Symptomatic Treatment for Uncomplicated Acute Diverticulitis: A Prospective Cohort Study
Symptomatic Treatment for Uncomplicated Acute Diverticulitis: A Prospective Cohort Study
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DOI：
10.1097/dcr.0000000000000579
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发表时间：
2016-06-01
影响因子：
3.9
通讯作者：
Sallinen, Ville J.
中科院分区：
文献类型：
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作者：
Mali, Juha P.;Mentula, Panu J.;Sallinen, Ville J.
背景：尽管存在非抗生素治疗无并发症憩室炎的证据，但尚未得到广泛采用。目的：这项前瞻性单臂研究的目的是在30天的随访期间分析无并发症憩室炎的对症（非抗生素）治疗的安全性和有效性。设计：本研究是一项单臂前瞻性试验（ClinicalTrials.gov ID NCT02219698）。设置：本研究是在一家作为三级和二级护理转诊中心的学术教学医院进行的。患者：经ct证实无并发症的急性结肠憩室炎（包括憩室炎伴心包空气）的患者被纳入本研究。排除正在接受抗生素治疗、免疫抑制、怀疑腹膜炎、器官功能障碍、妊娠或其他需要抗生素感染的患者。干预措施：有症状的住院或门诊治疗包括轻度镇痛药（非甾体抗炎药或扑热息痛）。主要观察指标：并发症憩室炎发生率为主要观察指标。结果：161例患者纳入研究，153例（95%）完成了30天的随访。这些患者中有4例（3%）被误诊（最初CT扫描时为脓肿）。共有14例（9%）患者存在心包空气。共有140例（87%）患者作为门诊患者就诊，其中4例（3%）患者在随访期间入院。没有患者出现并发症憩室炎或需要手术，但在纳入后2天（中位数），14例（9%，6例口服，8例静脉注射）患者接受了抗生素治疗。局限性：由于缺乏对照组和随访时间相对较短，本研究受到限制。结论：无抗生素对症治疗无并发症憩室炎安全有效。
BACKGROUND: Even though evidence for nonantibiotic treatment of uncomplicated diverticulitis exists, it has not gained widespread adoption.OBJECTIVE: The aim of this prospective single-arm study was to analyze the safety and efficacy of symptomatic (nonantibiotic) treatment for uncomplicated diverticulitis during a 30-day follow-up period.DESIGN: This study is a single-arm prospective trial (ClinicalTrials.gov ID NCT02219698).SETTINGS: This study was performed at an academic teaching hospital functioning as both a tertiary and secondary care referral center.PATIENTS: Patients, who had CT-verified uncomplicated acute colonic diverticulitis (including diverticulitis with pericolic air), were evaluated for the study. Patients with ongoing antibiotic therapy, immunosuppression, suspicion of peritonitis, organ dysfunction, pregnancy, or other infections requiring antibiotics were excluded.INTERVENTIONS: Symptomatic in-or outpatient treatment consisted of mild analgesics (nonsteroidal anti-inflammatory drug or paracetamol).MAIN OUTCOME MEASURES: The incidence of complicated diverticulitis was the primary outcome.RESULTS: Overall, 161 patients were included in the study, and 153 (95%) completed the 30-day follow-up. Four (3%) of these patients were misdiagnosed (abscess in the initial CT scan). A total of 14 (9%) patients had pericolic air. Altogether, 140 (87%) patients were treated as outpatients, and 4 (3%) of them were admitted to the hospital during the follow-up. None of the patients developed complicated diverticulitis or required surgery, but, 2 days (median) after inclusion, antibiotics were given to 14 (9%, 6 orally, 8 intravenously) patients.LIMITATIONS: This study is limited by the lack of a comparison group and by the relatively short follow-up.CONCLUSIONS: Symptomatic treatment of uncomplicated diverticulitis without antibiotics is safe and effective.