From the Guidelines
Treatment for colonic diverticulosis primarily focuses on dietary modifications and lifestyle changes, with a high-fiber diet being the cornerstone of management, aiming for 25-35 grams of fiber daily through fruits, vegetables, whole grains, and legumes, as recommended by the American College of Physicians 1.
Key Recommendations
- A high-fiber diet should be increased gradually to avoid bloating and gas, with fiber supplements like psyllium (Metamucil) at 1 teaspoon 1-3 times daily mixed with water to help reach fiber goals 1.
- Adequate hydration with 8-10 glasses of water daily is essential to soften stool and prevent constipation, and regular physical activity helps maintain bowel regularity 1.
- Avoid nuts, seeds, and popcorn only if they personally trigger symptoms, as evidence doesn't support universal restriction, and for occasional constipation, over-the-counter stool softeners like docusate sodium (100-300 mg daily) may help 1.
- Antibiotics are not needed for uncomplicated diverticulosis, and these measures work by preventing constipation and reducing pressure in the colon, which helps prevent diverticula from forming or becoming inflamed 1.
Management of Acute Diverticulitis
- For patients with acute uncomplicated left-sided colonic diverticulitis, outpatient management is suggested, with supportive care, such as bowel rest and hydration, and without the use of antibiotics, unless the patient has a systemic inflammatory response or immunosuppression 1.
- For patients with complicated diverticulitis, elective surgery may be considered to prevent recurrent diverticulitis, with a personalized discussion of potential benefits, harms, costs, and patient's preferences 1.
Colonoscopy
- Colonoscopy is suggested after an initial episode of complicated left-sided colonic diverticulitis in patients who have not had recent colonoscopy, to rule out colorectal cancer or advanced colonic neoplasia 1.
- Colonoscopy should not be performed until the acute phase of diverticulitis is resolved, and the decision to perform colonoscopy should be based on individual patient circumstances, such as the availability of adequate home care 1.
From the Research
Treatment Options for Colonic Diverticulosis
- The primary goals of treatment for symptomatic uncomplicated diverticular disease are to prevent complications and reduce the frequency and intensity of symptoms 2.
- Treatment options for colonic diverticulosis include:
- Fibre supplementation to reduce intraluminal pressure and slow down the worsening of the disease 3, 4.
- Probiotics, mesalazine, and rifaximin, which seem to be effective in relieving symptoms and preventing acute diverticulitis 2, 5, 6.
- A diet abundant in fruit and vegetables is recommended for patients with uncomplicated diverticulosis 5.
- Cyclic rifaximin administration is an adequate approach to relieving symptoms and preventing acute diverticulitis in patients with symptomatic diverticulosis 5, 6.
Management of Complicated Diverticulitis
- Hospitalization, bowel rest, and intravenous antibacterial agents are mandatory for complicated diverticulitis 3, 4, 6.
- Surgical consultation is indicated for disease that does not respond to medical management or for repeated attacks that may be less likely to respond to medical therapy and have a higher mortality rate 3, 4.
- Prompt surgical consultation is also recommended when there is evidence of abscess formation, fistula formation, obstruction, or free perforation 4.
Role of Antibiotics in Treatment
- Antibiotics play a key role in the management of both uncomplicated and complicated diverticular disease, with rifaximin demonstrating effectiveness in obtaining symptom relief and improving symptoms 6.
- Broad-spectrum antibiotics are recommended for patients with acute diverticulitis, and inpatient management and intravenous antibiotics are necessary in complicated cases 2, 6.