Which anti-inflammatory agents are effective for the management of diverticulitis?

Updated: Aug 06, 2019
  • Author: Elie M Ghoulam, MD, MS; Chief Editor: BS Anand, MD  more...
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An increasing number of studies have reported the efficacy of different regimens of anti-inflammatory agents, including mesalamine; nonabsorbable antibiotics such as rifaximin; and probiotics alone or in combination in the management of diverticulitis. [42, 43] The American Gastroenterological Association (AGA) does not recommend the use of mesalamine, and it suggests against the use of rifaximin or probiotics, following acute uncomplicated diverticulitis. [5]

In the first US double-blind, placebo-controlled trial of the anti-inflammatory agent mesalamine for diverticulitis, 117 patients randomly assigned within 7 days of documented acute diverticulitis to a once-daily regimen of either 2.4 g delayed-release mesalamine or placebo over 12 weeks, followed by a 9-month treatment-free period, demonstrated persistently lower global symptoms scores for 10 gastrointestinal symptoms on a 0-6 Likert scale in patients receiving mesalamine compared with the placebo group. [43] The rate of complete response was significantly higher with the use of mesalamine than placebo at 6 weeks and 52 weeks, whereas probiotics in combination with mesalamine did not provide additional efficacy. [43]

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