Medical Management of “Uncomplicated” Colonic Diverticular Disease: A Review on Poorly Absorbed Antibiotics Virginia Festa*, Marco Bianchi, Angelo Dezi, Roberto Luchetti and Maurizio Koch Gastroenterology and Liver Unit, Azienda Ospedaliera San Filippo Neri, 00135 Rome, Italy *Corresponding author: Virginia Festa, Gastroenterology and Liver Unit, Azienda Ospedaliera San Filippo Neri, Via Martinotti 20, 00135 Rome, Italy, Tel: +39-63-3062444; Fax: +39-63-3062641; E-mail: v.festa@sanfilipponeri.roma.it Rec Date: Mar 11, 2014 Acc Date: Apr 28, 2014 Pub Date: May 05, 2014 Copyright: © 2014 Festa V, et al. This is an open-access article distributed under the terms of the CreativeCommons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Diverticular disease of the colon is a common gastrointestinal disease. Although most patients remain asymptomatic for their whole life, about 20%-25% present symptoms related to “diverticular disease”. Current guidelines recommend only the use of high spectrum antibiotics in the initial treatment of acute diverticulitis. Several randomized trials suggest a role for a poorly absorbed antibiotic, such as rifaximin, in soothing symptoms and preventing complications such as diverticulitis. This review will highlight the role of long term administration of rifaximin in the treatment of symptomatic uncomplicated diverticular disease. The evidence suggests that rifaximin is effective for obtaining symptomatic relief and shows a positive trend in preventing complications. Keywords: Rifaximin; Laparoscopic lavage; Diverticular disease Introduction In the past few years, our understanding of diverticulitis has been turned on its head. Causative factors? Say goodbye to the "no seeds and pits" diet. Need for surgery? The simple rule of "2 attacks then operate" is gone. Free perforation? Instead of colostomy, do a laparoscopic lavage. And while the incidence of acute diverticulitis in the young is increasing, the need for aggressive surgical management in this age group is now open to question by Madoff [1]. The Changing Face of Epidemiology Diverticular disease of the colon is one of the most common and costly gastrointestinal disease, and its face is sharply changing, its prevalence increases with age from 5% in the fifth decade of life to 50% in the ninth decade [2,3]. Overall annual age-adjusted admissions for acute diverticulitis are strikingly increasing. In the United States population, a 26% increase between 1998 and 2005 has been recorded [4]. Rates of admission increased more rapidly within patients aged 18-44 years (+82%) and 45-74 years (+36%). Elective operations for diverticulitis rose from 16100 to 22500 per year during the same time period (+29%), also with a more rapid increase (73%) in rates of surgery for individuals aged 18 to 44 years [4]. Sandler et al. [5] have been estimated that, in United States, 3400 deaths could be attributed to diverticular disease, with an economic burden in term of direct health care costs of $2.4 billion [6], and the medical impact of this disorder is likely to increase substantially as the population get older. In Europe also, the incidence per 100000 person- years of colonic diverticular bleeding increased over time (from 3.3 in 1996 to 8.0 events in 2005). A small increasing trend was observed for the incidence per 100 000 person-years of intestinal perforations (from 1.5 to 2.3 events) [7,8]. Although most patients remain asymptomatic for their whole life, about 20%-25% present symptoms related to diverticular disease at some point [9-11]. Diverticular disease is usually classified as symptomatic uncomplicated disease (diverticulosis), recurrent symptomatic disease or complicated disease [12,13]. Symptomatic uncomplicated disease is characterized by abdominal pain (principally colicky left iliac fossa pain), and altered bowel habits [12-14]. After a first symptomatic episode, 20% of the treated patients develop recurrent symptoms [13]. Among patients with diverticular disease, 25% develop complications [4,15]. Acute diverticulitis is the most common complication of diverticular disease: it will develop in 10%-25% of people with diverticula [3]. Diverticulitis recurrence occurs in 7%-42% of people with diverticular disease, and after the first episode the calculated yearly risk of relapse is 3% [16]. Fifty percent of recurrence occurs within 1 year of the initial episode, and 90% within 5 years [17,18]. A cyclical increase in diverticulitis during the summer months has been noted: Rocco Ricciardi and coll. monitored rates of non elective diverticulitis admissions from 1997 through 2005, as recorded in the United States Nationwide Inpatient Sample (NIS) database, they have shown fewer non-elective diverticulitis admissions in February, with 25% increased rate in August [19]. Surgery, when performed in urgency and in septic complications, can achieve high mortality rate, up to 26% [20-22]. The Main Risk Factor for Complications: Aspirin or Non-Steroidal Antinflammatory Drugs The more and more wider use of Aspirin or Nonsteroidal anti- inflammatory drugs (NSAIDs) is a possible cause for the incremental rate of diverticular disease complications. NSAIDs, including aspirin, are a well-known cause of upper gastrointestinal tract complications, and are also implicated in lower gastrointestinal injury. In randomized trials of patients with Gastrointestinal & Digestive System Festa, et al., J Gastroint Dig Syst 2014, 4:3 http://dx.doi.org/10.4172/2161-069X.1000195 Review Article Open Access J Gastroint Dig Syst ISSN:2161-069X JGDS, an open access journal Volume 4 • Issue 3 • 1000195