Enfermedad diverticular del colon no complicada sintomática (EDCNCS)indicaciones para cirugía programada

  1. Escalera Pérez R. 1
  2. Gutiérrez Cafranga E. 1
  3. Muñoz Caracuel E. 1
  4. Mac Mathuna S. 1
  5. Gavilán Parras J. 1
  6. García Molina, F. J. 1
  1. 1 Hospital Universitario Jerez. Cádiz.
Revista:
Cirugía Andaluza

ISSN: 2695-3811,  1130-3212

Año de publicación: 2021

Volumen: 32

Número: 4

Páginas: 447-459

Tipo: Artículo

DOI: 10.37351/2021324.4 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

Otras publicaciones en: Cirugía Andaluza

Resumen

La Enfermedad diverticular del colon no complicada sintomática (EDCNCS) es una entidad clínica caracterizada por síntomas abdominales recurrentes con un considerable impacto psicosocial en algunos pacientes. Se ha considerado la principal forma de enfermedad diverticular, con una prevalencia estimada del 80%, aunque podría ser mucho más baja. La fisiopatología no se conoce en su totalidad pero la evidencia sugiere varios mecanismos. Los síntomas son poco específicos, lo que dificulta su diagnóstico y la exclusión de otros cuadros como el Síndrome de Intestino Irritable (SII). En líneas generales, se define como un cuadro de dolor abdominal recurrente en fosa iliaca izquierda ocasionado por la presencia de divertículos en el colon sin datos clínicos, de laboratorio o radiológicos de inflamación. El objetivo del presente trabajo es revisar la EDCNCS, su realidad clínica, fisiopatológica, diagnóstica y, sobre todo, sus indicaciones quirúrgicas. Los pilares fundamentales de su tratamiento serán el alivio de los síntomas y mejora de la calidad de vida; prevención de la progresión o aparición de diverticulitis aguda y la prevención de la recurrencia. Para ello se establecen tres escalones terapéuticos: medidas higiénico-dietéticas, farmacológico y quirúrgico, siendo este último difícil de establecer como lo demuestra el escaso número de publicaciones y pacientes intervenidos por dicha enfermedad en la bibliografía existente.

