What are the management and treatment options for a patient with a CT scan result showing diverticulosis?

Management of Diverticulosis

For a patient with a CT scan showing diverticulosis (without acute inflammation or complications), no medical treatment is required—focus entirely on lifestyle modifications to prevent progression to diverticulitis. 1

Understanding Your Diagnosis

Diverticulosis refers to the presence of outpouchings (diverticula) in the colon wall and is an anatomical finding, not a disease requiring treatment unless symptoms or complications develop. 2, 3 Approximately 1-4% of patients with diverticulosis will develop acute diverticulitis in their lifetime. 2

Dietary Recommendations

Increase your fiber intake to 20-30 grams daily from whole food sources, with a target exceeding 22.1 grams per day for statistically significant protective effects against disease progression. 1

• Prioritize fiber from fruits, vegetables, whole grains, and legumes, as fruit-derived fiber appears most protective compared to other sources. 1
• Gradually increase fiber intake over several weeks to minimize abdominal bloating and improve tolerance. 1
• Dietary sources of fiber are strongly preferred over supplements alone, though supplements can be used as an adjunct. 1

Foods You Should NOT Restrict

Do not avoid nuts, seeds, popcorn, or small-seeded fruits—this outdated recommendation lacks evidence and may actually reduce your beneficial fiber intake. 1, 4, 5

Lifestyle Modifications

• Engage in regular vigorous physical activity to decrease diverticulitis risk. 1, 5
• Achieve or maintain a normal BMI (18-25 kg/m²), as obesity increases progression risk. 1, 5
• Stop smoking immediately, as it is an established risk factor for diverticulitis development. 1, 5
• Minimize NSAID use when possible, as these medications increase diverticulitis risk; aspirin does not need to be routinely avoided. 1, 4
• Avoid chronic opioid use when possible, as opioids increase diverticulitis risk. 1, 2

What NOT to Do

Do not take antibiotics, mesalamine, rifaximin, or probiotics for prevention—there is no role for any of these medications in asymptomatic diverticulosis. 1, 4 The American Gastroenterological Association strongly recommends against mesalamine and conditionally recommends against rifaximin and probiotics, as they provide no benefit for prevention. 1

Monitoring and Follow-Up

• No routine imaging or colonoscopy is needed for asymptomatic diverticulosis. 1
• Be aware that approximately 50% of diverticulitis risk is genetic, so family history matters. 1, 4

When to Seek Medical Attention

Contact your physician immediately if you develop:

• Left lower quadrant abdominal pain
• Fever or chills
• Nausea or vomiting
• Changes in bowel habits

These symptoms may indicate progression to acute diverticulitis, which requires different management. 2

Common Pitfalls to Avoid

• Do not rely solely on fiber supplements instead of making dietary modifications. 1
• Do not unnecessarily restrict healthy foods like nuts, seeds, and popcorn based on outdated recommendations. 1
• Do not request or accept prescriptions for mesalamine, rifaximin, probiotics, or chronic antibiotics, as these lack evidence for prevention. 1
• Do not ignore modifiable risk factors such as smoking, obesity, and NSAID use. 1