Zurück zum Zitat Peppercorn MA (2004) The overlap of inflammatory bowel disease and diverticular disease. J Clin Gastroenterol 38(Suppl 1):S8–S10PubMedCrossRef Peppercorn MA (2004) The overlap of inflammatory bowel disease and diverticular disease. J Clin Gastroenterol 38(Suppl 1):S8–S10PubMedCrossRef
18.
Zurück zum Zitat Sheperd NA (1996) Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades. Gut 38:801–802CrossRef Sheperd NA (1996) Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades. Gut 38:801–802CrossRef
19.
Zurück zum Zitat Cohen HD, Das KM (2006) The metabolism of mesalamine and its possible use in colonic diverticulitis as an anti-inflammatory agent. J Clin Gastroenterol 40:S150–S154PubMedCrossRef Cohen HD, Das KM (2006) The metabolism of mesalamine and its possible use in colonic diverticulitis as an anti-inflammatory agent. J Clin Gastroenterol 40:S150–S154PubMedCrossRef
20.
Zurück zum Zitat Trespi E, Colla C, Panizza P et al (1999) Therapeutic and prophylactic role of mesalazine (5-ASA) in symptomatic diverticular disease of the large intestine. 4 year follow-up results. Minerva Gastroenterol Dietol 45:245–252 Trespi E, Colla C, Panizza P et al (1999) Therapeutic and prophylactic role of mesalazine (5-ASA) in symptomatic diverticular disease of the large intestine. 4 year follow-up results. Minerva Gastroenterol Dietol 45:245–252
21.
Zurück zum Zitat 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 34:510–515PubMedCrossRef 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 34:510–515PubMedCrossRef
22.
Zurück zum Zitat Tursi A, Brandimarte G, Giorgetti GM et al (2007) Balsalazide and/or high-potency probiotic mixture (VSL#3) in maintaining remission after attack of acute, uncomplicated diverticulitis of the colon. Int J Color Dis 22:1103–1108CrossRef Tursi A, Brandimarte G, Giorgetti GM et al (2007) Balsalazide and/or high-potency probiotic mixture (VSL#3) in maintaining remission after attack of acute, uncomplicated diverticulitis of the colon. Int J Color Dis 22:1103–1108CrossRef
23.
Zurück zum Zitat Brandimarte G, Tursi A (2004) Rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease. Med Sci Monit 10:170–173 Brandimarte G, Tursi A (2004) Rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease. Med Sci Monit 10:170–173
24.
Zurück zum Zitat Comparato G, Fanigliulo L, Cavallaro LG et al (2007) Prevention of complications and symptomatic recurrences in diverticular disease with mesalazine: a 12-month follow-up. Dig Dis Sci 52:2934–2941PubMedCrossRef Comparato G, Fanigliulo L, Cavallaro LG et al (2007) Prevention of complications and symptomatic recurrences in diverticular disease with mesalazine: a 12-month follow-up. Dig Dis Sci 52:2934–2941PubMedCrossRef
25.
Zurück zum Zitat Comparato G, Fanigliulo L, Aragona G et al (2007) Quality of life in uncomplicated symptomatic diverticular disease: is it another good reason for treatment? Dig Dis 25:252–259PubMedCrossRef Comparato G, Fanigliulo L, Aragona G et al (2007) Quality of life in uncomplicated symptomatic diverticular disease: is it another good reason for treatment? Dig Dis 25:252–259PubMedCrossRef
26.
Zurück zum Zitat Di Mario F, Aragona G, Leandro G et al (2005) Efficacy of mesalazine in the treatment of symptomatic diverticular disease. Dig Dis Sci 50:581–586PubMedCrossRef Di Mario F, Aragona G, Leandro G et al (2005) Efficacy of mesalazine in the treatment of symptomatic diverticular disease. Dig Dis Sci 50:581–586PubMedCrossRef
27.
Zurück zum Zitat Kruis W, Meier E, Schumacher M et al (2007) Treatment of painful diverticular disease of the colon with mesalamine: a placebo-controlled study. Gastroenterology 132:A-191, Abstract S1187 Kruis W, Meier E, Schumacher M et al (2007) Treatment of painful diverticular disease of the colon with mesalamine: a placebo-controlled study. Gastroenterology 132:A-191, Abstract S1187
28.
