A relação entre a dieta e a fisiopatologia da diverticulite: revisão integrativa / The relation between the diet and the diverticulitis pathophysiology: an integrative review

ABSTRACT BACKGROUND: Diverticulitis is an acute inflammatory process that affects individuals with diverticular disease. Given the sharp increase in the diagnostic rate of such a pathological process, there was also an increased interest in elucidating the possible causes related to the development of this clinical condition. Among the main factors investigated, diet excels, the object of study of this integrative literature review. METHODS: After searching the virtual health library and PubMed databases, five prospective cohort studies were selected that best answered the guiding question: "Is there a relationship between diet and the incidence of diverticulitis?". RESULTS: It was observed that the high intake of red meat and the low intake of dietary fiber were the most strongly associated dietary factors with the incidence of this inflammatory process. CONCLUSION: Therefore, it is evident that choosing healthy eating habits can considerably reduce the incidence of diverticulitis and, consequently, potentially more serious complications directly related to it.

RESUMO CONTEXTO: A diverticulite é um processo inflamatório agudo que afeta indivíduos com doença diverticular. Diante do acentuado aumento da taxa diagnóstica desse processo patológico, também houve o aumento do interesse em elucidar as possíveis causas relacionadas ao desenvolvimento dessa condição clínica. Entre os principais fatores investigados, destaca-se a dieta; objeto de estudo desta revisão integrativa da literatura. MÉTODOS: Após pesquisa nas bases de dados da biblioteca virtual em saúde e PubMed, foram selecionados cinco estudos de coorte prospectivos que melhor responderam à questão norteadora "Há relação entre dieta e incidência de diverticulite?". RESULTADOS E CONCLUSÃO: Observou-se que o alto consumo de carnes vermelhas e o baixo consumo de fibra alimentar são os fatores dietéticos mais fortemente associados à incidência desse processo inflamatório. Fica evidente, portanto, que a escolha de hábitos alimentares saudáveis pode reduzir consideravelmente a incidência de diverticulite e, consequentemente, de possíveis complicações mais graves diretamente relacionadas a ela.

Diverticulitis aguda de intestino delgado en un paciente con enfermedad de Crohn: Report of one case / Acute small bowel diverticulitis in a patient with crohn’s disease

Diverticular disease of the small intestine is rare, especially when it is located in the jejunum. It is generally asymptomatic, but in some patients it may have complications such as acute diverticulitis with peritonitis, gastrointestinal bleeding or obstruction. In such cases, the recommended treatment is surgery. We report a 77-year-old patient with ileal Crohn’s disease with a long-standing inflammatory phenotype, who developed acute diverticulitis of the jejunum presenting a severe septic shock and secondary multiple-organ failure. It resolved with medical treatment and prolonged antibiotic therapy.

Enfermedad diverticular: mitos y realidades / Diverticular disease: myths and realities

Diverticulosis and diverticular disease of the colon are common conditions in Western countries. The incidence and prevalence of these diseases are increasing and becoming significant for health systems. A growing body of knowledge is shifting the paradigm of the pathogenesis and treatment of diverticular disease. Low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors leading to diverticular disease. The risk of developing diverticulitis among individuals with diverticulosis is lower than 10 to 25%. Studies indicate that diverticular disease may become a chronic disorder in some patients, not merely an acute illness. Contrary to the advice from international guidelines, studies have not shown that a high-fiber diet protects against diverticulosis. The evidence about the use of antibiotics in uncomplicated diverticulitis is sparse and of low quality. In relation to surgery, studies support a more conservative approach to prophylactic surgery in patients with recurrent disease or chronic symptoms. Finally, new pathophysiological knowledge suggests that other treatments may be useful (mesalamine, rifaximin and probiotics). However, more research is necessary to validate the safety, effectiveness and cost-effectiveness of these strategies.

