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Efficacy of Mesalazine in the Treatment of Symptomatic Diverticular Disease

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Abstract

We aimed to improve symptoms by means of mesalazine in symptomatic colonic diverticular disease patients. One hundred seventy outpatients (98 M, 72 F; age, 67.1 years; range, 39–84 years) were assigned to four different schedules: rifaximin, 200 mg bid (Group R1: 39 pts), rifaximin, 400 mg bid (Group R2: 43 pts), mesalazine, 400 mg bid (Group M1: 40 pts), and mesalazine, 800 mg bid (Group M2: 48 pts), for 10 days per month. At baseline and after 3 months we recorded 11 clinical variables (upper/lower abdominal pain/discomfort, bloating, tenesmus, diarrhea, abdominal tenderness, fever, general illness, nausea, emesis, dysuria), scored from 0 = no symptoms to 3 = severe. The global symptomatic score was the sum of all symptom scores. After 3 months in all schedules but Group R1, 3 of the 11 symptoms improved (P < 0.03); the global score decreased in all groups but Group R1 (P < 0.0001). Mesalazine-treated patients had the lowest global score at 3 months (P < 0.001). Mesalazine is as effective as rifaximin (higher dosage schedule) for diminishing some symptoms, but it appears to be better than rifaximin for improving the global score in those patients.

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References

  1. Stollman NH, Baskin, JB, for and on behalf of the Ad Hoc Practice Parameters Committee of the American College of Gastroenterology: Diagnosis and management of diverticular disease of the colon in adults. Practice guidelines. Am J Gastroenterol 94(11):3110–3121, 1999

    Article  CAS  PubMed  Google Scholar 

  2. American Gastroenterological Association: The Burden of Gastrointestinal Disease. Bethesda, MD, American Gastroenterological Association, 2001

    Google Scholar 

  3. Almy TP, Howell DA: Diverticular disease of the colon. N Engl J Med 302:324–331, 1980

    Article  PubMed  CAS  Google Scholar 

  4. Kohler L, Sauerland S, Neugebauer E, for the Scientific Committee of the European Association for Endoscopic Surgery: Diagnosis and treatment of diverticular disease. Results of a consensus development conference. Surg Endosc 13:430–436, 1999

    CAS  PubMed  Google Scholar 

  5. Schwartz JT, Graham DY: Diverticular disease of the large intestine. In Diseases of the Colon, Rectum and Anal Canal. J Kirsner, R Shorter (eds). Baltimore, Williams & Wilkins, 1998, pp 519–536

    Google Scholar 

  6. Naitove A, Smith RE: Diverticular disease of the colon. In Gastrointestinal Disease, 5th ed. MH Sleisenger, TS Fordtran (eds). Philadelphia, Saunders, 1993, pp 1347–1363

    Google Scholar 

  7. Fleischner FG, Ming SC: Revised concepts on diverticular disease of the colon. II. So-called diverticulitis: diverticular sigmoiditis and perisigmoiditis, diverticular abscesses, fistula and frank peritonitis. Radiology 84:599–609, 1965

    PubMed  CAS  Google Scholar 

  8. Torsoli A, Inoue M, Manousos O, Smith A, Van Steensel CJ: Diverticular disease of the colon: data relevant to treatment. Gastroenterol Int 4:3–20, 1991

    Google Scholar 

  9. Brodribb AJ: Treatment of symptomatic diverticular disease with a high-fibre diet. Lancet 1(8013):664–666, 1977

    PubMed  CAS  Google Scholar 

  10. Ewerth S, Ahlberg J, Holmstrom B, Persson U, Uden R: Influence on symptoms and transit time of Vi SiblinR in diverticular disease. Acta Chir Scand 500:40–59, 1980

    Google Scholar 

  11. Solotoft J, Gudmand-Hoyer E, Krag B, Kristensen E, Wulff HR: A double blind trial of wheat bran on symptoms of irritable bowel syndrome. Lancet 1(7954):270–272, 1976

    Google Scholar 

  12. Longstregth GF, Fox DD, Youkeles L, Forsythe AB, Wolochow DA: Psyllium therapy in the irritable bowel syndrome. Ann Intern Med 95:53–56, 1981

    Google Scholar 

  13. Ritchie L: Similarity of bowel distension characteristics in the irritable bowel syndrome and diverticulosis. Gut 18:990, 1997

    Google Scholar 

  14. Papi C, Ciaco A, Koch M, Capurso L: Diverticular Disease Study Group Efficacy of rifaximin on symptoms of uncomplicated diverticular disease of the colon. A pilot multicentre open trial. Ital J Gastroenterol 24:452–456, 1992

    PubMed  CAS  Google Scholar 

  15. Papi C, Ciaco A, Koch M, Capurso L: Efficacy of rifaximin in the treatment of symptomatic diverticular disease of the colon. A multicentre double-blind placebo-controlled trial. Aliment Pharmacol Ther 9:33–39, 1995

    Article  PubMed  CAS  Google Scholar 

  16. Latella G, Pimpo MT, Sottili S, Zippi M, Viscido A, Chiaramonte M, Frieri G: Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon. Int J Colorectal Dis 18:55–62, 2003

    PubMed  Google Scholar 

  17. Iosca N, Ferrieri A: Terapia e profilassi con rifaximina degli episodi di diverticolite acuta. Recenti Prog Med 84(1):42–53, 1993

    Google Scholar 

  18. Kurpad AV, Shetty PS: Effects of antimicrobial therapy on faecal bulking. Gut 27:55–58, 1997

    Google Scholar 

  19. Ventrucci M, Ferrieri A, Roda E: Evaluation of the effect of rifaximin in colon diverticular disease by means of lactulose hydrogen breath test. Curr Med Res Opin 13:202–206, 1994

