Diverticular disease is one of the most prevalent medical conditions in the United States.1,2 Symptomatic diverticular disease comprises a spectrum ranging from mildly symptomatic, with a profile similar to irritable bowel syndrome, to acute bouts of diverticulitis with complications such as abscess or perforation.3 Traditional dietary, medical, and surgical approaches are being re-considered in light of newer data. Recent research and clinical studies suggest that inflammation plays a role in the pathophysiology of diverticular disease.4,5 Results from other studies indicate a need to revise current recommendations about dietary modifications.6,7 In response to these and other advances, clinicians are re-examining current standards of care and evaluating the role of emerging therapies in the management of diverticular disease.
1. Everhart JE. The Burden of Digestive Diseases in the United States. Chapter 20. Available at http://www3.niddk.nih.gov/Burden_of_Digestive_Diseases/index.shtml#CHAPTER20.
2. Nguyen GC, Sam J, Anand N. Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States. World J Gastroenterol. 2011;17(12):1600-1605.
3. Stollman N, Raskin JB: Diverticular disease of the colon. Lancet. 2004; 363:631-639.
4. Simpson J, Sundler F, Humes DJ, Jenkins D, Scholefield JH, Spiller RC. Post inflammatory damage to the enteric nervous system in diverticular disease and its relationship to symptoms. Neurogastroenterology & Motility. 2009;21(8):847-858.
5. Bianchi M, Festa V, Moretti A, Ciaco A, Mangone M, Tornatore V, et al. Meta-analysis: long-term therapy with rifaximin in the management of uncomplicated diverticular disease. Aliment Pharmacol Ther. 2011;33(8):902-910.
6. Peery AF, Barrett PR, Park D, Rogers AJ, Galanko JA, Martin CF, Sandler RS. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology. 2012;142(2):266-272.
7. Strate LL, Liu YL, Syngal S, Aldoori WH, Giovannucci, EL. Nut, corn and popcorn consumption and the incidence of diverticular disease. JAMA. 2008; 300(8):907-914.
This activity has been designed to meet the educational needs of gastroenterologists, internists, and surgeons who care for patients with diverticular disease. Other healthcare professionals, including physician assistants (PAs), nurse practitioners (NPs), and nurses, may also participate.
As a result of participating in the activity, learners will be better able to:
- Consider the clinical implications of current evidence supporting the role of chronic inflammation in the pathophysiology of diverticular disease
- Implement strategies to improve the care of patients with diverticular disease based on current evidence
- Evaluate the potential clinical role of new therapeutic approaches in managing diverticular disease in specific patient groups
AMA PRA Category 1 Credit(s)TM
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of CME and Alliance Medical Communications. The American Academy of CME is accredited by the ACCME to provide continuing medical education for physicians.
