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      Cyclic rifaximin therapy effectively prevents the recurrence of symptoms after exacerbation of symptomatic uncomplicated diverticular disease: a retrospective study

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          Abstract

          Introduction

          Symptomatic uncomplicated diverticular disease (SUDD) is the most common manifestation of diverticulosis. Data concerning the optimal treatment after SUDD exacerbation are inconsistent.

          Aim

          To assess the effectiveness and necessity of cyclic rifaximin treatment for recurrent SUDD symptoms and for preventing exacerbations in patients who responded to the initial treatment.

          Material and methods

          A retrospective observational study was performed in 2017. Physicians responded to a survey on patients with recurrent SUDD during the observation period, who were cyclically treated with rifaximin 400 mg b.i.d. for 7 days per month. The patients’ SUDD history, diagnostic methods, treatment, and results were evaluated.

          Results

          In total 294 patients were included in this study (67% women, median age: 65 years (26–87)). The mean duration of diverticular disease (DD) was 4.5 years (1–20), and 88% had at least one repeated episode of SUDD exacerbation before rifaximin. A total of 267 patients were treated with rifaximin. Changes in the severity of pain, abdominal tenderness, diarrhoea, constipation, and bloating were assessed every 2 months. After 6 months of rifaximin treatment there was a statistically significant reduction in the total severity score (median from 1.8 (max. 3 points) to 0.2; p < 0.0001; sum from 9.37 (max. 18 points) to 1.35; p < 0.0001) and an improvement in individual symptom score.

          Conclusions

          Cyclical rifaximin is effective in treating exacerbation of SUDD. This regimen leads to a gradual cessation of symptoms over a 6-month period. In patients who responded to the initial treatment, cyclic rifaximin therapy is needed to maintain remission.

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          Most cited references23

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          Burden of digestive diseases in the United States part II: lower gastrointestinal diseases.

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            Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy.

            Colonic diverticulosis is the most common finding during routine colonoscopy, and patients often question the significance of these lesions. Guidelines state that these patients have a 10% to 25% lifetime risk of developing acute diverticulitis. However, this value was determined based on limited data, collected before population-based colonoscopy, so the true number of cases of diverticulosis was not known. We measured the long-term risk of acute diverticulitis among patients with confirmed diverticulosis discovered incidentally on colonoscopy.
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              American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis.

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                Author and article information

                Journal
                Prz Gastroenterol
                Prz Gastroenterol
                PG
                Przegla̜d Gastroenterologiczny
                Termedia Publishing House
                1895-5770
                1897-4317
                12 March 2019
                2019
                : 14
                : 1
                : 69-78
                Affiliations
                [1 ]Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
                [2 ]Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
                [3 ]Department of General and Colorectal Surgery, USK-WAM University Teaching Hospital, Lodz, Poland
                [4 ]General and Endocrine Surgery and Gastroenterological Oncology Department, Poznan University of Medical Sciences, Poznan, Poland
                Author notes
                Address for correspondence: Anna M. Pietrzak MD, PhD, Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, 5 Roentgena St, 02-781 Warsaw, Poland. e-mail: anpietrzak@ 123456gmail.com
                Article
                36011
                10.5114/pg.2019.83428
                6444108
                30944680
                c555e584-50c5-46bb-ad6d-f5a5747a6187
                Copyright: © 2019 Termedia Sp. z o. o.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                : 20 November 2018
                : 04 January 2019
                Categories
                Original Paper

                symptomatic uncomplicated diverticular disease,diverticulitis,rifaximin,eubiosis

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