Materiały źródłowe

• #1 Diverticulitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758

  Diverticulitis is inflammation of irregular bulging pouches in the wall of the large intestine. […] Mild diverticulitis is usually treated with rest, changes in your diet and possibly antibiotics. Severe diverticulitis usually needs antibiotic treatment in the hospital. Surgery may be needed for severe or frequent diverticulitis. […] Diverticulitis is inflammation of one or more diverticula. This may happen because of bacterial disease or damage to diverticula tissues.

• #1 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.

• #1 Conservative Treatment of Acute Colonic Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5610668/

  Along with dietary restrictions, bed rest has been part of the routine treatment of acute diverticulitis. However, beneficial effects of bed rest have never been studied nor proven. […] Routine antibiotic treatment of uncomplicated acute diverticulitis used to be, and in part still is, a standard practice. Several observational studies however show that omitting antibiotics may be safe. […] Observation alone, patients had a significantly shorter length of hospital stay (median 2 days (IQR 13) versus median 3 days (IQR 23) in the antibiotic group (p = 0.006). Results from these randomized clinical trials confirm that omitting antibiotics in the treatment of uncomplicated diverticulitis is without significant short-term and mid-term repercussions. […] Outpatient treatment became feasible.

• #1 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. […] 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.

• #1 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.

• #1 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.

• #1 Acute Diverticulitis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-diverticulitis/

  Acute uncomplicated diverticulitis […] Treatment includes pain control with oral analgesics such as acetaminophen and ibuprofen and some degree of bowel rest. Opioid analgesia should be avoided due to its effect on intestinal motility. Bowel rest may involve a liquid diet for 2-3 days, followed by gradual advancement to a soft diet with eventual return to a regular diet. There is increasing evidence that antibiotics should not be used routinely for mild uncomplicated diverticulitis. Clinical judgement and consideration of risk factors (e.g., significant comorbidities, vomiting, symptoms ongoing for more than 5 days, substantially elevated WBC and/or CRP) can direct decisions regarding antibiotics. If antibiotics are used, coverage should include both gram negative and anaerobic species. Suitable therapies include: TMP/SMX 1DS tablet PO BID and metronidazole 500 mg PO BID for 4-7d, or amoxicillin-clavulanate 875 mg/125 mg PO BID for 4-7 days, or ciprofloxacin 500 mg PO BID and metronidazole 500 mg PO BID for 4-7 days.

• #1 Diagnosis and Management of Acute Diverticulitis | AAFP

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

  Uncomplicated diverticulitis is localized diverticular inflammation, whereas complicated diverticulitis is diverticular inflammation associated with an abscess, phlegmon, fistula, obstruction, bleeding, or perforation. […] In mild, uncomplicated diverticulitis, antibiotics do not accelerate recovery, or prevent complications or recurrences. Hospitalization should be considered if patients have signs of peritonitis or there is suspicion of complicated diverticulitis. Inpatient management includes intravenous fluid resuscitation and intravenous antibiotics. […] The decision to proceed to surgery in patients with recurrent diverticulitis should be individualized and based on patient preference, comorbidities, and lifestyle. Interventions to prevent recurrences of diverticulitis include increased intake of dietary fiber, exercise, cessation of smoking, and, in persons with a body mass index of 30 kg per m2 or higher, weight loss.

• #1 Acute Diverticulitis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-diverticulitis/

  Complicated diverticulitis should be treated with IV antibiotics: ceftriaxone 1-2g IV daily and metronidazole 500mg IV BID, or ciprofloxacin 400 mg IV BID and metronidazole 500 mg IV BID, or piperacillin/tazobactam 4.5g IV q8h or 3.375g IV q6h. Patients admitted with complicated diverticulitis should initially be kept on full bowel rest with IV hydration. Pain control with IV/IM analgesics should also be provided. Percutaneous drainage should be considered for abscesses larger than 4cm.

