One-year cyclic therapy with rifaximin-α is effective in the treatment of SUDD (Symptomatic Uncomplicated Diverticular Disease) also in patients with a history of complicated diverticulitis

Introduction: The treatment of diverticulosis symptoms in patients with a history of diverticulitis is a challenge in everyday clinical practice. Aim: Efficacy assessment of a cyclic, year-long treatment with rifaximin-alpha in patients with symptomatic uncomplicated diverticular disease (SUDD) and a history of past diverticulitis. Material and methods: This study is a multicenter, retrospective, observational study involving 48 centers. The study group included patients who reported to the outpatient clinic within a month with SUDD symptoms, who had a history of diverticulitis, and who were given a cyclic rifaximin-alpha treatment of 2 x 400 mg/day for 7 days and then once a month for 12 months. Epidemiological and demographic data, the course of diverticulosis, the number of inflammation episodes and their diagnoses, complications, symptoms of SUDD, and its treatment were evaluated. The efficacy of rifaximin-alpha therapy was assessed on a 4-point scale (0-no symptoms, 3-severe symptoms) every 3 months, and analyzed: pain, tenderness, bloating, bowel movements, and recurrence of inflammation during the 12-month treatment. Results: 178 patients (67% women, median age 65 years [34-92]) were included in the study. The average duration of diverticulosis was 6.4 years (3-20), and 59% of patients had more than one episode of diverticulitis during this period. In total, 87% of patients had symptoms of SUDD after or between episodes of diverticulitis. Abdominal pain was the most common symptom (92%). An inflammation episode was diagnosed using imaging in 50.5% of cases,and the rest-based on typical clinical symptoms. As many as 46.2% of patients required hospitalization, and complications were diagnosed in 44% of cases. One hundred and seventy (95%) patients completed the 12-month rifaximin-alpha therapy. Changes in the severity of pain, abdominal tenderness, diarrhea, constipation, and bloating were assessed every 3 months. After 12 months of treatment with rifaximin-alpha, there was a statistically significant reduction in the severity of symptoms overall (median from 1.5 [0-3 points] to 0.2; P<0.001) and each symptom evaluated individually. Regardless of the previous diagnostic method of diverticulitis (imaging or typical clinical presentation) or its complications (e.g. perforation, abscess), treatment with rifaximin-alpha was equally effective. Conclusions: Cyclic therapy with rifaximin-alpha is effective in treating SUDD symptoms and in preventing the recurrence of symptoms, also in patients with a history of diverticulitis-regardless of how the diagnosis was made and disease complications. The extended treatment regimen leads to a gradual resolution of symptoms during 12 months of observation. Cyclic use of rifaximin-alpha is necessary to maintain symptom remission.