GI, Improving Outcomes, Improving Throughput, Mythbusting

The State of the Colon Address

 

A history of “uncomplicated acute diverticulitis” :

– In the beginning, there was “PO therapy is equivalent to IV therapy.”

– Then, there was, “Short course of antibiotics similar to long courses of antibiotics! (4 days vs 7 days)”

– Followed by, “Antibiotics neither accelerate recovery nor prevent complications or recurrence.”

And now, some validation.

In the November 2014 issue of Scandinavian Journal of Gastroenterology, a retrospective population-based cohort study included all patients diagnosed with all types of acute colonic diverticulitis during the year 2011 at a single Swedish Hospital. 195 CT scan verified episodes of acute uncomplicated cases of diverticulitis were identified, with 178 cases not treated with antibiotics and the remaining 17 patients were treated with antibiotics. 6 patients that were not treated with antibiotics were readmitted and 2 developed an abscess (3.4% and 1.1% respectively), compared to one patient (5.9%) in the group that was treated with antibiotics and still developed an abscess. Twenty-five (12.8%) patients in the no-antibiotic group presented with a recurrence within 1 year.

Compare this to the AAFP Review on Diverticulitis, which cites an historic recurrence rate of between 9 and 36%, and what I call a 3.9% “bad bounceback rate” – meaning, they return with a perforation, abscess, or fistula. While the results from the above mentioned Journal are only from a single institute and not blinded, and having a second arm that is only comprised of 17 patients is a bit quirky- this is the second study suggesting that antibiotics do not accelerate recovery and do not prevent complications or recurrence.

 

And that is the State of the Colon in 2014.

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http://www.ncbi.nlm.nih.gov/pubmed/19016815

http://www.ncbi.nlm.nih.gov/pubmed/20140619

http://www.ncbi.nlm.nih.gov/pubmed/22290281

http://www.ncbi.nlm.nih.gov/pubmed/25369865

http://www.aafp.org/afp/2013/0501/p612.html

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One thought on “The State of the Colon Address

  1. Pingback: Rethinking Diverticulitis | EM in Focus

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