title: Short-term Intravenous Antibiotic Treatment in Uncomplicated Diverticulitis Does Not Increase the Risk of Recurrence Compared to Long-term Treatment Mesalamine did not prevent recurrent diverticulitis in phase 3 controlled trials. Intermittent treatment with mesalazine in the prevention of diverticulitis recurrence: a randomised multicentre pilot double-blind placebo-controlled study of 24-month duration Long-Term Evolution of Acute Colonic Diverticulitis After Successful Medical Treatment Effectiveness of different therapeutic strategies in preventing diverticulitis recurrence. Prediction and management of recurrent right colon diverticulitis Long-Term Follow-up After an Initial Episode of Diverticulitis: What Are the Predictors of Recurrence? Assessment of recurrence and complications following uncomplicated diverticulitis Diverticular Abscess Managed With Long-term Definitive Nonoperative Intent Is Safe
abstract: Purpose This study included all patients treated at the University Hospital of Geneva for a first episode of uncomplicated diverticulitis . Risks of recurrence and treatment failure were evaluated by comparing the results between short-course and long-course intravenous ( IV ) antibiotic therapy groups . Methods The records of all patients hospitalized at our facility from January 2007 to February 2012 for a first episode of uncomplicated diverticulitis ( Hinchey Ia ) , as confirmed by computed tomography , were prospect ively collected . We published an auxiliary analysis from this registered study at Clinical trials.gov ( identifier number : NCT01015378 ) . Two groups of patients were considered : one received a short-course IV antibiotic arm ( ceftriaxone and metronidazole ) for up to 5 days ( followed by 5 days of oral antibiotics ) ; the other received a long-course IV arm between days 5 and 10 . The primary outcome was the recurrence-free survival time . Results Follow-up was completed for 256 patients -50 % men and 50 % women , with a median age of 56 years ( range , 24 - 85 years ) . The average follow-up was 50 months ( range , 19 - 89 months ) . Of the 256 patients included in the study , 46 patients received a short-course IV antibiotic treatment and 210 received a long-course treatment .  The recurrence-free survivals were very similar between the two groups , which was supported by a log rank test ( P = 0.772 ) . Four treatment failures , all in the long-course IV antibiotic treatment group , occurred . Conclusion Treatment of diverticulitis with a short IV antibiotic treatment is possible and does not modify the recurrence rate in patients with uncomplicated diverticulitis BACKGROUND & AIMS No therapy has been proven to prevent the recurrence of diverticulitis . Mesalamine has shown efficacy in preventing relapse in inflammatory bowel disease , and there is preliminary evidence that it might be effective for diverticular disease . We investigated the efficacy of mesalamine in preventing recurrence of diverticulitis in 2 identical but separate phase 3 , r and omized , double-blind , placebo-controlled , multicenter trials ( identical confirmatory trials were conducted for regulatory reasons ) . METHODS We evaluated the efficacy and safety of multimatrix mesalamine vs placebo in the prevention of recurrent diverticulitis in 590 ( PREVENT1 ) and 592 ( PREVENT2 ) adult patients with ≥1 episodes of acute diverticulitis in the previous 24 months that resolved without surgery . Patients received mesalamine ( 1.2 g , 2.4 g , or 4.8 g ) or placebo once daily for 104 weeks . The primary end point was the proportion of recurrence-free patients at week 104 . Diverticulitis recurrence was defined as surgical intervention at any time for diverticular disease or presence of computed tomography scan results demonstrating bowel wall thickening ( > 5 mm ) and /or fat str and ing consistent with diverticulitis . For a portion of the study , recurrence also required the presence of abdominal pain and an increase in white blood cells . RESULTS Mesalamine did not reduce the rate of diverticulitis recurrence at week 104 . Among patients in PREVENT1 , 53%-63 % did not have disease recurrence , compared with 65 % of those given placebo . Among patients in PREVENT2 , 59%-69 % of patients did not have disease recurrence , compared with 68 % of those given placebo . Mesalamine did not reduce time to recurrence , and the proportions of patients requiring surgery were comparable among treatment groups . No new adverse events were identified with mesalamine administration . CONCLUSIONS Mesalamine was not superior to placebo in preventing recurrent diverticulitis . Mesalamine is not recommended for this indication . Clinical Trials.gov ID : NCT00545740 and NCT00545103 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 , r and omised , 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 r and omised 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 Question naire ( 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 Background The evidence is sparse concerning the natural history of acute diverticulitis after successful conservative management . This observational study aim ed to evaluate the rate , severity , and need of surgery for recurrence after a first episode of acute diverticulitis successfully managed conservatively . Methods All patients admitted for acute diverticulitis