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Diseases of old age Terapia 2020, 11 ( 394 ) :  54  -  62

Do not stop therapy of chronic diseases during the COVID-19 period. Cyclic combined treatment in diverticular disease: When, to whom, how many cycles and why?

Summary: The main goal of therapy in the Covid-19 era is to maintain remission and not to discontinue the current treatment, to reduce the risk of disease exacerbation and avoid hospitalization. Symptomatic uncomplicated diverticular disease (SUDD) is one of the most common diseases of the colon, resulting in a huge, growing number of outpatient visits and hospitalizations every year. Half of people over 60 years of age have diverticula, and after 70 years of age the incidence of diverticula is 64%. In recent years, an increase in the incidence of symptomatic forms has been observed, reaching 20% of people with diverticulosis. The etiology of the disease, which is still poorly understood, currently emphasizes the role of intestinal microbiota disorders, chronic minimal inflammation and a diet low in soluble fiber. The clinical spectrum of diverticular disease includes asymptomatic diverticulosis, symptomatic uncomplicated diverticular disease (SUDD), uncomplicated diverticulitis and its complications. In patients with diverticulosis, subjective symptoms in the form of recurrent abdominal pain of varying severity, flatulence and a variable rhythm of bowel movements indicate the need for treatment. According to the recommendations of PTG-E and TChP, chronic cyclic use of eubiotic rifaximin-α (2 × 400 mg for 7 days in a month, up to 12 months, and even up to 24 months in case of a previous diverticulitis episode) together with daily supplementation of soluble fiber (NNT=3) is recommended in the treatment of SUDD. If, in addition, there are general symptoms of diverticulitis (fever, abnormal laboratory results), the diagnosis is acute diverticulitis, which can be treated on an outpatient basis without the need for the patient to visit the emergency department and use systemic antibiotics, reserved for hospital treatment. The aim of SUDD treatment is to restore eubiosis, control the ailment, cure the inflammation, reduce complications and prevent relapses.
Keywords: diverticula, symptomatic uncomplicated diverticular disease - SUDD, diverticulitis, rifaximin-α, intestinal microbiota, arabinogalactan, lactoferrin

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