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

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

  Pain management is important. Morphine is acceptable for analgesia and is preferred over meperidine owing to the adverse effects associated with meperidine. […] The decision to proceed with elective surgery, typically at least 6 weeks after recovery from acute diverticulitis, should be made on a case-by-case basis. […] The classic three-stage surgical approach is rarely indicated at present because of its high associated morbidity and mortality. […] Increasing experience with laparoscopic techniques for colon resection suggests that some of its advantages include less pain, a smaller scar, and shorter recovery time. […] A lifelong high-fiber diet for those with asymptomatic diverticular disease may reduce the incidence of diverticulitis and its complications.

• #1 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.

• #1 Diverticulitis treatment – La Crosse – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/locations/la-crosse/services-and-treatments/colon-and-rectal-surgery/conditions-and-treatments/diverticulitis

  Diverticulitis Treatment in La Crosse […] Treatment of diverticulitis depends on the severity of your signs and symptoms. If your symptoms are mild, you may be treated at home with antibiotics to treat the infection and a liquid diet to help your bowel heal. […] Your health care team may recommend surgery to treat your diverticulitis if: […] You have had multiple episodes of diverticulitis. […] There are two main types of surgery: […] Your health care provider may recommend colonoscopy six weeks after you recover from diverticulitis, especially if you haven’t had the test in the previous year.

• #1 Diagnosis and Management of Acute Diverticulitis | AAFP

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

  Patients with a localized abscess may be candidates for CT-guided percutaneous drainage, a procedure that does not increase the risk of recurrent diverticulitis. […] Fifteen to 30 percent of patients admitted with acute diverticulitis require surgical intervention during that admission. Surgical options include laparoscopic or open approaches for drainage, washout, or resection. Laparoscopic surgery results in a shorter length of stay, fewer complications, and lower in-hospital mortality compared with open colectomy.

• #1 What Is Diverticulitis Supportive Therapy?

  https://www.healthline.com/health/diverticulitis-supportive-therapy

  Antibiotics are the primary treatment for diverticulitis, but supportive therapies at home may help as well. Supportive therapies for diverticulitis include things such as specialized diets and pain-relieving treatments. […] Supportive therapy steps you can take at home may help to relieve pain and lower inflammation. Supportive therapy includes self-care measures such as temporary specialized diets, heat therapy for pain relief, and resting. […] Supportive therapies for diverticulitis include: Over-the-counter (OTC) pain relievers: A doctor might prescribe OTC pain relievers to manage your symptoms. Liquid diet: A liquid diet can help ease symptoms of diverticulitis. Typically, it consists of beverages such as water, coffee, tea, juices, sports drinks, and soft drinks, along with broths, popsicles, and gelatin. In most cases, you’ll only be asked to follow a liquid for a few days. Low fiber diet: Low fiber diets can help lower inflammation. A low fiber diet is made up of skinless and seedless fruits and vegetables, eggs, dairy products, ground meat, white bread, pasta, and rice. After about 4 days of this diet, you’ll often be able to slowly start adding high fiber foods. Heating pads: Heating pads can be a great way to treat active diverticulitis pain.

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

  https://www.healthline.com/health/diverticulitis

  Treatment for diverticulitis will depend on the severity of your condition. […] Your treatment plan may include a combination of dietary changes, medications, and in rare cases, surgery. […] A doctor may recommend following a clear liquid diet if you’re experiencing a diverticulitis flare-up. […] A doctor may also recommend limiting your consumption of red meat, high fat dairy products, and refined grain products. […] As your symptoms improve, they might encourage you to eat more high fiber foods. […] Over-the-counter pain relievers like acetaminophen (Tylenol) may help reduce pain or discomfort from diverticulitis. […] It’s important not to take NSAIDs to help manage pain, as these may worsen diverticulitis. […] Severe diverticulitis may be caused by an infection. A doctor may prescribe the following antibiotics to treat it: metronidazole (Flagyl, Flagyl ER), amoxicillin, moxifloxacin.