The American Academy of CME designates this enduring material for a maximum of 2.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Neil H. Stollman, MD, FACP, FACG, AGAF (Chairman)
Associate Clinical Professor of Medicine
University of California, San Francisco
Chairman, Department of Medicine
Atla Bates Summit Medical Center
Martin H. Floch, MD, MACG, FACP, AGAF
Clinical Professor of Medicine
Yale University School of Medicine
Director of Ambulatory Gastroenterology
Yale Medical Group
New Haven, Connecticut
Robin Spiller, MD
Professor of Gastroenterology
Head, Division of Gastroenterology
Lead Director, Biomedical Research
Nottingham Digestive Diseases Centre
University of Nottingham
Queen’s Medical Centre
Nottingham, United Kingdom
Steven R. Peikin, MD-(Independent Clinical Peer Reviewer)
Professor of Medicine and Head, Division of Gastroenterology and Liver Diseases
Cooper Medical School of Rowan University and Cooper University Hospital
Adjunct Professor of Medicine
University of Medicine and Dentistry in New Jersey and Robert Wood Medical School
Camden, New Jersey
According to the disclosure policy of the Academy, all faculty, planning committee members, editors, managers and other individuals who are in a position to control content are required to disclose any relevant relationships with any commercial interests related to this activity. The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation. All educational materials are reviewed for fair balance, scientific objectivity and levels of evidence. Disclosures are as follows:
Martin H. Floch, MD, MACG, FACP, AGAF
Advisory Board – for scientific information:The Dannon Company, Shire Pharmaceuticals
Grants/Recipient/Research Support: Shire Pharmaceuticals (site PI; funds paid to Yale University School of Medicine)
Robin Spiller, MD
Advisory Board – for scientific information: Almirall, Ironwood, Prometheus, Shire Pharmaceuticals
Grants/Recipient/Research Support: Lesaffre, Norgine (site PI for both; funds paid to the University of Nottingham)
Neil H. Stollman, MD, FACP, FACG, AGAF
Grants/Recipient/Research Support: Salix Pharmaceuticals (funds paid to Northern California Gastroenterology Consultants)
Promotional Speakers’ Bureau: Aptalis, Otsuka, Warner Chilcott
Steven R. Peikin, MD- (Independent Clinical Peer Reviewer)
Advisory Board – for scientific information: Chiasma, Inc.
Intellectual Property: Novel Oral Cholecystokinin-like Drug
John JD Juchniewicz, MCIS, American Academy of CME and Deborah Dean, Michelle Yechout, and Wendy Gloffke, PhD, Alliance Medical Communications: No relevant financial relationships with any commercial interests.
Unapproved Product Use
This activity will review off-label or investigational use of mesalamine, probiotics, and rifaximin.
The information presented at this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician regarding diagnosis and treatment of a specific patient’s medical condition.
This activity is designed for use by health care professionals for educational purposes only. The opinions expressed in this educational activity are those of the faculty, and do not represent those of the Academy or Alliance Medical Communications. This activity is intended as a supplement to existing knowledge, published information, and practice guidelines. Learners should appraise the information presented critically, and draw conclusions only after careful consideration of all available scientific information.
In addition, the American Academy of CME requires all faculty/authors to note the level of evidence for any patient care recommendation made during their presentations. For this activity, the American Academy of CME used the Levels of Evidence and Grade Recommendation from the 2006 Diseases of the Colon and Rectum Practice Parameters [Rafferty J., Shellito P., Hyman NH., et al].
Levels of Evidence
I Meta-analysis of multiple well-designed, controlled studies, randomized trials with
low-false positive and low-false negative errors (high power)
II At least one well-designed experimental study; randomized trials with high false-positive
or high false-negative errors or both (low power)
III Well-designed, quasi experimental studies, such as nonrandomized, controlled,
single-group, preoperative-postoperative comparison, cohort, time, or matched
IV Well-designed, non-experimental studies, such as comparative and correlational
descriptive and case studies
V Case reports and clinical examples
Grade of Recommendation
A Evidence of type I or consistent findings from multiple studies of Type II, III, or IV
B Evidence of Type II, III, or IV and generally consistent findings
C Evidence of Type II, III, or IV but inconsistent findings
D Little or no systematic empirical evidence
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If you have any questions relating to the accreditation for this activity, please contact:
John JD Juchniewicz, MCIS, CCMEP
American Academy of CME, Inc.
2275 West County Line Road
Jackson, NJ 08527
Support for this activity has been made possible through an independent educational grant from:
There are no fees to participate in the activity. Participants must review the CME information including the activity objectives and disclosure statements, as well as the content of the activity. To receive CME credit for your participation, please complete the post-test (achieving a passing grade of 70% or greater), and program evaluation.
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© 2012. This CME-certified activity is held as copyrighted © by the American Academy of CME and Alliance Medical Communications. Through this notice, the Academy and Alliance Medical Communications grant permission of its use for educational purposes only. These materials may not be used, in whole or in part, for any commercial purposes without prior permission in writing from the copyright owner(s).
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