Materiały źródłowe

• #1 Diverticulitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10352-diverticulitis

  Diverticulitis is a complication that can affect people with diverticulosis, small pockets on the inside of their colon. If one of the pockets becomes injured or infected, it can cause inflammation inside. If you have a sharp pain in your lower left abdominal quadrant, it might be diverticulitis. […] Diverticulitis is inflammation in your diverticula, which are small pockets that can develop on the inside of your colon. Having diverticula is called diverticulosis. Its common as you get older, and most people never have any problems with it. But if one of your diverticula becomes inflamed, it can cause acute pain and other symptoms. It might mean that it has an infection, which needs medical attention. […] Most of the time, diverticulitis is uncomplicated, which means that inflammation and possible infection are the extents of the problem. It heals easily with the right treatment. Diverticulitis becomes complicated when the inflammation begins to cause secondary problems.

• #2 Diverticulitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diverticulitis/diagnosis-treatment/drc-20371764

  Treatment depends on how serious the condition is. […] When symptoms are mild and there are no complications, the condition is called uncomplicated diverticulitis. If your symptoms are mild, you may be treated at home. […] Your healthcare professional is likely to recommend a liquid diet. When symptoms begin to improve, you can gradually increase solid food, beginning with low-fiber foods. When you’re fully recovered, you can resume a regular diet with high-fiber foods. A fiber supplement may also be recommended. […] You also may have a prescription for antibiotics. You will need to take all of the pills even when you are feeling better. […] If you have serious symptoms or signs of complications, you’ll likely need to be in the hospital. Antibiotics are given with an intravenous tube, also called an IV.

• #2 Diverticulitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diverticulitis/diagnosis-treatment/drc-20371764

  Relatively simple procedures may be used to drain an abscess or stop bleeding related to diverticulitis. […] Surgery on the colon may be needed if: You have had complicated diverticulitis. Complications include ruptures in the colon wall, fistulas or other serious tissue damage. You have had multiple episodes of uncomplicated diverticulitis. You have a weakened immune system. […] Surgery is often performed through small openings in the abdomen. This procedure is called laparoscopic surgery. In some cases, surgery through a single, large opening is needed. There are generally two procedures for treating diverticulitis: The diseased section of the colon is removed. The remaining healthy tissues are connected to re-create a complete colon. The healthy section and diseased section are separated. The healthy section is directed to an opening in the abdomen wall. Waste is collected in a bag called a colostomy bag. This gives the diseased section time to heal. When it is healed, the two sections are reconnected, and the opening in the abdomen wall is closed.

• #2 Diverticulitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diverticulitis/diagnosis-treatment/drc-20371764

  Other surgical procedures may be necessary to treat complications such as peritonitis and fistulas. […] Your healthcare professional may recommend a colonoscopy six weeks or longer after you no longer have symptoms of diverticulitis. A colonoscopy is an exam used to look for irregular growths or cancer in the colon or rectum. A recommendation for this procedure depends on when you last had a colonoscopy and how serious your diverticulitis was.

• #3 Treatment for Diverticular Disease – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis/treatment

  Your doctor will recommend treatments based on whether you have chronic symptoms of diverticula, diverticulitis, or other complications of diverticular disease. […] If diverticula cause chronic symptoms, your doctor may recommend one or more treatments, such as high-fiber foods or fiber supplements, antibiotics, medicines to reduce inflammation, probiotics. […] For people who have diverticulitis without complications, doctors may recommend treatment at home. However, people typically need treatment in a hospital if they have severe diverticulitis, diverticulitis with complications, or a high risk for complications. […] Treatments for diverticulitis may include antibiotics, although not all people with diverticulitis need these medicines, a clear liquid diet for a short time to rest the colon, medicines for pain.