Referencias bibliográficas

  • Cuomo R, Barbara G, Pace F, Annese V, Bassotti G, Binda GA, et al. Italian consensus conference for colonic diverticulosis and diverticular disease. Vol. 2, United European Gastroenterology Journal. SAGE Publications Ltd; 2014. p. 413–42.
  • Strate LL, Modi R, Cohen E, Spiegel BMR. Diverticular disease as a chronic illness: Evolving epidemiologic and clinical insights. Vol. 107, American Journal of Gastroenterology. 2012. p. 1486–93.
  • Everhart JE, Ruhl CE. Burden of Digestive Diseases in the United States Part II: Lower Gastrointestinal Diseases. Gastroenterology. 2009;136(3):741–54.
  • Tursi A. Diverticulosis today: Unfashionable and still under-researched. Vol. 9, Therapeutic Advances in Gastroenterology. SAGE Publications Ltd; 2016. p. 213–28.
  • Tursi A, Scarpignato C, Strate LL, Lanas A, Kruis W, Lahat A, et al. Colonic diverticular disease. Vol. 6, Nature Reviews Disease Primers. Nature Research; 2020.
  • Tursi A, Elisei W, Franceschi M, Picchio M, Mario F di, Brandimarte G. The prevalence of symptomatic uncomplicated diverticular disease could be lower than expected: a single-center colonoscopy-based cohort study. 2021; Available from: www.eurojgh.com
  • Tursi A, Franceschi M, Elisei W, Picchio M, di Mario F, Brandimarte G. The natural history of symptomatic uncomplicated diverticular disease: A long-term follow-up study. Annals of Gastroenterology. 2021;34(2):208–13.
  • Annibale B, Lahner E, Maconi G, Usai P, Marchi S, Bassotti G, et al. Clinical features of symptomatic uncomplicated diverticular disease: A multicenter Italian survey. International Journal of Colorectal Disease. 2012 Sep;27(9):1151–9.
  • Scaioli E, Colecchia A, Marasco G, Schiumerini R, Festi D. Pathophysiology and Therapeutic Strategies for Symptomatic Uncomplicated Diverticular Disease of the Colon. Vol. 61, Digestive Diseases and Sciences. Springer New York LLC; 2016. p. 673–83.
  • Rezapour M, Ali S, Stollman N. Diverticular disease: An update on pathogenesis and management. Vol. 12, Gut and Liver. Editorial Office of Gut and Liver; 2018. p. 125–32.
  • Elisei W, Tursi ASL Roma AH, Laziale A. Recent advances in the treatment of colonic diverticular disease and prevention of acute diverticulitis [Internet]. Vol. 29, Ann Gastroenterol. 2016. Available from: www.annalsgastro.gr
  • Maconi G. Diagnosis of symptomatic uncomplicated diverticular disease and the role of rifaximin in management. Acta Biomedica. 2017;88(1):25–32.
  • Tursi A, Elisei W, Picchio M, Giorgetti GM, Brandimarte G. Moderate to Severe and Prolonged Left Lower-abdominal Pain is the Best Symptom Characterizing Symptomatic Uncomplicated Diverticular Disease of the Colon A Comparison With Fecal Calprotectin in Clinical Setting [Internet]. 2014. Available from: www.jcge.com
  • Scarpignato C, Barbara G, Lanas A, Strate LL. Management of colonic diverticular disease in the third millennium: Highlights from a symposium held during the United European Gastroenterology Week 2017. Vol. 11, Therapeutic Advances in Gastroenterology. SAGE Publications Ltd; 2018.
  • Lock JF, Galata C, Reißfelder C, Ritz JP, Schiedeck T. Operationsindikation und Operationszeitpunkt bei der Divertikelkrankheit. Vol. 117, Deutsches Arzteblatt International. Deutscher Arzte-Verlag GmbH; 2020. p. 591–6.
  • Tursi A, Brandimarte G, di Mario F, Andreoli A, Annunziata ML, Astegiano M, et al. Development and validation of an endoscopic classification of diverticular disease of the colon: The DICA classification. Vol. 33, Digestive Diseases. S. Karger AG; 2014. p. 68–76.
  • Mari GM, Crippa J, Borroni G, Cocozza E, Roscio F, Scandroglio I, et al. Symptomatic Uncomplicated Diverticular Disease and Incidence of Unexpected Abscess during Sigmoidectomy: A Multicenter Prospective Observational Study. Digestive Surgery. 2020 May 1;37(3):199–204.
  • Tursi A. Endoscopic Diagnosis of Diverticulosis and Diagnosis of Symptomatic Uncomplicated Diverticular Disease of the Colon: If You Properly Classify, You Properly Make the Diagnosis. Vol. 114, American Journal of Gastroenterology. Wolters Kluwer Health; 2019. p. 1349–50.
