A Primary-Care Interventional Model on the Diverticular Disease: Searching for the Optimal Therapeutic Schedule.
In routine colonoscopy, diverticulosis is the most commonly found feature, but only a minority of these cases show symptoms of diverticular disease.From June 2014 to December 2014, we enrolled prospectively 178 patients affected by symptomatic uncomplicated diverticular disease (Male/Female=0.47, mean age 71.7±11.5 y, range 41 to 95 y) from 15 General Pratictioners patient files. All patients were symptomatic; in all cases, diagnosis was been confirmed by a colonoscopy performed at least 1 year before. Patients with acute diverticulitis were excluded.On the basis of the predominant symptoms (abdominal complaints or constipation), patients were addressed to 4 different therapeutic approaches using mesalamine, rifaximine, probiotics (in a consortium of different species of Lactobacillus and Bifidobacterium), and fibers (Plantago Ovata Husk). All treatments lasted 3 months.



Sixty-three patients were enrolled in group A (rifaximine), 43 in group A1 (rifaximine+fibers+probiotics), 23 in group B (mesalamine), and 31 in group B1 (mesalamine+fibers).Analysis of variance suggested a statistically significant difference (P<0.003) among groups at the end of the observation period, with Groups A1 and B1 showing a higher number of bowel movement per week. Global linear measurement confirmed the role of treatment as a significant factor (F=2.858; P=0.039) associated with body mass index (F=6.972; P<0.009).



In accordance with the baseline clinical presentation, the supplementation of fiber and/or probiotics is associated with a statistically significant improvement in the clinical pattern of symptoms in patients with diverticular disease in a primary-care/family physician setting.
*Public Health Service, AUSL Parma ¶Department of Clinical and Experimental Medicine, University of Parma, Parma †Public Health Service, AUSL Treviso ‡Gastroenterological Unit, Treviso Hospital, Treviso §Department of Prevention, Occupational Health and Safety Unit ∥Provincial Agency for Health Services of the Autonomous Province of Trento, Trento, Italy.
Angelo
A
Campanini
Umberto
U
De Conto
Francesco
F
Cavasin
Fernanda
F
Bastiani
Antonio
A
Camarotto
Luigi
L
Gardini
Alessandra
A
Geremia
Cristina
C
Marastoni
Carlo
C
Missorini
Elena
E
Quarantelli
Umberto
U
Sassi
Francesco
F
Scarabello
Nadia
N
Dal Bo
Matteo
M
Riccò
Simone
S
Grillo
Stefano
S
Landi
Francesco
F
Di Mario
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004035:Diet Therapy / Q000379:methods*; D004043:Dietary Fiber / Q000627:therapeutic use; D000076385:Diverticular Diseases / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D019936:Probiotics / Q000627:therapeutic use*; D011446:Prospective Studies; D012294:Rifamycins / Q000627:therapeutic use; D000078262:Rifaximin; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004043:Dietary Fiber; D012294:Rifamycins; D019804:Mesalamine; D000078262:Rifaximin