• #3 Treatment for Diverticular Disease – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis/treatment

  If your diverticulitis doesn’t improve with treatment or if it leads to complications, you may need surgery to remove part of your colon, called a colectomy or colon resection. […] Doctors typically treat the complications of diverticular disease in a hospital. […] Doctors may recommend different treatments for abscesses. Doctors may prescribe antibiotics to treat small abscesses, drain abscesses that are large or don’t improve with antibiotics, recommend surgery after a large abscess heals, to prevent the abscess from coming back. […] Doctors typically recommend surgery to treat other diverticulitis complications, including fistulas, intestinal obstruction, perforation, peritonitis. […] In some cases, doctors may recommend lifestyle changes or surgery to prevent diverticulitis. […] In some cases, after a person has diverticulitis without complications, doctors may recommend surgery to remove part of the colon and prevent diverticulitis from occurring again.

• #4 Diverticulitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10352-diverticulitis

  If its mild and uncomplicated, it can go away on its own. But you should still go to a healthcare provider to have it evaluated. They might need to give you antibiotics for an infection, and some people might need prescription pain medications. Your provider will also tell you how to care for yourself at home while youre recovering. It takes about a week. Theyll want you to keep in touch during this time. […] If your healthcare provider has given you the go-ahead, you can treat diverticulitis at home with: A liquid diet. Avoiding solid foods gives your bowels a chance to rest and recover from the disease. Your provider can give you more specific instructions on what to eat and when. Prescription antibiotics. You may not need them, but if you do, your provider will give you some to take home with you. The type will depend on the kind of infection you have. Acetaminophen. For over-the-counter (OTC) pain relief, its best to stick to acetaminophen (Tylenol). Other common pain relievers could increase your risk of gastrointestinal (GI) bleeding.

• #4 Diverticulitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10352-diverticulitis

  You may not need treatment if you have a mild and uncomplicated case. But its important to see a healthcare provider about diverticulitis. If you dont, you may end up with a more severe and complicated case. Certain infections may need to be treated with antibiotics or antivirals to go away. Inflammation that doesnt go away may begin to cause secondary problems. Pain may also worsen. […] If conservative at-home treatment hasnt worked, or if you have severe, chronic or complicated diverticulitis, you may need to stay in the hospital for treatment. Treatment may include: IV medication. Your provider may give you antibiotics or antivirals through an IV line so that the medicine goes directly to your bloodstream. They may also give you pain relief this way. Some people may need strong analgesics, such as opioids. Blood transfusion. If youve lost a lot of blood from a bleeding diverticulum, you may need an emergency blood transfusion to replace it. Endoscopic procedures. Your provider might use a colonoscope or sigmoidoscope different types of endoscopes that examine your colon to treat minor complications. For example, they can often stop active bleeding, drain an abscess or open up a narrowed section of your bowel using tools passed through the endoscope. Surgery. Some people may need surgery to treat an abscess, persistent bleed, perforation (tear) or fistula. In rare cases of chronic diverticulitis, some people may need to have the problematic section of their bowel removed (colectomy). This might involve a temporary colostomy.

• #4 Diverticulitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/10352-diverticulitis

  Healthcare providers dont know enough about why diverticulitis happens or why it returns to know definitively how to prevent it. But they suspect that general bowel wellness can help. Eating more plants and fewer animal fats, drinking enough water and getting some regular exercise can help keep your bowel movements healthy. For some people, they might recommend fiber supplements or probiotics.

• #5 Diverticular disease | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/diverticular-disease-and-diverticulitis/

  Most cases of diverticular disease can be treated at home. […] The over-the-counter painkiller paracetamol is recommended to help relieve your symptoms. […] Eating a high-fibre diet may initially help to control your symptoms. […] Mild diverticulitis can often be treated at home. Your GP will prescribe antibiotics for the infection and you should take paracetamol for the pain. […] If you have more severe diverticulitis, you may need to go to hospital, particularly if your pain cannot be controlled using paracetamol. […] If you are admitted to hospital for treatment, you are likely to receive injections of antibiotics and be kept hydrated and nourished using an intravenous drip. […] In rare cases, a severe episode of diverticulitis can only be treated with emergency surgery. […] Surgery for diverticulitis involves removing the affected section of your large intestine.