  • Peery AF, Keku TO, Addamo C, McCoy AN, Martin CF, Galanko JA, et al. Colonic Diverticula Are Not Associated With Mucosal Inflammation or Chronic Gastrointestinal Symptoms. Clinical Gastroenterology and Hepatology. 2018 Jun 1;16(6):884-891.e1.
  • Järbrink-Sehgal ME, Rassam L, Jasim A, Walker MM, Talley NJ, Agréus L, et al. Diverticulosis, Symptoms and Colonic Inflammation: A Population-Based Colonoscopy Study. American Journal of Gastroenterology. 2019 Mar 1;114(3):500–10.
  • Tursi A, Brandimarte G, di Mario F, Lanas A, Scarpignato C, Bafutto M, et al. International consensus on diverticulosis and diverticular disease. Statements from the 3rd international symposium on diverticular disease. Journal of Gastrointestinal and Liver Diseases. 2019;28:57–65.
  • Lahat A, Fidder HH, Ben-Horin S. Development and validation of a diverticular clinical score for symptomatic uncomplicated diverticular disease after acute diverticulitis in a prospective patient cohort. Therapeutic Advances in Gastroenterology. 2020;13.
  • Cuomo R, Barbara G, Pace F, Annese V, Bassotti G, Binda GA, et al. Italian consensus conference for colonic diverticulosis and diverticular disease. Vol. 2, United European Gastroenterology Journal. SAGE Publications Ltd; 2014. p. 413–42.
  • Tursi A, Scarpignato C, Strate LL, Lanas A, Kruis W, Lahat A, et al. Colonic diverticular disease. Vol. 6, Nature Reviews Disease Primers. Nature Research; 2020.
  • Scaioli E, Colecchia A, Marasco G, Schiumerini R, Festi D. Pathophysiology and Therapeutic Strategies for Symptomatic Uncomplicated Diverticular Disease of the Colon. Vol. 61, Digestive Diseases and Sciences. Springer New York LLC; 2016. p. 673–83.
  • Jung HK, Choung RS, Locke GR, Schleck CD, Zinsmeister AR, Talley NJ. Diarrhea-predominant irritable bowel syndrome is associated with diverticular disease: A population-based study. American Journal of Gastroenterology. 2010;105(3):652–61.
  • Cuomo R, Barbara G, Andreozzi P, Bassotti G, Casetti T, Grassini M, et al. Symptom patterns can distinguish diverticular disease from irritable bowel syndrome. European Journal of Clinical Investigation. 2013 Nov;43(11):1147–55.
  • Bolster LT, Papagrigoriadis S. Diverticular disease has an impact on quality of life-results of a preliminary study.
  • Comparato G, Fanigliulo L, Aragona G, Cavestro GM, Cavallaro LG, Leandro G, et al. Quality of life in uncomplicated symptomatic diverticular disease: Is it another good reason for treatment? In: Digestive Diseases. 2007. p. 252–9.
  • Spiegel BMR, Reid MW, Bolus R, Whitman CB, Talley J, Dea S, et al. Development and validation of a disease-targeted quality of life instrument for chronic diverticular disease: the DV-QOL. Quality of Life Research. 2015 Jan 1;24(1):163–79.
  • van Dijk ST, Daniels L, de Korte N, Stockmann HB, Vrouenraets BC, Consten ECJ, et al. Quality of life and persistent symptoms after uncomplicated acute diverticulitis. Diseases of the Colon and Rectum. 2019 May 1;62(5):608–14.
  • Lanas A, Abad-Baroja D, Lanas-Gimeno A. Progress and challenges in the management of diverticular disease: which treatment? Vol. 11, Therapeutic Advances in Gastroenterology. SAGE Publications Ltd; 2018.
  • Tursi A. Diverticulosis today: Unfashionable and still under-researched. Vol. 9, Therapeutic Advances in Gastroenterology. SAGE Publications Ltd; 2016. p. 213–28.
  • Gargallo Puyuelo CJ, Sopeña F, Lanas Arbeloa A. Colonic diverticular disease. Treatment and prevention. Vol. 38, Gastroenterologia y Hepatologia. Ediciones Doyma, S.L.; 2015. p. 590–9.
  • Salem TA, Molloy RG, O’Dwyer PJ. Prospective, five-year follow-up study of patients with symptomatic uncomplicated diverticular disease. Diseases of the Colon and Rectum. 2007 Sep;50(9):1460–4.
  • Horgan AF, Ch B, Mcconnell EJ, Wolff BG, The S, Paterson C. Atypical Diverticular Disease Surgical Results.
  • Thorson AG, Beaty JS. Diverticular Disease. In: The ASCRS Textbook of Colon and Rectal Surgery. New York, NY: Springer New York; 2011.
  • Hjern F, Wolk A, Hkansson N. Obesity, physical inactivity, and colonic diverticular disease requiring hospitalization in women: A prospective cohort study. American Journal of Gastroenterology. 2012 Feb;107(2):296–302.