Enfrentamiento actual de la enfermedad diverticular complicada. visión del gastroenterólogo / Current approach to complicated diverticular disease by the gastroenterologist

Prevalence of colonic diverticulosis is increasing, although usually asymptomatic. Acute diverticulitis (AD)is the most frequent complications, afflicting 1-2 percent of cases in the long term. Diagnosis and classification of AD can usually be accomplished by simple clinical manifestations and laboratory tests. Ultrasonography and CT scan are the most frequently used imaging tests to confirm diagnosis and detect complications. Modifications to the classical Hinchey classification have incorporated uncomplicated AD (without abscess or perforation), the most frequent presentation, allowing to suggest therapy according to the severity of the disease. Uncomplicated AD usually has a benign course, does not require hospitalization and there is growing evidence suggesting that antibiotics are not required. Recurrence is uncommon and with low risk. The number of recurrences by itself is no more a valid criterion to indicate surgery and most patients should be managed medically, although there are no drugs with proven utility to modify the risk of recurrence. Complicated AD can be managed with intravenous antibiotics and percutaneous drainage of abscesses. Surgery is indicated in case of free perforation or diffuse peritonitis. There is a growing trend to use laparoscopic approach and perform peritoneal lavage, without resection in the emergency setting. However, many patients will require resective surgery during the follow-up. The classical paradigms that have guided the approach to colonic diverticulosis are being challenged by the lack of evidence, but the new ones still have to be constructed. For now, we must tolerate high levels of uncertainty and heterogeneity in the management of this common condition.

La diverticulosis colónica ha aumentado su frecuencia, es generalmente asintomática y se complica entre 1-2 por ciento a largo plazo, siendo la diverticulitis aguda (DA) la complicación más frecuente. El diagnóstico y categorización de la DA puede realizarse en base a las manifestaciones clínicas y exámenes de laboratorio simple. Las imágenes más utilizadas son la ecotomografía y la tomografía computada. Se han sugerido modificaciones a la clásica clasificación de Hinchey, que incorporan la DA no complicada y permiten sugerir la terapia de acuerdo a la gravedad. La DA no complicada (sin absceso ni perforación) es la presentación clínica más frecuente. Su evolución es benigna, no requiere hospitalización y existe evidencia creciente que cuestiona la utilidad de los antibióticos. La recurrencia es infrecuente y de bajo riesgo. El número de recurrencias no es un criterio válido para indicar la cirugía. La DA complicada puede manejarse con antibióticos intravenosos y drenaje percutáneo de abscesos. La cirugía está indicada en caso de perforación libre o peritonitis difusa. Existe una tendencia creciente a realizar aseo por vía laparoscópica, sin resección. La mayor parte de los pacientes con DA complicada requieren cirugía resectiva durante la evolución, mientras que aquellos con DA no complicada son de manejo médico, aunque no existen fármacos con utilidad demostrada para modificar el riesgo de recurrencia. Los paradigmas que han guiado el enfrentamiento de la diverticulosis colónica están siendo cuestionados por la falta de evidencia, por lo que, por ahora, debemos tolerar altos niveles de incerteza y heterogeneidad en el manejo de esta frecuente patología.

Diagnóstico por imágenes de diverticulitis de Meckel: presentación de un caso clínico y revisión de la literatura / Diagnostic imaging of Meckel diverticulitis: case clinical report and review of the literature

Presentamos un caso de diverticulitis de Meckel en un niño de 7 años, diagnosticado por ultrasonido y documentado por cirugía. Revisamos la literatura acerca de la etiología de esta patología, su cuadro clínico y describimos los hallazgos imagenológicos principales. No es una patología frecuente, pero es necesario considerarla en el diagnóstico diferencial del abdomen agudo.

Diverticulite de Meckel por corpo estranho / Meckel' diverticulites by corpus striatum

Os autores apresentam um caso raro de diverticulite de Meckel por corpo estranho. O quadro clínico sugeriu abdome agudo cirúrgico. Os autores comentam a dificuldade diagnóstica no pré-operatório.