• #1 Diverticulitis medication: Types and other treatments

  https://www.medicalnewstoday.com/articles/what-is-the-best-medication-for-diverticulitis

  Medications for diverticulitis include antibiotics, acetaminophen, antispasmodics, and tricyclic antidepressants. Some over-the-counter medications may worsen the condition, so it is important to contact a doctor for a treatment plan. […] The American College of Gastroenterology (ACG) advises that doctors typically recommend antibiotics and either a liquid or light diet to treat diverticulitis. […] According to the American Gastroenterological Association (AGA), doctors may use a combination of oral fluoroquinolone and metronidazole antibiotics to treat mild cases in the outpatient setting. […] A persons doctor can advise on whether they recommend antibiotic treatment based on the individuals circumstances. […] Doctors may recommend acetaminophen (Tylenol) or antispasmodic such as dicyclomine (Bentyl) and hyoscyamine (NuLev) for pain relief.

• #1 Diverticulitis: 7 Self-Care and Diet Tips for Managing a Flare

  https://www.medicalnewstoday.com/articles/home-remedies-for-diverticulitis

  Some people get relief from painful stomach cramps by applying heat. […] Probiotics contain beneficial species of gut bacteria. In some cases, they can also help with digestive conditions. […] One 2016 research review suggests that probiotics may reduce symptoms and recurrence of diverticular disease. […] Staying physically active, such as regularly exercising, releases endorphins, which are the body’s natural pain relievers. This might help alleviate pain due to diverticulitis. […] Herbs and spices that have anti-inflammatory or antimicrobial properties may benefit people with diverticulitis. […] Home remedies for diverticulitis can help people manage their condition. The treatments they use will depend on what works best for them and whether they are taking medications that could cause interactions. […] It is recommended that people with diverticulitis get advice from a doctor before trying any new home remedies.

• #1 How Do You Calm Down a Diverticulitis Attack? Symptoms & Treatment

  https://www.emedicinehealth.com/how_do_you_calm_down_a_diverticulitis_attack/article_em.htm

  Mild diverticulitis may go away on its own, while home remedies such as drinking plenty of fluids, a clear liquid diet, a bland/BRAT diet, heating pad, rest, pain relievers can help calm a mild diverticulitis attack. […] Treatment for diverticulitis depends on the severity, complications that may be present, and other underlying medical conditions. […] An attack of uncomplicated, mild diverticulitis may go away on its own, but it is important to see a doctor to assess the severity and determine if treatment is needed. […] To calm down a mild diverticulitis attack: Drink plenty of fluids […] A clear liquid diet for two to three days […] Progress to a bland, soft diet as tolerated such as the BRAT diet […] Use a heating pad to relieve mild cramps and pain […] Acetaminophen (Tylenol) for pain

• #1 Diverticulitis medication: Types and other treatments

  https://www.medicalnewstoday.com/articles/what-is-the-best-medication-for-diverticulitis

  The AGA advises that ongoing gastrointestinal symptoms are common after an episode of acute diverticulitis. A doctor may prescribe a low to modest dose of a tricyclic antidepressant after a full assessment. […] Doctors may prescribe antibiotics to treat diverticulitis. They may also recommend acetaminophen, antispasmodics, or tricyclic antidepressants to manage ongoing abdominal pain. […] Experts do not advise people to take NSAIDs for diverticulitis as they may cause further complications. However, doctors may recommend people with cardiovascular disease differently. A person should always follow a doctors advice. […] Someone with symptoms of diverticulitis should contact a doctor for an assessment and to discuss treatment options.

• #1 Conservative Treatment of Acute Colonic Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5610668/

  Since the treatment of acute diverticulitis has become more conservative over the last years, knowledge of conservative treatment strategies is increasingly important. […] Several treatment strategies that previously have been imposed as routine treatment are now obsolete. Uncomplicated diverticulitis patients can be treated without antibiotics, without bed rest, and without dietary restrictions; and a selected group of patients can be treated as outpatients. […] Dietary restrictions, from nil-per-mouth to liquids only or low-fiber diet, have been imposed as part of the routine treatment of acute diverticulitis. This is more tradition- than evidence-based. […] An unrestricted diet seems justified in patients with acute diverticulitis, in the absence of planned invasive procedures that demand fasting.

