From the Guidelines
After a diverticulitis flare, follow-up care should include a colonoscopy 6-8 weeks after symptoms resolve to rule out other conditions like colorectal cancer, especially for patients experiencing their first episode. During recovery, a clear liquid diet is advised during the acute phase of uncomplicated diverticulitis, and the diet should advance as symptoms improve 1. The patient can transition to a low-fiber diet before returning to a high-fiber diet (25-30g daily) once inflammation subsides.
Key Recommendations
- Antibiotics like ciprofloxacin 500mg twice daily plus metronidazole 500mg three times daily for 7-10 days can be used selectively, rather than routinely, in immunocompetent patients with mild uncomplicated diverticulitis 1.
- Patients who are immunocompromised are at high risk for complications and should be treated with antibiotics 1.
- Regular physical activity helps maintain bowel health, and patients should stay well-hydrated with at least 8 glasses of water daily.
- Avoid seeds, nuts, and popcorn only if they personally trigger symptoms, as research doesn't strongly support universal avoidance.
- Schedule regular follow-ups with your healthcare provider to monitor recovery and adjust treatment as needed.
Prevention of Recurrence
- Patients with a history of diverticulitis should consume a high-quality diet, achieve or maintain a normal body mass index, routinely be physically active, and not smoke 1.
- Elective surgery to prevent recurrent diverticulitis may be considered in patients who have either uncomplicated diverticulitis that is persistent or recurs frequently or complicated diverticulitis 1.
- Mesalamine is not recommended to prevent recurrent diverticulitis due to lack of evidence showing its effectiveness and potential harms 1.
From the Research
Diverticulitis Follow-up After Flare
- The management of diverticulitis after a flare-up is crucial to prevent recurrence and complications.
- Studies have shown that treatment with mesalazine or rifaximin can be effective in preventing diverticulitis recurrence 2, 3, 4, 5.
- A study published in 2004 found that rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease 2.
- Another study published in 2013 found that mesalazine is more effective than rifaximin in preventing diverticulitis recurrence 3.
- However, a retrospective study published in 2017 found that long-term treatment with rifaximin in a 10-day schedule appears more effective than mesalazine in preventing recurrent acute diverticulitis 4.
- A systematic review of randomized clinical trials published in 2016 found that mesalazine is effective in achieving symptom relief and primary prevention of diverticulitis in patients with symptomatic uncomplicated diverticular disease 5.
Treatment Options
- Mesalazine has been shown to be effective in preventing diverticulitis recurrence and achieving symptom relief 3, 5.
- Rifaximin has also been shown to be effective in preventing diverticulitis recurrence, particularly in a 10-day schedule 4.
- The choice of treatment should be based on individual patient needs and medical history.
Prevention of Recurrence
- Preventing diverticulitis recurrence is crucial to reduce the risk of complications and improve patient outcomes.
- Studies have shown that treatment with mesalazine or rifaximin can be effective in preventing diverticulitis recurrence 2, 3, 4, 5.
- A high-fiber diet and lifestyle modifications may also be beneficial in preventing diverticulitis recurrence, although the evidence is limited 6.