MDCalc

Management of Acute Diverticulitis

Based on guidelines from the American Gastroenterological Association.

These guideline summaries are shared for educational purposes only and are not intended to direct patient care. For detail on the specific recommendations and information about the evidence considered by the guideline developer, we encourage you to go to the original guideline statement cited below.

Diagnosis

Diagnosis
Conditional recommendation
Low quality evidence
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.

Treatment

Surgical Management
Conditional recommendation
Very low quality evidence
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.
Medical Management
Conditional recommendation
Low quality evidence
The AGA suggests that antibiotics should be used selectively, rather than routinely, in patients with acute uncomplicated diverticulitis.
Lifestyle
Conditional recommendation
Very low quality evidence
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
Low quality evidence
The AGA suggests against routinely advising patients with a history of diverticulitis to avoid the use of aspirin.
Conditional recommendation
Very low quality evidence
The AGA suggests advising patients with a history of diverticulitis to avoid the use of nonaspirin NSAIDs if possible.

Prevention

Prevention
Strong recommendation
Moderate quality evidence
The AGA recommends against the use of mesalamine after acute uncomplicated diverticulitis.
Conditional recommendation
Very low 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.
Literature
Original/Primary Reference
Research PaperStollman N, Smalley W, Hirano I, et al. American gastroenterological association institute guideline on the management of acute diverticulitis. Gastroenterology. 2015;149(7):1944-1949.