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Efficacy of rifaximin in the treatment of chronic relapsing diverticulitis

Abstract

Aim of investigation. To estimate efficacy of rifaximin in complex conservative treatment of chronic diverticulitis.

Material and methods. The main group included 43 patients that received 200 mg rifaximin every 8 h within conservative treatment mode for 14 days. Of all patients 34 were women (79,1%), 9 – men (20,9%), age of patients ranged 44 to 84 years. Severity of clinical symptoms at onset of treatment varied from 1 to 3 points, mean score was 2,11 points (М0=2 points). Extent of inflammatory changes (according to abdominal US or CT with estimation in relation to sigmoid colon axis) varied from 5 to 8 cm, mean – 6,2 cm (М0=6 cm), thickness of muscular layer – from 2 to 5 mm (mean – 2,7 mm, М0=2,5 mm). The control group included 40 patients, who received no rifaximin at conservative treatment. Of all patients 32 were women (80,0%), 8 – men (20,0%), age of patients ranged from 32 to 74 years (mean — 60,9 years, М0=60 years). Severity of clinical symptoms at beginning of treatment varied from 1 to 3 points, 2,18 points mean (М0=2 points). Extent of inflammatory changes varied from 5 to 8 cm, mean – 6,8 cm (М0=6 cm), thickness of muscular layer – from 2 to 5 mm (mean – 2,6 mm, М0=2,5 mm).

Results. At the end of 2nd day of treatment intensity of symptoms in main group was 1,55 points, in the control group – 1,69 points (р=0,12). According to US data, no changes in both groups were observed. At the 14th day intensity of clinical symptoms in the main group was 0,26 points (in the control group – 0,71 points; р=0,09). According to results of US in 31 patients of the main group (72,1%) and in 28 controls (70,0%) signs of active inflammation were absent.

Conclusions. Rifaximin – is an effective drug for complex conservative treatment of the chronic relapsing diverticulitis, that allows significantly to reduce terms for achievement of complete clinical response.

About the Authors

S. I. Achkasov
ФГБУ ГНЦ колопроктологии Минздравсоцразвития РФ
Russian Federation


A. I. Moskalyov
ФГБУ ГНЦ колопроктологии Минздравсоцразвития РФ
Russian Federation


Yu. L. Trubachyova
ФГБУ ГНЦ колопроктологии Минздравсоцразвития РФ
Russian Federation


A. F. Filon
ФГБУ ГНЦ колопроктологии Минздравсоцразвития РФ
Russian Federation


References

1. Болихов К.В. Острые воспалительные осложнения дивертикулярной болезни ободочной кишки (клиника, диагностика, лечение). Автореф. ... канд. мед. наук. – М., 2006. – 30 с.

2. Основы колопроктологии / Под ред. Г.И. Воробьева. – Ростов н/Д, 2001. – 414 с.

3. Pathology: manual / Ed. M.A.Paltsev, V.S.Paukov, E.G.Ulumbekov. – M.: GEOTAR-MED, 2002. – 960 p.

4. Ambrosetti P. Acute diverticulitis of the left colon: value of the initial CT and timing of elective colectomy. J Gastrointest Surg. 2008 Aug;12 (8):1318–20. Epub 2008 Apr 29.

5. Colecchia A, Vestito A, Pasqui F, et al. Efficacy of long term cyclic administration of the poorly absorbed antibiotic Rifaximin in symptomatic, uncomplicated colonic diverticular disease. World J Gastroenterol. 2007 Jan 14; 13 (2):264–9.

6. Frattini J, Longo WE. Diagnosis and treatment of chronic and recurrent diverticulitis. J Clin Gastroenterol. 2006 Aug; 40 Suppl 3:145–9.

7. Gordon PH. Principles and practice of surgery for the colon, rectum, and anus / by Philip H. Gordon, Santhat Nivatvongs. 3rd ed., 2007:949.

8. Hodgson WJ. The placebo effect. Is it important in diverticular disease? Am J Gastroenterol. 1977; 67:157–62.

9. Holmer C, Lehmann KS, Engelmann S, et al. Long-term outcome after conservative and surgical treatment of acute sigmoid diverticulitis. Langenbecks Arch Surg. 2011 Aug; 396 (6):825–32. Epub 2011 Jun 18.

10. Horgan AF, McConnell EJ, Wolff BG, et al. Atypical diverticular disease: surgical results. Dis Colon Rectum. 2001 Sep; 44 (9):1315–8.

11. Humes D, Simpson J, Spiller RC. Colonic diverticular disease. Clin Evid (Online). 2007 Aug 15; 2007. pii:0405.

12. Humes DJ, West J. Role of acute diverticulitis in the development of complicated colonic diverticular disease and 1-year mortality after diagnosis in the UK: population-based cohort study. Gut 2011; Published Online First: 6 May 2011.

13. D’Incà R, Pomerri F, Vettorato MG, et al. Interaction between rifaximin and dietary fibre in patients with diverticular disease. Aliment Pharmacol Ther. 2007 Apr 1; 25 (7):771–9.

14. Klarenbeek BR, Samuels M, van der Wal MA, et al. Indications for elective sigmoid resection in diverticular disease. Ann Surg. 2010 Apr; 251 (4):670–4.

15. Latella G, Pimpo MT, Sottili S, et al. Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon. Int J Colorectal Dis. 2003; 18:55–62.

16. Maconi G, Barbara G, Bosetti C, et al. Treatment of diverticular disease of the colon and prevention of acute diverticulitis: a systematic review. Dis Colon Rectum. 2011 Oct; 54 (10):1326–38.

17. Martel J, Raskin JB. History, incidence, and epidemiology of diverticulosis. J Clin Gastroenterol. 2008; 42:1125–7.

18. Mäkelä JT, Kiviniemi HO, Laitinen ST. Spectrum of disease and outcome among patients with acute diverticulitis. Dig Surg. 2010 Aug; 27 (3):190–6. Epub 2010 Jun 22.

19. Morini S, Hassan C, Zullo A, et al. Epithelial cell proliferation of the colonic mucosa in diverticular disease: a case-control study. Aliment Pharmacol Ther. 2005 Jun 1; 21 (11):1385–90.

20. Painter NS, Burkitt DP. Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol. 1975; 4:3–21.

21. Papi C, Ciaco A, Koch M, Capurso L. Efficacy of rifaximin on symptoms of uncomplicated diverticular disease of the colon. A pilot multicentre open trial. Diverticular Disease Study Group. Ital J Gastroenterol. 1992; 24:452– 6.

22. 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 placebocontrolled trial. Aliment Pharmacol Ther. 1995; 9:33–9.

23. Petruzziello L, Iacopini F, Bulajic M, et al. Review article: uncomplicated diverticular disease of the colon. Aliment Pharmacol Ther. 2006 May 15; 23 (10):1379–91.

24. Zullo A, Hassan C, Maconi G, et al. Cyclic antibiotic therapy for diverticular disease: a critical reappraisal. J Gastrointestin Liver Dis. 2010 Sep; 19(3):295–302.


Review

For citations:


Achkasov S.I., Moskalyov A.I., Trubachyova Yu.L., Filon A.F. Efficacy of rifaximin in the treatment of chronic relapsing diverticulitis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2012;22(2):71-76. (In Russ.)

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ISSN 1382-4376 (Print)
ISSN 2658-6673 (Online)