• #5 Diverticular disease | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/diverticular-disease-and-diverticulitis/

  Diverticular disease and diverticulitis are related digestive conditions that affect the large intestine (colon). […] Treating diverticular disease and diverticulitis involves a high-fibre diet to ease symptoms, and paracetamol can be used to relieve pain; other painkillers such as aspirin or ibuprofen are not recommended for regular use, as they can cause stomach upsets. […] Mild diverticulitis can usually be treated at home with antibiotics prescribed by your GP. More serious cases may need hospital treatment to prevent and treat complications. […] Surgery to remove the affected section of the intestine is sometimes recommended if there have been serious complications, although this is rare. […] Treatment options for diverticular disease and diverticulitis depend on how severe your symptoms are.

• #5 Diverticular disease | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/diverticular-disease-and-diverticulitis/

  In some cases, the surgeon may decide your large intestine needs to heal before it can be reattached, or that too much of your large intestine has been removed to make reattachment possible. […] In general terms, elective (non-emergency) surgery is usually successful, although it does not achieve a complete cure in all cases.

• #6 Diverticulitis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/173388-treatment

  Successful percutaneous drainage of a diverticular abscess has not been associated with greater recurrence or more severe disease and does not necessitate elective colectomy. […] Antibiotics are known to be the mainstay of therapy for most patients with acute diverticulitis, but recent studies have questioned their necessity, especially in mild, uncomplicated disease. […] The American Gastroenterological Association (AGA) suggests selective, rather than routine, use of antibiotics in patients with acute uncomplicated diverticulitis. […] Patients with mild diverticulitis, typically with Modified Hinchey stage 0 and Ia disease, can be started on an outpatient treatment regimen. […] Hospitalization is required in the presence of evidence of severe diverticulitis, such as systemic signs of infection or peritonitis.

• #6 Diverticulitis Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/173388-treatment

  The management of patients with diverticulitis depends on their presentation severity, presence of complications, and comorbid conditions. Therefore, there is no standard treatment in the medical management of diverticular disease, including diverticulitis. […] Uncomplicated diverticulitis can be managed medically and in an ambulatory setting, whereas complicated disease requires a more aggressive approach that can often require urgent or elective surgery, and treatments that are specific to the complication itself (eg, abscess drainage). […] Emergency colectomy is performed when severe complications arise or when the patient’s condition does not respond to medical treatment. […] Elective resection of the involved bowel segment after three episodes of uncomplicated diverticulitis to prevent further attacks is generally recommended by consensus guidelines.

• #7 Diverticular disease and diverticulitis: Learn More – Treating acute diverticulitis – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK506996/

  Diverticulitis can usually be treated effectively. In straightforward (uncomplicated) cases, antibiotics often aren’t needed. Surgery is only necessary if the inflammation is so severe that it could lead to complications. […] In about 95 out of 100 people, uncomplicated diverticulitis goes away on its own within a week. In about 5 out of 100 people, the symptoms stay and treatment is needed. Surgery is only rarely necessary. […] The use of antibiotics can sometimes be avoided in uncomplicated diverticulitis but only if an ultrasound or CT scan has been done and no abscesses were found. Then antibiotics probably wouldn’t reduce the risk of complications. […] Antibiotics are generally only recommended for the treatment of uncomplicated diverticulitis if there’s an increased risk of complications for instance if someone has chronic kidney disease, a weakened immune system, high blood pressure or allergies.

• #8 Treating acute diverticulitis | informedhealth.org

  https://www.informedhealth.org/treating-acute-diverticulitis.html

  Antibiotics are generally only recommended for the treatment of uncomplicated diverticulitis if there’s an increased risk of complications for instance if someone has chronic kidney disease, a weakened immune system, high blood pressure or allergies. […] In uncomplicated diverticulitis, it’s important to see a doctor regularly particularly in the first few days in order to detect any complications early enough. […] Serious complications are rare in uncomplicated diverticulitis. But it’s still important to look out for warning signs, including severe abdominal pain, fever, a hard and tense tummy, and nausea. Symptoms like this should be checked out by a doctor as soon as possible. […] In about 80 out of 100 people, complicated diverticulitis clears up within a few weeks of having treatment with antibiotics. About 20 out of 100 people have surgery.