• #1 Diverticular Disease & Diverticulitis | Causes & Symptoms | Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/diverticular-disease/

  What treatment is available for diverticular disease? The causes of flare-ups of diverticular disease or the development of complications such as acute diverticulitis is unknown, despite research. Following the diagnosis of diverticular disease, many people will ask their doctor for advice on how to prevent development of complications. […] Diet: You are advised to eat a healthy, balanced diet including whole grains, fruit and vegetables. This involves eating lots of different healthy foods. The aim is to have a fibre containing starchy food with each meal. Plus five portions of fruit and/or vegetables per day. Try to drink at least two litres (eight to ten cups) of fluid every day to help the fibre pass through the bowel. A portion of fruit and vegetables is 80g (or a handful). Smoothies are 150ml portion as they generally contain a lower amount of fibre. If you don’t have much fibre in your diet or suffer from constipation it is important to increase your intake slowly. This will to avoid symptoms of bloating and wind, it may take some time for improvements to be seen to constipation symptoms. There is no need to avoid seeds, nuts, popcorn or fruit skins.

• #1 Conservative Treatment of Acute Colonic Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5610668/

  Several treatment strategies that previously have been imposed as routine treatment are now obsolete. Dietary restrictions and bed rest have no place in the treatment of acute diverticulitis any more. Omitting antibiotics for uncomplicated diverticulitis has shown to be safe, and therefore antibiotics should not be used in these patients routinely. […] To date, no pharmacological therapies have been able to prevent recurrence of diverticulitis after an acute episode. Mesalazine did not show any effect in four randomized placebo-controlled trials, whereas rifaximin and probiotics have not been studied sufficiently to conclude anything on their efficacy. […] For the prevention of recurrent disease in imaging-proven acute diverticulitis patients, there is a complete lack of evidence for efficacy of dietary interventions.

• #1 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.

• #1 Diverticular Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0800/diverticular-disease.html

  Diverticulitis should be suspected in patients with isolated left lower quadrant pain, abdominal distention or rigidity, fever, and leukocytosis. […] Treatment decisions are based on the categorization of disease as complicated vs. uncomplicated. Selected patients with uncomplicated diverticulitis may be treated without antibiotics. Complicated diverticulitis is treated in the hospital with modified diet or bowel rest, antibiotics, and pain control. […] Colonoscopy should be considered six to eight weeks after resolution of a complicated case of diverticulitis unless the patient has had a high-quality colonoscopy in the past year. […] For patients who have normal vital signs, are able to maintain oral intake, and have no signs of complications (e.g., peritonitis, fever), outpatient management is appropriate. Antibiotics should not be used routinely in the treatment of uncomplicated diverticulitis.

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

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

  Outpatient diet—There is no evidence for dietary restrictions in acute uncomplicated diverticulitis. Some guidelines allow regular diet in patients who can tolerate it, while others endorse a „modified” diet. One approach is to limit patients to a liquid diet until they can be reassessed within a week, after which their diet can be liberalized to soft or regular if they demonstrate clinical improvement. […] 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 who improve—Repeat imaging studies are not necessary in patients who continue to demonstrate clinical improvement. Upon resolution of all symptoms, patients should be monitored for any recurrence of symptoms and undergo colonoscopy in six to eight weeks if they have not done so within the previous year.

• #1

  https://www.asge.org/home/resources/key-resources/blog/view/practical-solutions/2023/09/27/case-8–acute-uncomplicated-diverticulitis

  The common antibiotic therapy for acute uncomplicated diverticulitis treated in the outpatient setting is ciprofloxacin 500 mg by mouth every 12 hours and metronidazole 500 mg by mouth every eight hours for 10 to 14 days. […] Inpatient criteria for acute uncomplicated diverticulitis include sepsis, severe abdominal pain or peritonitis, age older than 70, significant comorbidities, immunosuppression, intolerance of oral intake and failed outpatient therapy. […] If patients meet the criteria for inpatient management of acute uncomplicated diverticulitis, the management consists of intravenous antibiotics, intravenous fluids, pain control and bowel rest (consider a liquid diet). […] Inpatient antibiotics include Piperacillin 3.375 grams IV every six hours or Ciprofloxacin 400 mg IV every 12 hours with Metronidazole 500 mg IV every eight hours. IV antibiotics are continued until symptoms improve, typically 3 to 5 days, and then patients are transitioned to oral antibiotics once the patient is tolerating oral intake. Total antibiotic therapy (IV + PO) is 10 to 14 days. […] Discharge criteria include normalization of vital signs, resolution of severe abdominal pain, resolution of significant leukocytosis and tolerance of oral diet.

