Doença diverticular

A maioria dos pacientes com diverticulite não complicada se recupera após o tratamento clínico e não requer intervenção cirúrgica.

Doença recorrente

A doença diverticular recorre em 5% a 11% dos pacientes ao longo de 5 anos após um episódio de diverticulite não complicada.[7]Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32. https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00313-4 http://www.ncbi.nlm.nih.gov/pubmed/32381121?tool=bestpractice.com ​​​ Os fatores de risco para recorrência parecem ser uma idade mais jovem à apresentação, sexo feminino, etnia asiática, obesidade, tabagismo, episódio prévio de doença recorrente e formação de abscesso ou doença complicada ao diagnóstico inicial.[7]Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32. https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00313-4 http://www.ncbi.nlm.nih.gov/pubmed/32381121?tool=bestpractice.com [97]Hupfeld L, Burcharth J, Pommergaard HC, et al. Risk factors for recurrence after acute colonic diverticulitis: a systematic review. Int J Colorectal Dis. 2017 May;32(5):611-22. http://www.ncbi.nlm.nih.gov/pubmed/28110383?tool=bestpractice.com [98]Kang G, Son S, Shin YM, et al. Recurrence of uncomplicated diverticulitis: a meta-analysis. Medicina (Kaunas). 2022 Jun 2;58(6):758. https://www.mdpi.com/1648-9144/58/6/758 http://www.ncbi.nlm.nih.gov/pubmed/35744021?tool=bestpractice.com ​ A doença recorrente está associada a uma alta taxa de mortalidade, e a resposta à terapia é menos favorável.

A mesalazina, os probióticos ou a rifaximina não são recomendados para a prevenção da diverticulite recorrente.[43]Peery AF, Shaukat A, Strate LL. AGA clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology. 2021 Feb;160(3):906-11.e1. https://www.gastrojournal.org/action/showPdf?pii=S0016-5085%2820%2935512-8 http://www.ncbi.nlm.nih.gov/pubmed/33279517?tool=bestpractice.com [91]Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al; Clinical Guidelines Committee of the American College of Physicians. Colonoscopy for diagnostic evaluation and interventions to prevent recurrence after acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians. Ann Intern Med. 2022 Mar;175(3):416-31. https://www.acpjournals.org/doi/10.7326/M21-2711 http://www.ncbi.nlm.nih.gov/pubmed/35038270?tool=bestpractice.com As evidências mostram que a mesalazina não reduz o risco de recorrência.[99]Balk EM, Adam GP, Cao W, et al. Evaluation and management after acute left-sided colonic diverticulitis : a systematic review. Ann Intern Med. 2022 Mar;175(3):388-98. https://www.acpjournals.org/doi/10.7326/M21-1646 http://www.ncbi.nlm.nih.gov/pubmed/35038269?tool=bestpractice.com [ ] For people with diverticulitis, how does mesalamine (5-ASA) compare with placebo for prevention of recurrence?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1968/fullMostre-me a resposta Não há evidências suficientes para o uso da rifaximina, de mesalazina e rifaximina, da combinação de balsalazida (um pró-fármaco do ácido 5-aminossalicílico) e probióticos, ou do chá de bardana.[91]Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al; Clinical Guidelines Committee of the American College of Physicians. Colonoscopy for diagnostic evaluation and interventions to prevent recurrence after acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians. Ann Intern Med. 2022 Mar;175(3):416-31. https://www.acpjournals.org/doi/10.7326/M21-2711 http://www.ncbi.nlm.nih.gov/pubmed/35038270?tool=bestpractice.com [99]Balk EM, Adam GP, Cao W, et al. Evaluation and management after acute left-sided colonic diverticulitis : a systematic review. Ann Intern Med. 2022 Mar;175(3):388-98. https://www.acpjournals.org/doi/10.7326/M21-1646 http://www.ncbi.nlm.nih.gov/pubmed/35038269?tool=bestpractice.com

Pós-cirurgia

Após o tratamento cirúrgico eletivo, até 25% dos pacientes continuam a apresentar dor persistente ou diverticulite recorrente.[43]Peery AF, Shaukat A, Strate LL. AGA clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology. 2021 Feb;160(3):906-11.e1. https://www.gastrojournal.org/action/showPdf?pii=S0016-5085%2820%2935512-8 http://www.ncbi.nlm.nih.gov/pubmed/33279517?tool=bestpractice.com ​​