title: Systematic review of medical therapy to prevent recurrent diverticulitis.
abstract: OBJECTIVE
  One of today's controversies remains the prevention of recurrent diverticulitis. Current guidelines advise a conservative approach, based on studies showing low recurrence rates and a high operative morbidity and mortality. Conservative measures in prevention recurrence are dietary advises and medical therapies, including probiotics and 5-aminosalicylic acid.
  
  
  OBJECTIVE
  The aim of this systematic review is to assess whether medical or dietary therapies can prevent recurrent diverticulitis after a primary episode of acute diverticulitis.                                               METHOD AND SEARCH STRATEGY:                          We searched different databases for papers published between January 1966 and January 2011.
  
  
  METHODS
  Clinical studies were eligible for inclusion if they assessed the prevention of recurrent diverticulitis with a medical or dietary therapy. Exclusion criteria were studies without a control group.
  
  
  RESULTS
  Three randomized controlled trials (RCT), all with a Jadad quality score of 2 out of 5, were included in this systematic review. Mesalazine results in significantly less disease recurrence and fewer symptoms after an acute episode. The use of probiotics decreases symptoms but does not reduce recurrence. No difference in effect is seen when Balsalazide is added to probiotics compared to probiotics only. No relevant studies on dietary therapy/advices or antibiotics for prevention of recurrent diverticulitis were found.
  
  
  CONCLUSIONS
  The evidence that supports medical therapy to prevent recurrent diverticulitis is of poor quality. Treatment with 5-aminosalicylic acid seems promising. Based on current data, no recommendation of any non-operative relapse prevention therapy for diverticular disease can be made.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. c.unlu@amc.nl
authors.forename: Cagdas
authors.initials: C
authors.lastname: Unlü
authors.forename: Lidewine
authors.initials: L
authors.lastname: Daniels
authors.forename: Bart C
authors.initials: BC
authors.lastname: Vrouenraets
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004043:Dietary Fiber / Q000627:therapeutic use; D004238:Diverticulitis / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D019804:Mesalamine / Q000627:therapeutic use; D019936:Probiotics / Q000627:therapeutic use; D012008:Recurrence
chemical_list: D000900:Anti-Bacterial Agents; D004043:Dietary Fiber; D019804:Mesalamine