between 1994 and 2011 were considered for inclusion in the study . Severity of the first episode , demographic data , comorbidities , management , recurrence , and elective or emergency surgery during the follow-up period were prospect ively recorded . Results The study included 560 patients . The mean follow-up period was of 67.2 ± 44.4 months . Severe diverticulitis was diagnosed in 22.3 % of the cases . Recurrence was observed in 14.8 % of the patients , and the rate of severe recurrence was 3.4 % . Most of the recurrences occurred during the first year of follow-up evaluation . Chronic corticoid therapy ( P = 0.043 ) and the presence of more than one abscess ( P < 0.001 ) were significantly related to recurrence . In the event of a mild recurrence , the first episode was either mild or severe ( P = 0.172 ) . In the case of severe recurrence , most patients presented with a previous severe diverticulitis ( P < 0.001 ) . During the follow-up period , 6.8 % of the patients needed an elective operation , and 1.4 % of them underwent emergency surgery . Conclusion The rate of severe recurrence after successful nonoperative management of acute diverticulitis was low , and emergency surgery was rare . Prophylactic surgery , even in cases of recovered severe diverticulitis , should be considered on a case-by-case basis . Strict follow-up assessment during the first year is advised BACKGROUND Colonic diverticulitis shows a high recurrence rate . AIMS To assess the efficacy of three different therapeutic strategies in preventing diverticulitis recurrence . MATERIAL S AND METHODS One hundred thirty patients suffering from Acute Uncomplicated Diverticulitis ( AUD ) ( 81 males , 49 females , mean age 64.71 years , range 40 - 85 ) were prospect ively assessed . After obtaining remission , considered present when both endoscopic and histological damage were absent , the patients were treated with mesalazine 1.6 g/day ( 59 patients , group A ) , or rifaximin 800 mg/day for 7 days every month ( 52 patients , group B ) . Clinical , endoscopic and histological follow-up was performed after 6 , 12 and thereafter every 12 months after diagnosis of AUD . RESULTS Seven patients were excluded from final evaluation because they were lost to follow-up . Fifty-five group A patients and 49 group B patients patients were available for the final assessment at the end of a 24-month follow-up . Sustained remission was significantly higher in group A with respect to group B. CONCLUSIONS Patients taking mesalazine have lower risk of diverticulitis recurrence than patients taking rifaximin because of the lower prevalence of persisting endoscopic and histological inflammation Purpose While the incidence of right colonic diverticulitis ( RCD ) is rare in Western countries , the right colon is the most common site of diverticulitis in Asian countries . However , its recurrent pattern and management were rarely studied . This study was design ed to eluci date the pattern of recurrence in RCD . Methods Of the 154 patients admitted as right colonic diverticulitis between February 2004 and March 2012 , 104 patients were enrolled , prospect ively . The recurrence rate , size , multiplicity , location , diagnostic criteria score , and predisposing factors were evaluated based on Hinchey ’s classification of diverticulitis . Results There were 104 patients with right colonic diverticulitis in this study , and 20 patients ( 19.2 % ) recurred after medical treatment . When the diverticula were not located in the right colon , the recurrence rate was significantly higher than the diverticula located only in the right colon ( p = 0.004 ) . The recurrence rate of diverticulitis for a single diverticulum was significantly lower than that for multiple diverticula ( p = 0.02 ) . Of the 20 patients with recurrence , 1 ( 5 % ) patient underwent laparoscopic diverticulectomy due to a misdiagnosis of diverticulitis as appendicitis . The remaining 19 patients ( 95 % ) received nonoperative management and recovered without any sequelae . Conclusions The recurrence rate was 19.2 % , and the predisposing factors were the location of diverticula and the multiplicity of primary diverticula . The re-recurrence rate of recurred patients was 26.3 % . The recurred lesions were controlled simply by nonoperative management . Elective surgery was also a treatment option PURPOSE : The purpose of our study was to determine the clinical and CT predictors of recurrent disease after a first episode of diverticulitis that was successfully managed nonoperatively . METHODS : We retrospectively analyzed 954 consecutive patients who presented to our institution with diverticulitis from 2002 to 2008 . Patients were identified with International Classification of Diseases , 9th Revision/Current Procedural Terminology codes . Patients were excluded if they had subsequent colectomy based on the first attack ( n = 81 ) , or if the attack they had between 2002 and 2008 was not their first attack ( n = 201 ) . We evaluated CT variables chosen by a panel of expert gastrointestinal radiologists . These radiologists review ed the available published literature for CT imaging characteristics thought to predict diverticulitis severity . CT variables ( n = 20 ) were determined by prospect i ve reevaluation of scans by blinded study radiologists . Clinical variables ( n = 43 ) were coded