A carregar...
Publicação
Doença diverticular do cólon : novas perspectivas
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 992.47 KB | Adobe PDF |
Orientador(es)
Resumo(s)
A doença diverticular do cólon (DDC) é uma das patologias gastrointestinais mais comuns, cada vez mais prevalente e com grande impacto nos custos da saúde. Devido à sua complexidade e heterogeneidade relativamente à terminologia, bem como do ponto de vista fisiopatológico e clínico, a conduta e gestão desta patologia representam um grande desafio na prática médica. Este estudo tem como objectivo esclarecer o estado da arte da DDC, averiguando o impacto das novas descobertas a nível fisiopatológico, opções diagnósticas e terapêuticas. Esta patologia engloba um variado espectro de entidades: diverticulose assintomática, doença diverticular (DD) sintomática não complicada, colite segmentar associada a diverticulose e diverticulite aguda (DA) com ou sem complicações associadas. Apesar dos mecanismos fisiopatológicos da DDC ainda não estarem completamente esclarecidos, alguns progressos foram feitos, propondo-se um impacto genético e uma possível relação com alterações microbióticas intestinais. Alguns marcadores biológicos revelaram-se úteis nesta abordagem, nomeadamente a calprotectina fecal (CF) no diagnóstico diferencial da DD sintomática não complicada com a síndrome do intestino irritável (SII) e a proteína C-reactiva (PCR) que associada a determinados sintomas se pode relacionar fortemente com o diagnóstico de DA se valores acima de 5mg/dL. Alguma evidência apoia a dieta rica em fibra como prevenção útil na formação de divertículos. O tratamento da DD sintomática não complicada assenta numa dieta rica em fibra, associada a rifaximina e eventualmente o uso de probióticos e mesalazina, apesar de alguma controvérsia. O uso de antibióticos na terapia da DA também passou por uma recente revolução, reservando-se o seu uso para as complicações e apenas em casos selecionados de DA sem complicações. Na DA complicada tem-se apostado também menos na cirurgia em prol de alternativas como imagiologia de intervenção, drenagem percutânea e antibioterapia dirigida, contudo a literatura ainda é escassa principalmente nos casos mais complexos desta entidade.
Colonic diverticular disease (CDD) is one of the most common gastrointestinal diseases and has become progressively more prevalent thus having a greater impact on healthrelated costs. Due to its complex and heterogenous terminology, physiopathology and clinical presentation, its management represents an important challenge in medical practice. This study’s main objective is to clarify the colonic diverticulosis state of the art by evaluating the impact of recent physiopathological discoveries, diagnostic and therapeutic options. This disease contains a large variety of entities: asymptomatic diverticulosis (AD) symptomatic uncomplicated diverticular disease (SUDD), segmental colitis associated with diverticulosis and acute diverticulitis (AD) with or without any associated complications. Although the physiopathological mechanisms of colonic diverticulosis are not fully understood, some progress has been made by associating it with the genetic background and possibly with changes in intestinal microbiology. Some biological markers have proved useful in this approach, namely fecal calprotectin (FC) in the differential diagnosis of uncomplicated symptomatic DD with irritable bowel syndrome (IBS) and C-reactive protein (CRP) which, when associated with certain symptoms, may be strongly related to the diagnosis of AD if values above 5mg / dL. Some evidence supports a fiber rich diet as a useful prevention in diverticular formation. SUDD treatment is based on a fiber rich diet associated with rifaximin. Probiotic drugs and mesalazine may also be used although opinions are controversial. The use of antibiotics in AD therapy also underwent a recent revolution, reserving its use only for complications and selected cases of uncomplicated AD. Surgery on complicated diverticulitis has been steadily decreasing due to the emergence of alternatives such as intervention radiology, percutaneous drainage and directed antibiotic therapy but studies are still not clear especially in the most complex cases.
Colonic diverticular disease (CDD) is one of the most common gastrointestinal diseases and has become progressively more prevalent thus having a greater impact on healthrelated costs. Due to its complex and heterogenous terminology, physiopathology and clinical presentation, its management represents an important challenge in medical practice. This study’s main objective is to clarify the colonic diverticulosis state of the art by evaluating the impact of recent physiopathological discoveries, diagnostic and therapeutic options. This disease contains a large variety of entities: asymptomatic diverticulosis (AD) symptomatic uncomplicated diverticular disease (SUDD), segmental colitis associated with diverticulosis and acute diverticulitis (AD) with or without any associated complications. Although the physiopathological mechanisms of colonic diverticulosis are not fully understood, some progress has been made by associating it with the genetic background and possibly with changes in intestinal microbiology. Some biological markers have proved useful in this approach, namely fecal calprotectin (FC) in the differential diagnosis of uncomplicated symptomatic DD with irritable bowel syndrome (IBS) and C-reactive protein (CRP) which, when associated with certain symptoms, may be strongly related to the diagnosis of AD if values above 5mg / dL. Some evidence supports a fiber rich diet as a useful prevention in diverticular formation. SUDD treatment is based on a fiber rich diet associated with rifaximin. Probiotic drugs and mesalazine may also be used although opinions are controversial. The use of antibiotics in AD therapy also underwent a recent revolution, reserving its use only for complications and selected cases of uncomplicated AD. Surgery on complicated diverticulitis has been steadily decreasing due to the emergence of alternatives such as intervention radiology, percutaneous drainage and directed antibiotic therapy but studies are still not clear especially in the most complex cases.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Doença diverticular Antibióticos Calprotectina fecal Colonoscopia Fibra