    Article  PubMed  CAS  Google Scholar 

  20. Rogler G, Andus T: Cytokines in inflammatory bowel disease. World J Surg 22:382–389, 1998

    Article  PubMed  CAS  Google Scholar 

  21. Izzo AA, Mascolo N, Capasso F: Nitric oxide as a modulator of intestinal water and electrolyte transport. Dig Dis Sci 43:1605–1620, 1998

    PubMed  CAS  Google Scholar 

  22. Gore S, Sheperd NA, Wilkinson SP: Endoscopic crescentic fold disease of the sigmoid colon: the clinical and hystopathological spectrum of a distinctive endoscopic appearance. Int J Colorect Dis 7:76–81, 1992

    CAS  Google Scholar 

  23. Makapugay LM, Dean PJ: Diverticular disease-associated chronic colitis. Am J Surg Pathol 20(1):94–102, 1996

    Article  CAS  PubMed  Google Scholar 

  24. Sheperd NA: Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades. Gut 38:801–802, 1996

    CAS  PubMed  Google Scholar 

  25. Trespi E, Colla C, Panizza P, Polino MG, Venturini A, Bottani G, De Vecchi P, Matti C: Ruolo terapeutico e profilattico della mesalazina (5-ASA) nella malattia diverticolare sintomatica del crasso. Minerva Gastroenterol Dietol 45:245–252, 1999

    Google Scholar 

  26. Tursi A, Brandimarte G, Daffinà R: Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon. Dig Liver Dis 34:510–515, 2002

    PubMed  CAS  Google Scholar 

  27. Peppercorn MA: Drug-responsive chronic segmental colitis associated with diverticula: a clinical syndrome in the elderly. Am J Gastroenterol 87:609–612, 1992

    CAS  PubMed  Google Scholar 

  28. Brandt LJ: The colon. In Gastrointestinal Disorders of the Elderly. LJ Brandt (ed). New York, Raven Press, 1984, pp 261–367

    Google Scholar 

  29. Marshak RH, Janowitz HD, Present DH: Granulomatous colitis in association with diverticula. N Engl J Med 283:1080–1084, 1970

    Article  PubMed  CAS  Google Scholar 

  30. Marshak RH, Lindner AE, Maklansky D: Paracolic fistulous tracts in diverticulitis and granulomatous colitis. JAMA 243:1943–1946, 1980

    PubMed  CAS  Google Scholar 

  31. McCue J, Coppen MJ, Rasbridge SA, et al.: Coexistent Crohn’s disease and sigmoid diverticulitosis. Postgrad Med J 65:636–639, 1989

    Article  CAS  PubMed  Google Scholar 

  32. Meyers MA, Alonso DR, Morson BC, Bartram C: Pathogenesis of diverticulitis complicating granulomatous colitis. Gastroenterology 74:24–31, 1978

    PubMed  CAS  Google Scholar 

  33. Schmidt GT, Lennard-Jones JE, Morson BC, Young AC: Crohn’s disease of the colon an dits distinction from diverticulitis. Gut 9:7–16, 1968

    CAS  PubMed  Google Scholar 

  34. Spiliadis CA, Spiliadis CA, Lennard-Jones JE: Ulcerative colitise with relative sparing of the rectum. Dis Colon Rectum 30:334–336, 1987

    CAS  PubMed  Google Scholar 

  35. Morson BC, Dawson IMP, Day DW, Jass JR, Price AB, Williams Gt: Inflammatory disorders. In Gastrointestinal Pathology, 3rd ed. Morson, Dawson (eds). Oxford, Blackwell Scientific, 1990, p 521

    Google Scholar 

  36. Lee FD, Maguire C, Obeidat W, Russel RI: The significance of cryptolytic lesions in inflammatory bowel disease. Gut 37:21A, 1995

    Google Scholar 

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Authors and Affiliations

  1. Chair of Gastroenterology, University of Parma, Parma, Italy

    Francesco Di Mario MD, Giovanni Aragona MD, Giuseppe Comparato MD, Libera Fanigliulo MD, Lucas G. Cavallaro MD, Giulia M. Cavestro MD, Veronica Iori MD, Marta Maino MD & AlÌ M. Moussa MD

  2. Gastroenterological Hospital “S. De Bellis,” IRCCS, Castellana Grotte, Bari, Italy

    Gioacchino Leandro MD

  3. Gastroenterology and Endoscopy Unit, Az. Ospedaliera, Parma, Italy

    Alessandro Gnocchi MD & Angelo Franzé MD

  4. U.O. Chirurgia Borgovalditaro, AUSL, Parma, Italy

    Giancarlo Mazzocchi MD

  5. Università degli Studi di Parma, Dipartimento di Scienze Cliniche, sezione di Gastroenterologia, Via Gramsci 14, Parma, 43100, Italy

    Francesco Di Mario MD

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  1. Francesco Di Mario MD
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  2. Giovanni Aragona MD
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  3. Gioacchino Leandro MD
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  4. Giuseppe Comparato MD
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  6. Lucas G. Cavallaro MD
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  9. Marta Maino MD
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  13. Angelo Franzé MD
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Corresponding author

Correspondence to Francesco Di Mario MD.

Additional information

This work was carried out under the auspices of the Roberto Farini Foundation for Gastroenterological Research.

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Mario, F.D., Aragona, G., Leandro, G. et al. Efficacy of Mesalazine in the Treatment of Symptomatic Diverticular Disease. Dig Dis Sci 50, 581–586 (2005). https://doi.org/10.1007/s10620-005-2478-z

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  • DOI: https://doi.org/10.1007/s10620-005-2478-z

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