  • Abraha I, Binda GA, Montedori A, Arezzo A, Cirocchi R. Laparoscopic versus open resection for sigmoid diverticulitis. Vol. 2017, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2017.
  • Spiller R. Diverticular disease and IBS overlapping or misunderstanding? In: Journal of Clinical Gastroenterology. Lippincott Williams and Wilkins; 2016. p. S29–32.
  • Milasavljevic T, Brandimarte G, Stollman N, Barbara G, Lahat A, Scarpignato C, et al. Course of the diverticular disease: What is changing? Journal of Gastrointestinal and Liver Diseases. 2019;28:11–5.
  • Biagi E, Nylund L, Candela M, Ostan R, Bucci L, Pini E, et al. Through ageing, and beyond: Gut microbiota and inflammatory status in seniors and centenarians. PLoS ONE. 2010;5(5).
  • Yamada E, Inamori M, Uchida E, Tanida E, Izumi M, Takeshita K, et al. Association between the location of diverticular disease and the irritable bowel syndrome: A multicenter study in Japan. American Journal of Gastroenterology. 2014 Dec 11;109(12):1900–5.
  • Shahedi K, Fuller G, Bolus R, Cohen E, Vu M, Shah R, et al. Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clinical Gastroenterology and Hepatology. 2013 Dec;11(12):1609–13.
  • Gatta L, di Mario F, Curlo M, Vaira D, Pilotto A, Lucarini P, et al. Long-term treatment with mesalazine in patients with symptomatic uncomplicated diverticular disease. Internal and Emergency Medicine. 2012 Apr;7(2):133–7.
  • Järbrink-Sehgal ME, Rassam L, Jasim A, Walker MM, Talley NJ, Agréus L, et al. Diverticulosis, Symptoms and Colonic Inflammation: A Population-Based Colonoscopy Study. American Journal of Gastroenterology. 2019 Mar 1;114(3):500–10.
  • Picchio M, Elisei W, Tursi A. Mesalazine to treat symptomatic uncomplicated diverticular disease and to prevent acute diverticulitis occurrence. A systematic review with meta-analysis of randomized, placebo-controlled trials. Vol. 27, Journal of Gastrointestinal and Liver Diseases. Romanian Society of Gastroenterology; 2018. p. 291–7.
  • Dahl C, Crichton M, Jenkins J, Nucera R, Mahoney S, Marx W, et al. Evidence for dietary Fibre modification in the recovery and prevention of reoccurrence of acute, uncomplicated diverticulitis: A systematic literature review. Vol. 10, Nutrients. MDPI AG; 2018.
  • Kaiser AM, Jiang JK, Lake JP, Ault G, Artinyan A, Gonzalez-Ruiz C, et al. The management of complicated diverticulitis and the role of computed tomography. American Journal of Gastroenterology. 2005 Apr;100(4):910–7.
  • Daniels L, Ünlü, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. British Journal of Surgery. 2017 Jan 1;104(1):52–61.
  • Lahat A, Necula D, Yavzori M, Picard O, Halperin S, Eliakim R, et al. Prolonged recurrent abdominal pain is associated with ongoing underlying mucosal inflammation in patients who had an episode of acute complicated diverticulitis. Journal of Clinical Gastroenterology. 2019 May 1;53(5):E178–85.
  • Tursi A, Elisei W, Giorgetti GM, Damiano Inchingolo C, Nenna R, Picchio M, et al. Detection of Endoscopic and Histological Innammation aaer an Attack of Colonic Diverticulitis is Associated with Higher Diverticulitis Recurrence. Vol. 22, J Gastrointestin Liver Dis. 2013.
  • Mari GM, Crippa J, Roscio F, Scandroglio I, Cocozza E, Borroni G, et al. Quality of Life After Elective Laparoscopic Sigmoidectomy for Symptomatic Uncomplicated Diverticular Disease [Internet]. 2020. Available from: www.surgical-laparoscopy.com
  • Flum DR, Read TE. Evidence-Based Management of Diverticular Disease: What’s New and What’s Missing? Diseases of the Colon and Rectum. Lippincott Williams and Wilkins; 2020. p. 715–7.
  • Eglinton T, Nguyen T, Raniga S, Dixon L, Dobbs B, Frizelle FA. Patterns of recurrence in patients with acute diverticulitis. British Journal of Surgery. 2010 Jun;97(6):952–7.
  • Saavedra-Perez D, Curbelo-Peña Y, Sampson-Davila J, Albertos S, Serrano A, Ibañez L, et al. Management of symptomatic uncomplicated diverticular colon disease: A systematic review of diagnosis and treatment. Gastroenterologia y Hepatologia. Ediciones Doyma, S.L.; 2021.
  • Heise CP. Epidemiology and pathogenesis of diverticular disease. Journal of Gastrointestinal Surgery. 2008 Aug;12(8):1309–11.
