Mesalamine (5-ASA) for the Prevention of Recurrent Diverticulitis (Review)

Background Mesalamine, or 5-aminosalicylic acid (5-ASA) has been studied for the prevention of recurrent diverticulitis. Objectives To evaluate the efficacy of mesalamine (5-ASA) for the prevention of recurrent diverticulitis. Search methods We searched databases from 2010 to September 2017. In addition, we scanned reference lists from eligible publications, and we contacted corresponding authors to ask about additional trials. Selection criteria We included randomized controlled clinical trials comparing the efficacy of 5-ASA versus placebo or another active drug for the prevention of recurrent diverticulitis. Main results We included in this review seven studies with a total of 1805 participants. We judged all seven studies to have unclear or high risk of bias. Investigators found no evidence of an effect when comparing 5-ASA versus control for the prevention of recurrent diverticulitis (31.3% vs 29.8%; RR 0.69, 95% confidence interval (CI) 0.43–1.09); very low quality of evidence). Five of the seven studies provided data on adverse events of 5-ASA therapy. The most commonly reported side effects were gastrointestinal symptoms (epigastric pain, nausea, and diarrhea). No significant difference was seen between 5-ASA and control (67.8% vs 64.6%; RR 0.98, 95% CI 0.91–1.06; P = 0.63; moderate quality of evidence), nor was significant heterogeneity observed (I2 = 0%; P = 0.50). Authors’ conclusion  The effects of 5-ASA on recurrence of diverticulitis are uncertain owing to the small number of heterogenous trials included in this review. Rates of recurrent diverticulitis were similar among participants using 5-ASA and control participants. Effective medical strategies for the prevention of recurrent diverticulitis are needed, and further randomized, double-blinded, placebo-controlled trials of rigorous design are warranted to specify the effects of 5-ASA (mesalamine) in the management of diverticulitis.