• #9 Diverticular Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1001/p1229.html

  Patients with suspected diverticulitis should undergo computed tomography with intravenous and oral contrast rather than other diagnostic modalities such as endoscopy or contrast radiography. […] To provide adequate coverage of gram-negative rods and anaerobic bacteria, patients with acute diverticulitis treated as outpatients should receive metronidazole (Flagyl) combined with a quinolone or with trimethoprim-sulfamethoxazole (Bactrim, Septra) or amoxicillin-clavulanate (Augmentin). […] Patients hospitalized with acute diverticulitis should receive metronidazole or clindamycin (Cleocin) combined with an aminoglycoside, a monobactam, or a third-generation cephalosporin. […] The severity of the inflammatory and infectious processes, as well as the underlying health of the patient, determines the appropriate treatment for patients with diverticulitis.

• #10 Diverticulitis treatment: Mild and severe, diet, and more

  https://www.medicalnewstoday.com/articles/diverticulitis-treatment

  If a person has diverticulitis, their doctor may recommend that they eat a high-fiber diet. They may also suggest taking fiber supplements. […] In some cases, a person with diverticulitis may require antibiotic treatment. […] Antibiotic treatment for mild diverticulitis usually lasts 710 days. […] A doctor may recommend that a person has a clear liquid diet for a short time. This is to allow the colon to rest. […] If a person requires inpatient treatment for diverticulitis, they may need intravenous (IV) antibiotics. […] Usually, a person will have IV antibiotics for 35 days. Once this course is complete, they will usually switch to oral antibiotics for 1014 days. […] A doctor can find and stop diverticular bleeding using a colonoscopy or an angiogram. […] A doctor can treat smaller diverticular abscesses with IV antibiotics. They may drain the pus from large abscesses.

• #11 Diverticulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/173388-overview

  Indications for hospital admission include the following: Evidence of severe diverticulitis (ie, systemic signs of infection or peritonitis); Inability to tolerate oral hydration; Failure of outpatient therapy (ie, persistent or increasing fever, pain, or leukocytosis after 2-3 days); Immune-compromise or significant comorbidities; Pain severe enough to require parenteral narcotic analgesia. […] Patients with complicated diverticular disease fall under Modified Hinchey stage Ib II, III and IV. Individuals in Modified Hinchey stage Ib may require hospitalization and the following treatment regimen: Clear liquid diet; advancement to low fiber as tolerated; Intravenous (IV) or PO antibiotics; Elective surgical resection; Abscess 4 cm: Drain percutaneously; Abscess 3 cm: Antibiotics typically resolve.

• #11 Diverticulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/173388-overview

  Modified Hinchey stages II-IV require hospitalization, nothing by mouth, IV antibiotics, and percutaneous abscess drainage; surgical consultation and elective procedure for patients in stage II, and urgent surgical evaluation and resection for those in stage III and IV. […] Monotherapy with beta-lactamase-inhibiting antibiotics or carbapenems is appropriate for patients who are moderately ill and require admission. […] Pain management considerations are as follows: Morphine is preferred, despite theoretical risk of affecting bowel tone and sphincters; Acetaminophen and antispasmodics such as dicyclomine are first-line agents for managing pain and cramping in mild to moderate disease. […] Classic surgical indications include some features characteristic of Hinchey stage III or IV disease, such as the following: Free-air perforation with fecal peritonitis; Suppurative peritonitis secondary to a ruptured abscess; Uncontrolled sepsis; Abdominal or pelvic abscess (unless CT scan-guided aspiration is possible); Fistula formation; Intestinal obstruction; Failing medical therapy.

• #12 Diagnosis and Management of Acute Diverticulitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0501/p612.html

  Outpatient management has traditionally consisted of a clear liquid diet, oral broad-spectrum antibiotics, and follow-up in two to three days. Outpatient management with rest and fluids is effective for patients with mild diverticulitis. […] Hospitalization should be considered if patients have signs of peritonitis or there is suspicion of complicated diverticulitis. Inpatient management includes no food or drink by mouth, intravenous fluid resuscitation (normal saline or lactated Ringer solution), and intravenous antibiotics. Clinical improvement is expected within two to four days and includes decreasing fever, leukocytosis, and pain. […] A randomized controlled trial including 50 patients found that starting oral antibiotics after clinical improvement with intravenous antibiotics resulted in shorter hospitalizations, greater cost savings, and no increased risk of recurrence compared with longer treatment with intravenous antibiotics.