• #1 Colonic Diverticulitis – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/diverticular-disease/colonic-diverticulitis

  Surgery is required immediately for patients with free perforation or when feculent peritonitis is suspected based on clinical examination or imaging. Other indications for surgery include severe symptoms that do not respond to nonsurgical treatment within 3 to 5 days and increasing pain, tenderness, and fever. Approximately 15 to 20% of people admitted with acute diverticulitis require surgery during that admission. […] For uncomplicated diverticulitis, surgical resection was previously recommended based on the number of recurrences. Currently, the American Society of Colon and Rectal Surgeons (ASCRS) and other practice guidelines recommend a case-by-case evaluation rather than mandatory elective segmental colectomy after a second episode.

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

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

  Overall, between 16 and 42 percent of patients have one or more recurrent episode(s) after nonoperative management of acute diverticulitis. Thus, most patients do not develop recurrent diverticulitis. […] Surgery, however, may be indicated in patients with recurrent diverticulitis who develop symptoms. Overall, approximately 15 percent of patients with acute diverticulitis will require surgical intervention at some time during the course of their disease, nearly all of whom have had either a complicated episode or several uncomplicated episodes of diverticulitis. […] For patients who have had complicated diverticulitis or who are immunosuppressed, we suggest elective colon resection. Such patients are at high risk of developing serious complications or dying from recurrent diverticulitis and emergency surgery.

• #1 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. […] Guidelines from the American Society of Colon and Rectal Surgeons (ASCRS) echo AGAs recommendations. […] One notable change: AGA recommends selective, rather than routine, antibiotic use in immunocompetent patients with mild disease. […] AGA does, however, advise antibiotic treatment for patients with comorbidities, who present with concerning, high-risk symptoms or who present with complicated diverticulitis. […] 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. […] The report states that at five-year follow up, patients with recurrent diverticulitis experienced improved quality of life after elective resection.

• #1 Evolving Approaches to Diverticulitis Give Surgeons a Gut Check in Management Options | ACS

  https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2023/november-december-2023-volume-108-issue-11/evolving-approaches-to-diverticulitis-give-surgeons-a-gut-check-in-management-options/

  Today, we need to keep in mind that there are patients who do well with a primary anastomosis. […] Another controversial area in the surgical management of diverticulitis is laparoscopic versus the more traditional open surgery, particularly for emergent cases. […] With minimally invasive surgery, the operation is conducted through small incisions and is generally linked to shorter hospital stays and fewer complications, as well as less pain for the patient. […] Use your judgment and individualized treatment, rather than a one-size-fits-all thought process, Dr. Fichera said. […] If we have supporting evidence, it helps us educate patients as far as what they can do for themselves to change their diet or other risk factors, Dr. Denoya said. […] You still need to use your judgment and engage in individualized treatment, Dr. Fichera stated.

• #1 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.

• #1 Management of acute diverticulitis – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/management-of-acute-diverticulitis/

  Recommendations for all aspects of the management of acute uncomplicated diverticulitis, from follow-up colonoscopies to medications to diet and lifestyle interventions. […] AGA suggests that antibiotics should be used selectively, rather than routinely, in patients with acute uncomplicated diverticulitis. […] AGA suggests that colonoscopy 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. […] AGA suggests against elective colonic resection in patients with an initial episode of acute uncomplicated diverticulitis. The decision to perform elective prophylactic colonic resection in this setting should be individualized. […] AGA suggests a fiber-rich diet or fiber supplementation in patients with a history of acute diverticulitis.

• #2 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.

• #2 Diverticulitis: Symptoms, Causes & Treatment

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

  Diverticulitis is inflammation in your diverticula, which are small pockets that can develop on the inside of your colon. […] 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. […] 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. […] 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.

