自从2008年墨西哥胃肠病协会发布关于结肠憩室病的诊断和治疗指南以来,对这种疾病的认识已经取得了重大进展。对2008年1月至2018年7月医学文献中发表的文章进行了系统评价,以修订和更新2008年指南并提供新的循证建议。包括在该时间范围内发表的所有西班牙语和英语高质量文章。三轮投票中接受的43份声明的最终版本,利用德尔菲法,是写的,并为每个陈述确定了证据的质量和建议的强度,利用等级制度。目前的共识包含有关定义的新数据,分类,流行病学,病理生理学,结肠憩室病的危险因素。特别强调计算机断层扫描和结肠镜检查的有用性,以及控制出血的内镜方法。讨论了无并发症憩室炎的门诊治疗,以及利福昔明和美沙拉嗪在复杂急性憩室炎治疗中的作用。描述了其微创替代方案和手术选择,强调他们的适应症,局限性,和禁忌症。新的声明提供了基于最新科学证据的指南。每个陈述都被讨论,以及它的证据质量和建议的强度。
Since the publication of the 2008
guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008
guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present
consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide
guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.