• #12 Diagnosis and Management of Acute Diverticulitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0501/p612.html

  The usual practice in the United States for the treatment of diverticulitis includes broad-spectrum antibiotics against gram-negative rods and anaerobic bacteria. However, evidence supporting their use in uncomplicated diverticulitis is lacking. A study randomized 623 patients to antibiotics or placebo and found that antibiotic therapy for uncomplicated diverticulitis did not accelerate recovery, prevent complications, or prevent recurrence. […] Patients who present with symptoms consistent with recurrent diverticulitis warrant a complete evaluation. Studies have shown recurrence rates of diverticulitis from 9 to 36 percent. […] A modeling analysis found that the most cost-effective approach was to perform surgery only after the third episode of acute uncomplicated diverticulitis requiring hospitalization, but the decision to proceed to surgery should be individualized and based on patient preference, comorbidities, and lifestyle.

• #13

  https://fascrs.org/patients/diseases-and-conditions/a-z/diverticular-disease-expanded-version

  Patients who have signs of a more serious attack, such as high white blood cell count, high fever, changes in heart rate or blood pressure, or patients who do not get better with oral antibiotics, will have to be admitted to the hospital for hydration and intravenous (IV) antibiotics. […] Surgery for acute diverticulitis is limited to a few circumstances. These include: an attack of diverticulitis that causes the colon to perforate, resulting in pus or stool leaking into the abdominal cavity and causing peritonitis. Patients with colonic perforation are usually quite ill, and present with severe abdominal pain and changes in heart rate and blood pressure. These patients often require emergency surgery. […] […] An abscess that cannot be safely drained with percutaneous drainage, or if the percutaneous drainage was ineffective. […] The patient fails to improve with appropriate medical therapy, including IV antibiotics and hospitalization. […] Aggressive treatment, including surgery, is often required for patients who are immunocompromised (patients who have received an organ transplant or who are receiving chemotherapy). […]

• #14 Diverticulitis: Symptoms, Causes, Diagnosis, Treatment, Surgery

  https://www.webmd.com/digestive-disorders/understanding-diverticulitis-basics

  There are two main types: […] Primary bowel resection. In this procedure, your surgeon will remove diseased parts of the intestine and reconnect the healthy sections. You can have normal bowel movements afterward. […] Bowel resection with colostomy. This needs to be done if there’s so much swelling that the surgeon can’t reconnect your colon to your rectum right away. Your doctor will create an opening in your abdominal wall so waste can flow into a bag. Surgeons can often reconnect the bowel after the inflammation has passed. […] The kind of operation you need depends on the type of complication you have and how serious it is. When you’re healed, your doctor might give you a colonoscopy to rule out colon cancer.

• #15 Diverticulosis and Diverticulitis: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/colorectal-diseases/diverticular-disease/treatment

  In a primary bowel resection, the surgeon removes the parts of the colon affected by diverticulitis and reconnects the healthy portions of the bowels. […] In cases where inflammation is too severe to reconnect the colon and rectum, the surgeon may perform a bowel resection with a colostomy, in which the colon is connected via an opening in the abdominal wall. […] Diverticulitis can be successfully treated with antibiotics, surgery, and dietary changes. Diverticula are unlikely to disappear, but symptoms can be managed with proper treatment. […] Guidelines for the best treatment of diverticulitis continue to evolve. NewYork-Presbyterians surgeons have extensive experience in this area and are passionate about refining treatments based on the causes of diverticulosis and diverticulitis.

• #16 Patient education: Diverticular disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diverticular-disease-beyond-the-basics

  Hospital treatment — If you have severe disease, you are not in good health, or your symptoms do not get better in two to three days, you might need to be hospitalized for treatment. […] […] Surgery — If you develop a generalized infection in the abdomen (peritonitis), you will usually require an emergency operation. […] […] Surgery versus medical therapy — An operation to remove the diseased area of the colon may be necessary if you do not improve with medical therapy. […] […] After diverticulitis resolves — After an episode of diverticulitis resolves, if you have not had a recent colonoscopy, the entire length of the colon should be evaluated to determine the extent of disease and to rule out the presence of abnormal lesions such as polyps or cancer. […] […] Diverticular bleeding — Most cases of diverticular bleeding resolve on their own. However, some people will need further testing or treatment to stop bleeding, which may include a colonoscopy, angiography (a treatment that blocks off the bleeding artery), bleeding scan, or surgery.

