Management of Acute Diverticulitis
Based on guidelines from the American Gastroenterological Association.
Diagnosis
Diagnosis
The AGA suggests that colonoscopy be performed after resolution of acute diverticulitis in appropriate candidates to exclude the misdiagnosis of a colonic neoplasm if a high-quality examination of the colon has not been recently performed.
Conditional recommendation
Low quality evidence
Treatment
Surgical Management
The AGA suggests against elective colonic resection in patients with an initial episode of acute uncomplicated diverticulitis. The decision to perform elective prophylactic colonic resection in this setting should be individualized.
Conditional recommendation
Very low quality evidence
Medical Management
The AGA suggests that antibiotics should be used selectively, rather than routinely, in patients with acute uncomplicated diverticulitis.
Conditional recommendation
Low quality evidence
Lifestyle
The AGA suggests a fiber-rich diet or fiber supplementation in patients with a history of acute diverticulitis.
Conditional recommendation
Very low quality evidence
The AGA suggests against routinely advising patients with a history of diverticulitis to avoid consumption of seeds, nuts, and popcorn.
Conditional recommendation
Very low quality evidence
The AGA suggests advising patients with diverticular disease to consider vigorous physical activity.
Conditional recommendation
Very low quality evidence
The AGA suggests against routinely advising patients with a history of diverticulitis to avoid the use of aspirin.
Conditional recommendation
Low quality evidence
The AGA suggests advising patients with a history of diverticulitis to avoid the use of nonaspirin NSAIDs if possible.
Conditional recommendation
Very low quality evidence
Prevention
Prevention
The AGA recommends against the use of mesalamine after acute uncomplicated diverticulitis.
Strong recommendation
Moderate quality evidence
The AGA suggests against the use of rifaximin after acute uncomplicated diverticulitis.
Conditional recommendation
Very low quality evidence
The AGA suggests against the use of probiotics after acute uncomplicated diverticulitis.
Conditional recommendation
Very low quality evidence
What do the icons mean?
How strong is the AGA's recommendation?
Strong recommendation
Most individuals in this situation would want the recommended course of action, and only a small proportion would not.Conditional recommendation
The majority of individuals in this situation would want the suggested course of action, but many would not.Moderate quality evidence
We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.Low quality evidence
Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect.Very low quality evidence
We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
