title: Effect of oral mesalamine on inflammatory response in acute uncomplicated diverticulitis.
abstract: OBJECTIVE
  To evaluate the impact of mesalamine administration on inflammatory response in acute uncomplicated diverticulitis.
  
  
  METHODS
  We conducted a single centre retrospective cohort study on patients admitted to our surgical department between January 2012 and May 2014 with a computed tomography -confirmed diagnosis of acute uncomplicated diverticulitis. A total of 50 patients were included in the analysis, 20 (study group) had received 3.2 g/d of mesalamine starting from the day of admission in addition to the usual standard treatment, 30 (control group) had received standard therapy alone. Data was retrieved from a prospective database. Our primary study endpoints were: C reactive protein mean levels over time and their variation from baseline (ΔCRP) over the first three days of treatment. Secondary end points included: mean white blood cell and neutrophile count over time, time before regaining of regular bowel movements (passing of stools), time before reintroduction of food intake, intensity of lower abdominal pain over time, analgesic consumption and length of hospital stay.
  
  
  RESULTS
  Patients characteristics and inflammatory parameters were similar at baseline in the two groups. The evaluation of CRP levels over time showed, in treated patients, a distinct trend towards a faster decrease compared to controls. This difference approached statistical significance on day 2 (mean CRP 6.0 +/- 4.2 mg/dL and 10.0 +/- 6.7 mg/dL respectively in study group vs controls, P = 0.055). ΔCRP evaluation evidenced a significantly greater increment of this inflammatory marker in the control group on day 1 (P = 0.03). A similar trend towards a faster resolution of inflammation was observed evaluating the total white blood cell count. Neutrophile levels were significantly lower in treated patients on day 2 and on day 3 (P < 0.05 for both comparisons). Mesalamine administration was also associated with an earlier reintroduction of food intake (median 1.5 d and 3 d, study group vs controls respectively, P < 0.001) and with a shorter hospital stay (median 5 d and 5.5 d, study group vs controls respectively, P = 0.03).
  
  
  CONCLUSIONS
  Despite its limitations, this study suggests that mesalamine may allow for a faster recovery and for a reduction of inflammatory response in acute uncomplicated diverticulitis.
authors.affiliation: Luca Nespoli, Giulia Lo Bianco, Fabio Uggeri, Fabrizio Romano, Angelo Nespoli, Luca Gianotti, Department of Surgery and Translational Medicine, University of Milan-Bicocca, San Gerardo Hospital, 20900 Monza, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Nespoli
authors.affiliation: Luca Nespoli, Giulia Lo Bianco, Fabio Uggeri, Fabrizio Romano, Angelo Nespoli, Luca Gianotti, Department of Surgery and Translational Medicine, University of Milan-Bicocca, San Gerardo Hospital, 20900 Monza, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Lo Bianco
authors.affiliation: Luca Nespoli, Giulia Lo Bianco, Fabio Uggeri, Fabrizio Romano, Angelo Nespoli, Luca Gianotti, Department of Surgery and Translational Medicine, University of Milan-Bicocca, San Gerardo Hospital, 20900 Monza, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Uggeri
authors.affiliation: Luca Nespoli, Giulia Lo Bianco, Fabio Uggeri, Fabrizio Romano, Angelo Nespoli, Luca Gianotti, Department of Surgery and Translational Medicine, University of Milan-Bicocca, San Gerardo Hospital, 20900 Monza, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Romano
authors.affiliation: Luca Nespoli, Giulia Lo Bianco, Fabio Uggeri, Fabrizio Romano, Angelo Nespoli, Luca Gianotti, Department of Surgery and Translational Medicine, University of Milan-Bicocca, San Gerardo Hospital, 20900 Monza, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Nespoli
authors.affiliation: Luca Nespoli, Giulia Lo Bianco, Fabio Uggeri, Fabrizio Romano, Angelo Nespoli, Luca Gianotti, Department of Surgery and Translational Medicine, University of Milan-Bicocca, San Gerardo Hospital, 20900 Monza, Italy.
authors.forename: Davide Paolo
authors.initials: DP
authors.lastname: Bernasconi
authors.affiliation: Luca Nespoli, Giulia Lo Bianco, Fabio Uggeri, Fabrizio Romano, Angelo Nespoli, Luca Gianotti, Department of Surgery and Translational Medicine, University of Milan-Bicocca, San Gerardo Hospital, 20900 Monza, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Gianotti
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D004238:Diverticulitis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007558:Italy; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage*; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D005765:Gastrointestinal Agents; D018836:Inflammation Mediators; D019804:Mesalamine; D002097:C-Reactive Protein
keywords: 5-ASA; Acute diverticulitis; Benign colonic disease; Inflammatory bowel disease