From the Guidelines
Treatment for diverticulosis is primarily focused on managing symptoms and preventing complications, with a strong emphasis on lifestyle modifications and selective use of medications.
Key Recommendations
- Dietary changes: A high-fiber diet is recommended to help manage symptoms and prevent complications 1.
- Antibiotic use: Antibiotics should be used selectively, rather than routinely, in patients with acute uncomplicated diverticulitis, and are advised in patients with comorbidities, refractory symptoms, or elevated inflammatory markers 1.
- Colonoscopy: Colonoscopy should 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 1.
- Elective surgery: Elective surgery may be considered in patients with recurrent or complicated diverticulitis, but the decision should be individualized and based on a discussion of potential benefits, harms, and patient preferences 1.
- Medications: Mesalamine is not recommended for the prevention of recurrent diverticulitis due to lack of evidence and potential harms 1.
Clinical Considerations
- Patient education: Patients should be educated on the risks and benefits of different treatment options, as well as the importance of lifestyle modifications, such as a high-fiber diet and regular physical activity 1.
- Shared decision-making: Clinicians should take a team-based approach to shared decision-making with patients, including discussions with primary care physicians, gastroenterologists, and surgeons 1.
- Individualized care: Treatment decisions should be individualized based on patient characteristics, disease severity, and patient preferences 1.
From the Research
Treatment for Diverticulosis
The treatment for diverticulosis typically involves lifestyle modifications and dietary changes. Some key points to consider include:
- Increasing dietary fibre to reduce the risk of diverticulosis 2
- Using fibre, probiotics, rifaximin, and mesalazine to achieve symptomatic relief in patients with symptomatic uncomplicated diverticular disease (SUDD) 2, 3
- Modifying lifestyle and using antibiotics, with surgery as an option in some cases 4
Treatment for Symptomatic Uncomplicated Diverticular Disease (SUDD)
For patients with SUDD, treatment options include:
- Fibre supplementation to prevent progression to symptomatic disease or improve symptoms 5
- Probiotics, mesalazine, and non-absorbable antibiotics to bring symptomatic relief 3
- Rifaximin with cyclic administration for lasting problems 3
Treatment for Diverticulitis
For patients with diverticulitis, treatment options include:
- Hydration and adjustments in the dietary regimen for mild cases 3
- Antibiotics for severe or repeated diverticulitis, sepsis, and complications 5, 3
- Surgery in some cases, such as abscess, fistula, obstruction, or free perforation 5, 3, 6
- Conservative treatment, including non-surgical drainage, for some cases of abscess and perforation 3