• #17 Nonsurgical Treatment for Diverticular Disease | NYU Langone Health

  https://nyulangone.org/conditions/diverticular-disease/treatments/nonsurgical-treatment-for-diverticular-disease

  If you have signs of diverticular bleeding, your doctor typically performs a colonoscopy to determine the source. During the procedure, the doctor may be able to stop the bleeding by applying a clip, injecting medication, or using a concentrated form of heat to seal the diverticular pouch. […] For people who have a microperforation or an abscess, a doctor may prescribe bowel rest and antibiotics. Most of the time, antibiotics are administered through a vein with intravenous (IV) infusion. […] An abscess may need to be drained. An interventional radiologist who has expertise in gastrointestinal imaging procedures inserts a needle into the abscess and drains the infected fluid. This does not require surgery. […] Regardless of the type of treatment you receive, your doctor also may put you on a liquid diet and observe you to monitor your symptoms. As your symptoms improve, you can gradually add foods back to your diet under the guidance of your doctor.

• #18 Living with diverticulitis: Get the full scope of symptoms, treatment, and prevention | Digestive | UT Southwestern Medical Center

  https://utswmed.org/medblog/diverticulitis-symptoms-treatment/

  People with diverticulosis might not experience symptoms or complications that require treatment. […] However, most patients with diverticulitis can manage their symptoms with antibiotics and lifestyle changes. […] If you are among the 80% of people with mild symptoms (uncomplicated diverticulitis), your treatment plan likely will focus on short-term symptom relief and creating a long-term plan to prevent flare-ups. Your provider might prescribe a few days of rest and possibly 10 days of oral antibiotics, such as Ciprofloxacin or Flagyl (metronidazole), to help reduce inflammation. […] To help prevent recurring flare-ups, which happen in one-third of patients with uncomplicated diverticulitis, we recommend a high-fiber diet rich in foods such as bran, whole-wheat pasta, apples, pears, raspberries, beans, sweet potatoes, avocados, and vegetables.

• #18 Living with diverticulitis: Get the full scope of symptoms, treatment, and prevention | Digestive | UT Southwestern Medical Center

  https://utswmed.org/medblog/diverticulitis-symptoms-treatment/

  If your flare-up presents severe symptoms, you might need to stay in the hospital to get IV fluids and antibiotics. Your care team will likely recommend a clear, liquid diet for several days before slowly reintroducing bland foods. […] For some patients, colorectal surgery is the most appropriate treatment to significantly reduce diverticulitis flare-ups. […] A sigmoidectomy ends recurring flare-ups for more than 95% of patients. If another flare-up occurs, we can treat it with antibiotics such as Augmentin or a combination approach of Ciprofloxacin and Flagyl.

• #19 Diverticulitis: What It Is, Symptoms, Causes & Treatment Options

  https://www.hoag.org/specialties-services/digestive-health/diseases-conditions/diverticulitis-treatment/

  Rare cases may involve more serious complications like abscesses, diverticular bleeding or peritonitis. Hospitalization or surgery to remove part of the colon may be required in certain cases to help these more serious symptoms improve. […] Various studies have shown that taking certain medications may potentially increase your risk of developing diverticulitis or severe complications. […] Doctors once recommended that those with diverticulitis or diverticular disease should avoid eating seeds and small nuts, including those found in foods like strawberries and popcorn. […] These days, its recommended that those with a history of diverticular disease drink plenty of water and eat a diet thats rich in high-fiber foods like vegetables, lentils, fruits and whole grains. […] While theres no known way to definitively prevent diverticulosis and diverticulitis, there are certain steps you can take to potentially reduce the risk of developing diverticulitis if you have diverticulosis.