Zurück zum Zitat Tursi A, Brandimarte G, Giorgetti GM et al (2006) Mesalazine and/or Lactobacillus casei in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomized, open-label study. J Clin Gastroenterol 40:312–316PubMedCrossRef Tursi A, Brandimarte G, Giorgetti GM et al (2006) Mesalazine and/or Lactobacillus casei in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomized, open-label study. J Clin Gastroenterol 40:312–316PubMedCrossRef
29.
Zurück zum Zitat Tursi A, Brandimarte G, Giorgetti GM et al (2007) Continuous versus cyclic mesalazine therapy for patients affected by recurrent symptomatic uncomplicated diverticular disease of the colon. Dig Dis Sci 52:671–674PubMedCrossRef Tursi A, Brandimarte G, Giorgetti GM et al (2007) Continuous versus cyclic mesalazine therapy for patients affected by recurrent symptomatic uncomplicated diverticular disease of the colon. Dig Dis Sci 52:671–674PubMedCrossRef
30.
Zurück zum Zitat Gatta L, Vakil N, Vaira D, Pilotto A, Curlo M, Comparato G et al (2010) Efficacy of 5-ASA in the treatment of colonic diverticular disease. J Clin Gastroenterol 44:113–119PubMedCrossRef Gatta L, Vakil N, Vaira D, Pilotto A, Curlo M, Comparato G et al (2010) Efficacy of 5-ASA in the treatment of colonic diverticular disease. J Clin Gastroenterol 44:113–119PubMedCrossRef
31.
Zurück zum Zitat Makapugay LM, Dean PJ (1996) Diverticular disease-associated chronic colitis. Am J Surg Pathol 20:94–102PubMedCrossRef Makapugay LM, Dean PJ (1996) Diverticular disease-associated chronic colitis. Am J Surg Pathol 20:94–102PubMedCrossRef
32.
Zurück zum Zitat Tursi A, Papagrigoriadis S (2009) Review article: the current and evolving treatment of colonic diverticular disease. Aliment Pharmacol Ther 30:532–546PubMedCrossRef Tursi A, Papagrigoriadis S (2009) Review article: the current and evolving treatment of colonic diverticular disease. Aliment Pharmacol Ther 30:532–546PubMedCrossRef
33.
Zurück zum Zitat Eliakim R, Rachmilewitz D (1992) Potential mediators in inflammatory bowel disease. Gastroenterol Int 5:48–56 Eliakim R, Rachmilewitz D (1992) Potential mediators in inflammatory bowel disease. Gastroenterol Int 5:48–56
34.
Zurück zum Zitat Grisham MB (1994) Oxidants and free radicals in inflammatory bowel disease. Lancet 344:859–861PubMedCrossRef Grisham MB (1994) Oxidants and free radicals in inflammatory bowel disease. Lancet 344:859–861PubMedCrossRef
35.
Zurück zum Zitat Gore S, Sheperd NA, Wilkinson SP (1992) Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance. Int J Color Dis 7:76–81CrossRef Gore S, Sheperd NA, Wilkinson SP (1992) Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance. Int J Color Dis 7:76–81CrossRef
36.
Zurück zum Zitat Peppercorn MA (1992) Drug-responsive chronic segmental colitis associated with diverticula: a clinical syndrome in the elderly. Am J Gastroenterol 87:609–612PubMed Peppercorn MA (1992) Drug-responsive chronic segmental colitis associated with diverticula: a clinical syndrome in the elderly. Am J Gastroenterol 87:609–612PubMed
Metadaten
Titel
Intermittent treatment with mesalazine in the prevention of diverticulitis recurrence: a randomised multicentre pilot double-blind placebo-controlled study of 24-month duration
verfasst von
F. Parente
S. Bargiggia
A. Prada
A. Bortoli
A. Giacosa
B. Germanà
A. Ferrari
G. Casella
G. De Pretis
G. Miori
The “Gismi Study Group”
Publikationsdatum
01.10.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 10/2013
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-013-1722-9

Weitere Artikel der Ausgabe 10/2013

International Journal of Colorectal Disease 10/2013 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.