• #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 Diverticular Disease and Diet | Patient Education | UCSF Health

  https://www.ucsfhealth.org/education/diverticular-disease-and-diet

  Diverticulitis occurs when the pouches in the colon become infected or inflamed. Dietary changes can help the colon heal. […] During flare ups of diverticulitis, follow a clear liquid diet. Your doctor will let you know when to progress from clear liquids to low fiber solids and then back to your normal diet. […] When you’re able to eat solid food, choose low fiber foods while healing. […] After symptoms improve, usually within two to four days, you may add 5 to 15 grams of fiber a day back into your diet. Resume your high fiber diet when you no longer have symptoms.

• #2 Conservative Treatment of Acute Colonic Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5610668/

  Along with dietary restrictions, bed rest has been part of the routine treatment of acute diverticulitis. However, beneficial effects of bed rest have never been studied nor proven. […] Routine antibiotic treatment of uncomplicated acute diverticulitis used to be, and in part still is, a standard practice. Several observational studies however show that omitting antibiotics may be safe. […] Observation alone, patients had a significantly shorter length of hospital stay (median 2 days (IQR 13) versus median 3 days (IQR 23) in the antibiotic group (p = 0.006). Results from these randomized clinical trials confirm that omitting antibiotics in the treatment of uncomplicated diverticulitis is without significant short-term and mid-term repercussions. […] Outpatient treatment became feasible.

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

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

  No oral antibiotics—Antibiotics used to be the cornerstone of diverticulitis treatment. However, such practice was largely based upon retrospective studies and clinical experience rather than high-quality evidence. In an open-label randomized trial (DINAMO) of 480 patients with imaging-confirmed uncomplicated diverticulitis whose symptoms were adequately controlled in the emergency department, outpatient treatment with or without amoxicillin-clavulanic acid resulted in similarly low rates of unscheduled return visits or hospitalization. […] Our suggestion for the selective use of antibiotics to treat uncomplicated diverticulitis is consistent with recommendations from the American Gastroenterological Association (AGA), American Society of Colon and Rectal Surgeons (ASCRS), European Association of Endoscopic Surgery (EAES)/Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and American College of Physicians (ACP).

• #2 Diverticular Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0800/diverticular-disease.html

  Diverticulitis should be suspected in patients with isolated left lower quadrant pain, abdominal distention or rigidity, fever, and leukocytosis. […] Treatment decisions are based on the categorization of disease as complicated vs. uncomplicated. Selected patients with uncomplicated diverticulitis may be treated without antibiotics. Complicated diverticulitis is treated in the hospital with modified diet or bowel rest, antibiotics, and pain control. […] Colonoscopy should be considered six to eight weeks after resolution of a complicated case of diverticulitis unless the patient has had a high-quality colonoscopy in the past year. […] For patients who have normal vital signs, are able to maintain oral intake, and have no signs of complications (e.g., peritonitis, fever), outpatient management is appropriate. Antibiotics should not be used routinely in the treatment of uncomplicated diverticulitis.

• #2 How to Manage and Treat Diverticulitis: Hamid Kamran, MD, FACG: Gastroenterologist

  https://www.agstexas.com/blog/how-to-manage-and-treat-diverticulitis

  If you are suffering from diverticulitis, you should seek medical treatment from your local gastroenterologist as soon as possible. Fortunately, there are various steps that you and your doctor can take to help manage diverticulitis. These include, […] Antibiotics usually are needed to treat patients with diverticulitis. For those with relatively mild symptoms, usually oral antibiotics will be sufficient. Common antibiotic choices can include ciprofloxacin, metronidazole, cephalexin, and doxycycline. However, for patients with severe cases, intravenous antibiotics administered in a hospital may be needed. […] During an acute case of diverticulitis, a liquid or low fibre diet may be advised by your doctor. Adhering to such a diet should reduce the amount of material passing through the colon, and thus reduce the symptoms and problems of diverticulitis.