based on a retrospective chart review . Univariate analysis of variables in relation to recurrent disease was performed by a log-rank test of Kaplan-Meier estimates . Multivariate analysis was performed using Cox proportional hazards modeling . Variables with P < .2 on univariate analysis were included in a stepwise selection algorithm . RESULTS : The study population included 672 patients ; mean age , 61 ± 15 years ; mean follow-up , 42.8 ± 24 months . The index presentation of diverticulitis was most commonly located in the sigmoid colon ( 72 % ) , followed by descending colon ( 33 % ) , right colon ( 5 % ) , and transverse colon ( 3 % ) . Overall recurrence at 5 years was 36 % by ( 95 % CI 31.4%–40.6 % ) Kaplan-Meier estimate . Complicated recurrence ( fistula , abscess , free perforation ) occurred in 3.9 % ( 95 % CI 2.2%–5.6 % ) of patients at 5 years by Kaplan-Meier estimate . Family history of diverticulitis ( HR 2.2 , 95 % CI 1.4–3.2 ) , length of involved colon > 5 cm ( HR 1.7 , 95 % CI 1.3–2.3 ) , and retroperitoneal abscess ( HR 4.5 , 95 % CI 1.1–18.4 ) were associated with diverticulitis recurrence . Right colon disease ( HR 0.27 , 95 % CI 0.09–0.86 ) was associated with freedom from recurrence . CONCLUSION : Although diverticulitis recurrence is common following an initial attack that has been managed medically , complicated recurrence is uncommon . Patients who present with a family history of diverticulitis , long segment of involved colon , and /or retroperitoneal abscess are at higher risk for recurrent disease . Patients who present with right-sided diverticulitis are at low risk for recurrent disease . These findings should be taken into consideration when counseling patients regarding the potential benefits of prophylactic colectomy The natural history of sigmoid diverticulitis has been inferred from population ‐based or retrospective studies . This study assessed the risk of a recurrent attack following the first episode of uncomplicated diverticulitis BACKGROUND : Initial nonoperative management of diverticular abscess has become the st and ard of care ; however , the need for elective resection after this index episode is unclear . OBJECTIVE : The purpose of this study was to assess the long-term outcomes of expectant management after initial nonoperative treatment of diverticular abscess . DESIGN : This was a retrospective chart review with prospect i ve telephone follow-up of patients . SETTING S : The study was conducted at a large tertiary academic colorectal surgery practice in Canada . PATIENTS : Adult patients with CT-documented acute sigmoid diverticulitis complicated by abscess managed nonoperatively from 2000 to 2013 were included . INTERVENTIONS : Long-term definitive nonoperative management of diverticular abscess . MAIN OUTCOME MEASURES : The primary outcome was  emergency sigmoidectomy or death from recurrent diverticulitis . Secondary outcomes were recurrent diverticulitis and elective sigmoidectomy for diverticulitis . RESULTS : Of 135 patients with acute diverticulitis complicated by abscess , a total of 73 patients were managed with nonoperative intent and long-term expectant management . The median follow-up was 62 ( Q1 to Q3 : 28–98 ) months . After resolution of the index episode , 22 patients [ 30.1 % ( 95 % CI , 19.6%–40.6 % ) ] experienced a recurrent episode of diverticulitis at a median of 23 ( range , 9–40 ) months . Two patients [ 2.7 % ( 95 % CI , –1.0 % to 6.4 % ) ] had a recurrent episode with peritonitis that required sigmoidectomy with stoma at 6 and 64 months . Both patients underwent reversal after 4 and 8 months . Seven [ 9.6 % ( 95 % CI , 2.8%–16.4 % ) ] patients experienced a complicated recurrence and underwent an  elective sigmoidectomy  [ median time to colectomy , 33 ( range , 16–56 ) months ] . Thirteen patients [ 17.8 % ( 95 % CI , 9.0%–26.6 % ) ] experienced an uncomplicated recurrence , all of whom were managed with continued nonoperative intent [ median follow-up , 81 ( range , 34–115 ) months ] . No mortality occurred . On multivariate logistic regression , female gender ( p = 0.048 ) and a previous episode of uncomplicated diverticulitis before the index diverticular abscess ( p = 0.020 ) were associated with a recurrent episode . LIMITATIONS : This study was limited by its retrospective design and modest sample size . CONCLUSIONS : After initial successful nonoperative management of diverticulitis with abscess , expectant management with nonoperative intent is a safe long-term option with low rates of surgery , especially in the emergency setting . See Video , Supplemental Digital Content 1 , on the nonoperative management of diverticular abscess at http://links.lww.com/DCR/A234
target: Primary diverticulitis with abscess formation and young age increased the risk of recurrence .
  Readmission risk was higher within the first year after remission .
  Conclusions The best treatment strategy for recurrent diverticulitis is undetermined .
background: Purpose Several factors may influence the risk of recurrence after an episode of acute colonic diverticulitis .
  Until now , a comprehensive systematic overview and evaluation of relevant risk factors have not been presented .
  This review aim ed at assembling and evaluating current evidence on risk factors for recurrence after conservatively treated acute colonic diverticulitis .