• #20 Management of Diverticular Disease

  https://www-staging.uspharmacist.com/article/management-of-diverticular-disease

  A follow-up colonoscopy should be done 4 to 6 weeks after discharge, and a high-fiber diet should be recommended. There is evidence that a high-fiber diet alleviates the symptoms of diverticular disease. Fiber intake of greater than 10 g daily (preferably 20-30 g daily) is recommended for all patients with diverticular diseases, except those suffering an acute attack of diverticulosis. […] Anti-inflammatories: Anti-inflammatory drugs, 5-aminosalicylic acid (5-ASA) medications in particular, may be of benefit to patients with chronic low-level diverticular symptoms. There is strong evidence that mesalamine taken with rifamixin (a nonabsorbable antibiotic) improves the severity of symptoms of patients with diverticular disease. It also prevents recurrence of diverticulitis episodes in patients with complicated diverticulitis. […] A high-fiber diet can alleviate symptoms of diverticular disease (diverticulosis and diverticulitis) and prevent recurrence of acute diverticulitis. A growing body of evidence suggests that mesalamine with rifamixin may also be used as maintenance therapy to alleviate symptoms.

• #21 Diverticulosis: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24883-diverticulosis

  Most people wont need treatment for diverticulosis itself. But your provider might recommend that you begin incorporating more fiber into your diet. This is to address the likely cause of your diverticulosis and to prevent further complications related to constipation, bloating or other symptoms. More fiber will help poop pass more smoothly through your colon and help sweep it clean as it goes. […] About 3% of people may need treatment to help stop persistent diverticular bleeding. This usually happens during a colonoscopy. When a gastroenterologist finds bleeding during a colonoscopy, they can pass tools through the colonoscope to seal the broken blood vessel. Alternatively, a provider might use an angiogram to find the bleeding, then treat it by injecting medications into the blood vessel.

• #22 Acute colonic diverticulitis: Outpatient management and follow-up – UpToDate

  https://www.uptodate.com/contents/acute-colonic-diverticulitis-outpatient-management-and-follow-up

  Patients should be reassessed in the clinic within one week of their initial presentation to the emergency room or discharge from the hospital. Thereafter, all patients should be reassessed weekly until all symptoms resolve. […] Patients with chronic smoldering diverticulitis should be referred for surgical evaluation. […] After successful nonoperative management of acute diverticulitis, elective surgery should be offered to patients who are at high risk of developing serious complications or dying from recurrent diverticulitis, including those with complicated diverticulitis and those who are immunosuppressed. […] Elective colon resection is generally not offered to immunocompetent patients with a history of uncomplicated diverticulitis, regardless of the number of past episodes. […] After the complete resolution of symptoms associated with acute diverticulitis (typically in six to eight weeks), we suggest that a colonoscopy be performed to assess the extent of a patient’s diverticular disease and exclude a concomitant colonic cancer, unless one has been performed within the previous year.

• #22 Acute colonic diverticulitis: Outpatient management and follow-up – UpToDate

  https://www.uptodate.com/contents/acute-colonic-diverticulitis-outpatient-management-and-follow-up

  In order to prevent recurrence, patients with a history of colonic diverticulitis should consume a high-fiber diet; however, they do not need to avoid seeds, corn, and nuts. […] Overall, between 16 and 42 percent of patients have one or more recurrent episode(s) after nonoperative management of acute diverticulitis. […] Surgery, however, may be indicated in patients with recurrent diverticulitis who develop symptoms. […] The guidelines from the American Society of Colon and Rectal Surgeons (ASCRS) called for an individualized approach to recommending elective sigmoid colectomy after recovery from uncomplicated diverticulitis.

• #23 New Guidelines Inform Diverticulitis Treatment | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2021/01/new-guidelines-inform-diverticulitis-treatment

  Guidelines around surgery have also changed. Surgeons should advise elective segmental resection on a case-by-case basis rather than on a specific number of episodes. Factors to consider include disease severity, patient preferences and values, and the benefits and risks. Chronic gastrointestinal symptoms may not improve with surgery. […] The report states that at five-year follow up, patients with recurrent diverticulitis experienced improved quality of life after elective resection. However, 15 percent of patients experienced recurrent diverticulitis after surgery, and between 22 and 25 percent had ongoing abdominal pain. […] AGA also recommends waiting at least six to eight weeks after an acute episode. Screening before the episode has fully resolved increases risk of perforation, discomfort and can create a more technically demanding procedure for the clinician.

