Year 2024 / Volume 116 / Number 3
Original
Non-antibiotic treatment of uncomplicated acute diverticulitis is applicable and safe in our environment. A prospective multicenter study

140-147

DOI: 10.17235/reed.2023.9737/2023

Javier Serrano González, Laura Román García de León, Pablo Galindo Jara, José Luis Lucena de la Poza, Arsenio Sánchez Movilla, Laura Colao García, Jesús Gabriel García Schiever, David Varillas Delgado,

Abstract
Introduction: acute diverticulitis is one of the most frequent underlying causes behind individuals attending the Emergency Room with abdominal pain. The most widespread therapy for acute uncomplicated diverticulitis includes outpatient treatment with antibiotics; however, several publications indicate that patients can also be successfully treated without antibiotics. The results of the implementation of this more recent protocol in two hospitals in Madrid are presented. Methods: an observational prospective study was performed. Participants were patients diagnosed with uncomplicated acute diverticulitis at two hospitals in Madrid, Hospital Universitario de Torrejón and Hospital Universitario Puerta de Hierro Majadahonda, between December 2018 and August 2021, treated on an outpatient basis without antibiotic therapy. The study group was compared with a control group, composed of patients diagnosed with uncomplicated acute diverticulitis and treated with outpatient antibiotic therapy at Hospital Universitario Puerta de Hierro between March 2015 and March 2018. Results: three hundred and sixty-one patients were included, 182 in the study group and 179 in the control group. Diverticulitis was persistent in 19 patients (10.4 %) in the study group, who were not treated with antibiotics, and in five patients (2.8 %) in the control group, treated with outpatient antibiotic therapy (p = 0.004). Recurrences occurred in 23 patients (12.6 %) in the study group, and in 53 patients (29.6 %) in the control group (p < 0.0001). The analysis of the complications found no significant differences between both groups (p = 0.109). No urgent surgical intervention or mortality was recorded in the study group. Conclusions: in our environment, symptomatic non-antibiotic treatment of uncomplicated acute diverticulitis cases is safe, without showing a higher rate of complications. Although, there seems to be a worse initial symptom control.
Lay Summary
Background A diverticulum is a pouch-like structure that appears in both the small and large intestine, being more common in the latter. Up to 70% of people over 70 years old have them. Acute diverticulitis is the inflammation of these diverticula, developing abdominal pain with or without fever. In mild cases, treatment consisted of digestive rest, pain killers and antibiotics. However, the possibility of treating these cases without antibiotics has been studied in the past few years. Purpose To present the results of non-antibiotic treatment after starting this protocol in two Hospitals in Madrid, and to asses its safety and effectiveness. Method Two groups were created: a current group of patients treated with diet and analgesics, and a control group with patients treated in the past with diet, analgesics and antibiotics. The results from both groups were compared. Main Results In the study group, only one of the 182 patients developed a complication of the inflamed diverticula, and no patients died. Reappearance of the disease in long-term follow-up was more frequent in the group treated with antibiotics than in the actual group. However, symptoms disappeared faster in patients treated with antibiotics. Conclusions To remove antibiotics from the treatment of acute diverticulitis does not imply a worse outcome. Although, total recovery might take longer.
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Serrano González J, Román García de León L, Galindo Jara P, Lucena de la Poza J, Sánchez Movilla A, Colao García L, et all. Non-antibiotic treatment of uncomplicated acute diverticulitis is applicable and safe in our environment. A prospective multicenter study. 9737/2023


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Publication history

Received: 22/05/2023

Accepted: 28/09/2023

Online First: 06/11/2023

Published: 04/03/2024

Article revision time: 104 days

Article Online First time: 168 days

Article editing time: 287 days


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