  • Bassotti G, Battaglia E, de Roberto G, Morelli A, Tonini M, Villanacci V. Alterations in Colonic Motility and Relationship to Pain in Colonic Diverticulosis. 2005;
  • Bassotti G, Battaglia E, Bellone G, Dughera L, Fisogni S, Zambelli C, et al. Interstitial cells of Cajal, enteric nerves, and glial cells in colonic diverticular disease. Journal of Clinical Pathology. 2005 Sep;58(9):973–7.
  • Deery SE, Hodin RA. Management of Diverticulitis in 2017. Journal of Gastrointestinal Surgery. 2017 Oct 1;21(10):1732–41.
  • Clemens CHM, Samsom M, Roelofs J, van Berge Henegouwen GP, Smout AJPM. Colorectal visceral perception in diverticular disease. Gut. 2004 May;53(5):717–22.
  • Wess L, Eastwood MA, Edwards CA, Busuttil A, Miller A, Eastwood M. Collagen alteration in an animal model of colonic diverticulosis. Vol. 38, Gut. 1996.
  • Lee KN, Lee OY. The role of mast cells in irritable bowel syndrome. Vol. 2016, Gastroenterology Research and Practice. Hindawi Limited; 2016.
  • Rosemar A, Ivarsson ML, Börjesson L, Holmdahl L. Increased concentration of tissue-degrading matrix metalloproteinases and their inhibitor in complicated diverticular disease. Scandinavian Journal of Gastroenterology. 2007;42(2):215–20.
  • Humes DJ, Simpson J, Smith J, Sutton P, Zaitoun A, Bush D, et al. Visceral hypersensitivity in symptomatic diverticular disease and the role of neuropeptides and low grade inflammation. Neurogastroenterology and Motility. 2012 Apr;24(4).
  • Barbaro MR, Cremon C, Fuschi D, Scaioli E, Veneziano A, Marasco G, et al. Nerve fiber overgrowth in patients with symptomatic diverticular disease. Neurogastroenterology and Motility. 2019;31(9).
  • Bode MK, Karttunen TJ, Mäkelä J, Risteli L, Risteli J. Type I and III Collagens in Human Colon Cancer and Diverticulosis. 2000.
  • Scarpignato C, Barbara G, Lanas A, Strate LL. Management of colonic diverticular disease in the third millennium: Highlights from a symposium held during the United European Gastroenterology Week 2017. Vol. 11, Therapeutic Advances in Gastroenterology. SAGE Publications Ltd; 2018.
  • Tursi A, Elisei W, Picchio M, Giorgetti GM, Brandimarte G. A Comparison With Fecal Calprotectin in Clinical Setting [Internet]. 2014. Available from: www.jcge.com
  • Tursi A, Brandimarte G, Elisei W, Giorgetti GM, Inchingolo CD, Aiello F. Faecal calprotectin in colonic diverticular disease: A case-control study. International Journal of Colorectal Disease. 2009;24(1):49–55.
  • Tursi A, Elisei W, Brandimarte G, Giorgetti GM, Inchingolo CD, Nenna R, et al. Musosal tumour necrosis factor α in diverticular disease of the colon is overexpressed with disease severity. Colorectal Disease. 2012 May;14(5).
  • Tursi A. Biomarkers in diverticular diseases of the colon. Digestive Diseases. 2012;30(1):12–8.
  • Tursi A. A critical appraisal of advances in the diagnosis of diverticular disease. Vol. 12, Expert Review of Gastroenterology and Hepatology. Taylor and Francis Ltd; 2018. p. 791–6.
  • Daniels L, Philipszoon LE, Boermeester MA. A hypothesis: Important role for gut microbiota in the etiopathogenesis of diverticular disease. Vol. 57, Diseases of the Colon and Rectum. Lippincott Williams and Wilkins; 2014. p. 539–43.
  • Barbara G, Scaioli E, Barbaro MR, Biagi E, Laghi L, Cremon C, et al. Gut microbiota, metabolome and immune signatures in patients with uncomplicated diverticular disease. Gut. 2017 Jul 1;66(7):1252–61.
  • Tursi A, Mastromarino P, Capobianco D, Elisei W, Miccheli A, Capuani G, et al. Assessment of fecal microbiota and fecal metabolome in symptomatic uncomplicated diverticular disease of the colon. In: Journal of Clinical Gastroenterology. Lippincott Williams and Wilkins; 2016. p. S9–12.
  • Kvasnovsky CL, Leong LEX, Choo JM, Abell GCJ, Papagrigoriadis S, Bruce KD, et al. Clinical and symptom scores are significantly correlated with fecal microbiota features in patients with symptomatic uncomplicated diverticular disease: A pilot study. European Journal of Gastroenterology and Hepatology. 2018 Jan 1;30(1):107–12.
  • Kruis W, Meier E, Schumacher M, Mickisch O, Greinwald R, Mueller R. Randomised clinical trial: Mesalazine (Salofalk granules) for uncomplicated diverticular disease of the colon - A placebo-controlled study. Alimentary Pharmacology and Therapeutics. 2013 Apr;37(7):680–90.
