triumph group - south american guidelines diverticular disease€¦ · •degree of recommendation...

South American Guidelines Diverticular disease

Mauro Bafutto

South America

Diverticular disease guidelines

• WGO (2007)

• Bazilian Guidelines (2008)

Definitions

Epidemiology

Etiology

Pathophysiology

Medical and surgical management

Medical and surgical management

Diverticulitis : Diagnostic and Treatment Bazilian Guidelines (2008)

• DEGREE OF RECOMMENDATION AND STRENGTH

OF EVIDENCE:

• A: Experimental or observational studies of best consistency.

• B: Experimental or observational studies of lower consistency.

• C: Case reports (non-controlled studies). • D: Opinion without critical evaluation, based on

consensus, physiologicalstudies or animal models

Definitions

• The diverticulitis means the presence of inflammation and infections associated with diverticula, more often localized in the sigmoid colon. The diverticular disease corresponds to the set of events associable to diverticulosis, since non-especific abdominal pain to complicated diverticulitis (D).

• The non-complicated diverticulitis is one with peridiverticulite or phlegmon, while the complicated diverticulitis is one that leads to intestinal obstruction, abscess formation, peritonitis and fístula (D).

Epidemiology

• The prevalence of colonic diverticulosis increases with age

• Lower than 10%for the population under 40 years, reaches a third of population over 45 years and is estimated to be between 50% and 66% for individuals with more than 80 years, reaching up to 80% this elderly population. (D).

• It is estimated that between 10% and 25% of individuals with diverticulosis evolve with diverticulitis (D).

Medical and surgical management

• The treatment of uncomplicated acute diverticulitis It is initially clinical through fasting (with or without the use of NG decompression) or liquid diet without waste, corporately to employment off broad spectrum antibiotics . (D)

• Empirical antibiotic therapy should be directed against gram-negative (D).

• There is evidence that systemic monotherapy is equally effective to associations antibiotic (A). Antibiotic therapy is usually maintained for seven to 10 days (D).

• Symptomatic improvement is expected between two and three days after introduction of the treatment, after this period the

diet can be progredida (D).

Medical and surgical management

• For elective surgery, the operation of choice became the sigmoidectomy or left colectomy with colorretal anastomosis (C). All the sigmoid colon must be removed (D). The primary anastomosis can also be performed in cases of pericolonic or pelvic abscess (Hinchey classification stages I and II) (D).

Paradox

• Mesalazine aprouved for regulatory agency

Diverticular disease projects for South America

• Guideline for South America – 2017 – 2018

• Multicentric researches

• Book – Diverticular disease : 3rd ed. Brasil 2016

Latin America 2018

• I World Diverticular Disease Congress