Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2015; 21(27): 8366-8372
Published online Jul 21, 2015. doi: 10.3748/wjg.v21.i27.8366
Effect of oral mesalamine on inflammatory response in acute uncomplicated diverticulitis
Luca Nespoli, Giulia Lo Bianco, Fabio Uggeri, Fabrizio Romano, Angelo Nespoli, Davide Paolo Bernasconi, Luca Gianotti
Luca Nespoli, Giulia Lo Bianco, Fabio Uggeri, Fabrizio Romano, Angelo Nespoli, Luca Gianotti, Department of Surgery and Translational Medicine, University of Milan-Bicocca, San Gerardo Hospital, 20900 Monza, Italy
Davide Paolo Bernasconi, Department of Health Sciences, Centre of Biostatistics for Clinical Epidemiology, University of Milan-Bicocca, 20900 Monza, Italy
Author contributions: Gianotti L, Nespoli L, Lo Bianco G and Nespoli A contributed equally to the ideation and design of this study; Lo Bianco G, Romano F and Uggeri F were responsible for the acquisition of data; Bernasconi DP carried out statistical analysis; Nespoli L, Lo Bianco G and Gianotti L drafted the manuscript; Nespoli L, Lo Bianco G, Bernasconi DP and Gianotti L revised the draft; Gianotti L and Nespoli A where in charge of study supervision.
Institutional review board statement: Because of the retrospective design, approval of the ethic commission was not required in our institution.
Informed consent statement: Not required for retrospective study.
Conflict-of-interest statement: The authors declare no existing conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Luca Nespoli, MD, Department of Surgery and Translational Medicine, University of Milan-Bicocca, San Gerardo Hospital, via Pergolesi 33, 20900 Monza, Italy. luca.nespoli@unimib.it
Telephone: +39-39-2333651 Fax: +39-39-2333652
Received: February 12, 2015
Peer-review started: February 12, 2015
First decision: March 10, 2015
Revised: March 24, 2015
Accepted: May 7, 2015
Article in press: May 7, 2015
Published online: July 21, 2015
Abstract

AIM: To evaluate the impact of mesalamine administration on inflammatory response in acute uncomplicated diverticulitis.

METHODS: We conducted a single centre retrospective cohort study on patients admitted to our surgical department between January 2012 and May 2014 with a computed tomography -confirmed diagnosis of acute uncomplicated diverticulitis. A total of 50 patients were included in the analysis, 20 (study group) had received 3.2 g/d of mesalamine starting from the day of admission in addition to the usual standard treatment, 30 (control group) had received standard therapy alone. Data was retrieved from a prospective database. Our primary study endpoints were: C reactive protein mean levels over time and their variation from baseline (ΔCRP) over the first three days of treatment. Secondary end points included: mean white blood cell and neutrophile count over time, time before regaining of regular bowel movements (passing of stools), time before reintroduction of food intake, intensity of lower abdominal pain over time, analgesic consumption and length of hospital stay.

RESULTS: Patients characteristics and inflammatory parameters were similar at baseline in the two groups. The evaluation of CRP levels over time showed, in treated patients, a distinct trend towards a faster decrease compared to controls. This difference approached statistical significance on day 2 (mean CRP 6.0 +/- 4.2 mg/dL and 10.0 +/- 6.7 mg/dL respectively in study group vs controls, P = 0.055). ΔCRP evaluation evidenced a significantly greater increment of this inflammatory marker in the control group on day 1 (P = 0.03). A similar trend towards a faster resolution of inflammation was observed evaluating the total white blood cell count. Neutrophile levels were significantly lower in treated patients on day 2 and on day 3 (P < 0.05 for both comparisons). Mesalamine administration was also associated with an earlier reintroduction of food intake (median 1.5 d and 3 d, study group vs controls respectively, P < 0.001) and with a shorter hospital stay (median 5 d and 5.5 d, study group vs controls respectively, P = 0.03).

CONCLUSION: Despite its limitations, this study suggests that mesalamine may allow for a faster recovery and for a reduction of inflammatory response in acute uncomplicated diverticulitis.

Keywords: Acute diverticulitis, Inflammatory bowel disease, 5-ASA, Benign colonic disease

Core tip: Acute uncomplicated diverticulitis is the most common presentation of symptomatic diverticular disease. Taking the lead from evidence suggesting that acute uncomplicated diverticulitis may represent a form of inflammatory bowel disease, our study investigated, to our knowledge for the first time, the impact of oral mesalamine administration on early inflammatory parameters. When compared to standard therapy alone, mesalamine addition seemed to allow for a faster decrease of inflammation and for a faster recovery of the patients. Despite the limitations inherent in the study design, the results may , in our opinion, constitute the basis for future randomized, placebo-controlled, studies.