  • Campanini A, de Conto U, Cavasin F, Bastiani F, Camarotto A, Gardini L, et al. A primary-care interventional model on the diverticular disease: Searching for the optimal therapeutic schedule. In: Journal of Clinical Gastroenterology. Lippincott Williams and Wilkins; 2016. p. S93–6.
  • Scarpignato C, Bertele A, Tursi A. Probiotics for the treatment of symptomatic uncomplicated diverticular disease: Rationale and current evidence. In: Journal of Clinical Gastroenterology. Lippincott Williams and Wilkins; 2016. p. S70–3.
  • Schultz JK, Azhar N, Binda GA, Barbara G, Biondo S, Boermeester MA, et al. European Society of Coloproctology: guidelines for the management of diverticular disease of the colon. Colorectal Disease. 2020 Sep 1;22(S2):5–28.
  • Beighton1 PH, Murdoch2 JL, Votteler3 T. Gastrointestinal complications of the Ehlers-Danlos syndrome. Vol. 10, Gut. 1969.
  • Stagi S, Lapi E, Chiarelli F, de Martino M. Incidence of diverticular disease and complicated diverticular disease in young patients with Williams syndrome. Vol. 26, Pediatric Surgery International. 2010. p. 943–4.
  • Hjern F, Johansson C, Mellgren A, Baxter NN, Hjern A. Diverticular disease and migration - The influence of acculturation to a Western lifestyle on diverticular disease. Alimentary Pharmacology and Therapeutics. 2006 Mar;23(6):797–805.
  • Drossman DA. The Functional Gastrointestinal Disorders and the Rome III Process.
  • Squella FB, Indisa C, Squella Boerr F. Clasificaciones en Gastroenterología Clasificación de Roma III para Síndrome de Intestino Irritable Rome III Classification for IBS Tabla 1. Criterios diagnósticos de Roma III del SII. Vol. 23, Gastroenterol. latinoam. 2012.
  • Mostafa R. Rome III: The functional gastrointestinal disorders, third edition, 2006. World Journal of Gastroenterology. 2008;14(13):2124.
  • Tursi A, Brandimarte G, di Mario F, Andreoli A, Annunziata ML, Astegiano M, et al. Development and validation of an endoscopic classification of diverticular disease of the colon: The DICA classification. Vol. 33, Digestive Diseases. S. Karger AG; 2014. p. 68–76.
  • Cuomo R, Cargiolli M, Cassarano S, Carabotti M, Annibale B. Treatment of diverticular disease, targeting symptoms or underlying mechanisms. Current Opinion in Pharmacology. 2018 Dec 1;43:124–31.
  • Parente F, Bargiggia S, Prada A, Bortoli A. Intermittent treatment with mesalazine in the prevention of diverticulitis recurrence: a randomised multicentre pilot double-blind placebo-controlled study of 24-month duration.
  • Vaira D, d’Amico F, Fiorini G, Tursi A, Saracino IM, Pavoni M, et al. Efficacy of a New Nutraceutical Formulation in Patients with Symptomatic Uncomplicated Diverticular Disease (SUDD): a Prospective Observational Study. J Gastrointestin Liver Dis [Internet]. 2019;28:49–52. Available from: http://dx.doi.org/10.15403/jgld-560
  • Rennie. Results of Resection for Diverticular Disease and its Complications. 1975. 1975 Sep;575.
  • Thörn M, Graf W, Påhlman L. Scientific paper Clinical and functional results after elective colonic resection in 75 consecutive patients with diverticular disease. 2002.
  • Carabotti M, Cuomo R, Barbara G, Pace F, Andreozzi P, Cremon C, et al. Demographic and clinical features distinguish subgroups of diverticular disease patients: Results from an Italian nationwide registry. United European Gastroenterology Journal. 2018 Jul 1;6(6):926–34.
  • Boostrom SY, Wolff BG, Cima RR, Merchea A, Dozois EJ, Larson DW. Uncomplicated Diverticulitis, More Complicated than We Thought. Journal of Gastrointestinal Surgery. 2012 Sep;16(9):1744–9.
  • Strate LL, Modi R, Cohen E, Spiegel BMR. Diverticular disease as a chronic illness: Evolving epidemiologic and clinical insights. Vol. 107, American Journal of Gastroenterology. 2012. p. 1486–93.
  • Tursi A, Scarpignato C. Symptomatic Uncomplicated Diverticular Disease: Chronic Abdominal Pain in Diverticulosis Is Not Enough to Make the Diagnosis. Vol. 16, Clinical Gastroenterology and Hepatology. W.B. Saunders; 2018. p. 2001–2.
Fuente de los datos: Dialnet