• #23 New Guidelines Inform Diverticulitis Treatment | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2021/01/new-guidelines-inform-diverticulitis-treatment

  Colonic diverticulitis remains a painful, unpredictable gastrointestinal disease that can lead to serious complications, chronic symptoms and poor quality of life. While complicated cases require aggressive treatment, recent American Gastroenterological Association (AGA) guidelines suggest a more conservative approach for uncomplicated, nonsevere diverticulitis. […] One notable change: AGA recommends selective, rather than routine, antibiotic use in immunocompetent patients with mild disease. While antibiotics have long been first-line therapy for acute uncomplicated diverticulitis, recent evidence suggests there is no benefit in immunocompetent patients with mild acute uncomplicated diverticulitis, the report states. […] AGA does, however, advise antibiotic treatment for patients with comorbidities, who present with concerning, high-risk symptoms or who present with complicated diverticulitis.

• #24 Treatment for Diverticulitis – Updated ASCRS Guidelines | Wolters Kluwer

  https://www.wolterskluwer.com/en/news/treatment-for-diverticulitis-updated-ascrs-guidelines-published-in-diseases-of-the-colon-and-rectum

  Reflecting research-driven changes in clinical practice, a revised set of evidence-based recommendations for the medical and surgical treatment of left-sided colonic diverticulitis has been published in Diseases of the Colon Rectum (DCR), the official journal of the American Society of Colon and Rectal Surgeons (ASCRS). […] Recommendations reflect the changing treatment paradigm for diverticulitis: more patients being treated as outpatients and fewer undergoing emergency surgery, while more patients are undergoing elective or laparoscopic (minimally invasive) surgery. […] Approaches to medical management, including recent evidence that not all patients with acute diverticulitis need antibiotics. Higher-risk patients should receive antibiotics, while some patients with mild disease may not benefit from antibiotics.

• #25 Recent updates on classification and unsolved issues of diverticular disease: a narrative review

  https://www.e-jyms.org/journal/view.php?number=2856

  A recent multicenter randomized clinical trial of 623 patients with uncomplicated acute diverticulitis showed no significant difference in recurrence or complications for 1 year after the episode between patients treated with and without antibiotics. […] Therefore, recent practice guidelines recommend antibiotics for uncomplicated mild diverticulitis only in cases of American Society of Anesthesiologists class III or IV comorbidities, persistent symptoms longer than 5 days prior to presentation, and a C-reactive protein level of 14 mg/dL or a white blood cell level of 15,000 cells/L. […] The evidence for treatment is limited; however, antibiotics such as ciprofloxacin and metronidazole with mesalamine or oral steroids can be considered. […] A high-fiber diet appears to reduce the long-term risk of diverticulitis recurrence, but a recent systematic literature review reported limited evidence. […] Although the importance of dietary fiber has waned recently, it is still recommended for its potential preventive benefits.

• #26 Study says aggressive treatment for diverticulitis is often overused – Harvard Health

  https://www.health.harvard.edu/blog/study-says-aggressive-treatment-for-diverticulitis-is-often-overused-201401156978

  Following a liquid diet for a while can help treat diverticulitis, but antibiotics, and sometimes even surgery, may be needed. […] While the team agreed that antibiotic use and surgery are sometimes necessary for diverticulitis, it concluded that there should be a lesser role for aggressive antibiotic or surgical intervention for chronic or recurrent diverticulitis than was previously thought necessary. […] Id be loath to say dont give antibiotics to patients with diverticulitis. It depends if they have clear cut diverticulitis accompanied by pain, fever, elevated white blood cell count, and an abnormal physical exam. […] Likewise, some people need surgery, especially if theyve had two episodes of diverticulitis in a six-month period, says Dr. Greenberger. […] In other words, treatments for diverticulitis need to be individualized.

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