title: Rationale and evidences for treatment of symptomatic uncomplicated diverticular disease.
abstract: BACKGROUND
  Symptomatic uncomplicated diverticular disease (SUDD) is one of the possible clinical manifestations of diverticular disease. It is a common disorder characterized by chronic abdominal symptoms ranging from lower left abdominal pain to alteration of bowel habit, that significantly reduce quality of life of subject affected. The present article aims to review the current data for medical management of SUDD.
  
  
  METHODS
  We analyzed the existing literature on the factors involved in the pathogenesis of SUDD and we highlighted the possible target for treatment. Treatment for SUDD should be direct to relieve chronic symptoms and prevent diverticulitis and its complications. In particular we focused on the role of probiotics, fiber-diet, mesalazine and rifaximin on these two aspects. In this setting, we conducted a PubMed search for guidelines, systematic reviews and meta-analyses and updated information to October 2016.
  
  
  RESULTS
  Each topic was evaluated according to the best evidences available. Best results seemed to be obtained with combined therapies and in particular with rifaximin associated to high fiber-diet. This regimen seems to guarantee better symptoms control compared to fiber alone and it is more effective in preventing acute diverticulitis. On the contrary, no clear evidences about the efficacy of mesalazine and probiotics are available.
  
  
  CONCLUSIONS
  The results of the studies available in literature are controversial and debatable, for this reason a clear and defined algorithm for treatment of SUDD has not yet been defined. Further randomized, double-blind, placebo controlled study are necessary.
authors.affiliation: Unit of Gastroenterology, Department of Clinical Medicine and Surgery, &quot;Federico II&quot; School of Medicine, Naples, Italy - rosario.cuomo@unina.it.
authors.forename: Rosario
authors.initials: R
authors.lastname: Cuomo
authors.affiliation: Unit of Gastroenterology, Department of Clinical Medicine and Surgery, &quot;Federico II&quot; School of Medicine, Naples, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Cargiolli
authors.affiliation: Unit of Gastroenterology, Department of Clinical Medicine and Surgery, &quot;Federico II&quot; School of Medicine, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Andreozzi
authors.affiliation: Unit of Gastroenterology, Department of Clinical Medicine and Surgery, &quot;Federico II&quot; School of Medicine, Naples, Italy.
authors.forename: Francesco P
authors.initials: FP
authors.lastname: Zito
authors.affiliation: Unit of Gastroenterology, Department of Clinical Medicine and Surgery, &quot;Federico II&quot; School of Medicine, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sarnelli
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004043:Dietary Fiber / Q000008:administration & dosage*; D000076385:Diverticular Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D019804:Mesalamine / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D017410:Practice Guidelines as Topic; D019936:Probiotics / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004043:Dietary Fiber; D005765:Gastrointestinal Agents; D012294:Rifamycins; D019804:Mesalamine; D000078262:Rifaximin