• #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

  https://www2.hse.ie/conditions/diverticular-disease-and-diverticulitis/diagnosis-and-treatment/

  While the symptoms of diverticular disease and diverticulitis are similar, treatment is different. […] Treatment for diverticulitis includes a low-fibre diet, antibiotics, treatment in hospital and surgery. […] Your GP may recommend a fluid-only diet for a few days until your symptoms improve. […] While you’re recovering, you should have a very low-fibre diet to rest your digestive system. […] You can usually treat diverticulitis at home. Your GP may prescribe antibiotics. […] More serious cases of diverticulitis may need hospital treatment. In hospital, you may get antibiotics and fluids directly into a vein (intravenous drip). […] An abscess is a common complication of diverticulitis. An abscess is a pus-filled cavity or lump in the tissue. You may need surgery to drain an abscess. […] Sometimes you will need surgery to treat other types of complications. This could be, for example, a blockage in your bowel. […] Surgery usually involves removing the affected section of your large bowel. This is known as a colectomy.

• #2 Diverticulitis: Practice Essentials, Background, Pathophysiology

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

  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; meperidine is associated with adverse effects; nonsteroidal anti-inflammatory drugs and corticosteroids have been associated with a greater risk of colonic perforation; 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 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, and immunocompromised status.

• #2 Diverticulitis Management: Outpatient or Inpatient – Current Treatment

  https://ppemedical.com/blog/diverticulitis-management-outpatient-or-inpatient/

  Diverticulitis is an infection and/or inflammation in diverticula (small pouches) that occurs in the digestive tract, specifically the colon. Some patients may require inpatient treatment for severe pain or complications. Some patients can be treated out of the hospital. […] The decision for inpatient treatment of diverticulitis is based on the degree of disease complication. Complicated diverticulitis with a perforation, abscess that fails IV antibiotics and percutaneous drainage, fistula or obstruction will likely require emergency surgery. […] These patients should receive IV fluids. Normal saline or lactated Ringers ensure adequate fluid volume. Most patients should be NPO status until they are able to tolerate clear liquids. Pain should be controlled by IV route if patients are NPO or orally if they are on a diet.

• #2 Diverticulitis > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/diverticulitis

  Treatments include IV antibiotics or oral antibiotics and a clear liquid diet for several days. […] Usually, diverticulitis can be resolved with mild treatments, including temporary diet changes and sometimes antibiotics. […] Treatment focuses on letting the colon rest and clearing up inflammation and infections. Recent research suggests that not all cases of diverticulitis require antibiotics, as previously thought. Some, but not all, patients require hospitalization. […] Inpatient (in-hospital) treatment. Patients with severe cases of diverticulitis may require intravenous antibiotics and fluids for several days. This approach allows the colon to rest. If a patient improves within a few days, he or she is usually sent home with a longer course of antibiotics. If the patient doesn’t improve, then surgery of the colon to remove sections with diverticula may be required.

• #2 Diverticular Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0800/diverticular-disease.html

  If symptoms do not improve after 48 to 72 hours, a broad-spectrum antibiotic against anaerobic and gram-negative rods should be initiated and typically continued for seven to 10 days. […] Patients with complicated acute diverticulitis should be admitted to the hospital. […] Intravenous antibiotics should be initiated. […] Abscesses smaller than 3 cm should be treated with intravenous antibiotics, and reevaluation if there is clinical deterioration. Imaging-guided percutaneous drainage is recommended for abscesses that are 3 cm or larger, with surgical consultation if needed. […] Surgical intervention is based on recurrence risk and the patient’s overall health status. Considerations for surgical referral include severity of pain or symptoms, complicated disease, potential for poor outcome, and the medical needs of the patient. […] Surgical referral for partial colectomy after the third reoccurrence appears to be most cost-effective.

• #2

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

  The options for surgical treatment include: removal of the involved part of the colon, with or without creation of a colostomy, a washout of the abdominal cavity and leaving the colon in place, or creating an ostomy (a surgically created opening between an internal organ and the body surface) to divert the fecal stream without removal of the colon. […] Removal of the affected portion of the colon, usually the sigmoid colon, is the most common procedure for surgical treatment of acute diverticulitis. […] Treatment of chronic diverticulitis involves treatment of recurrent disease, or the complications that may result from an acute attack. In general, treatment for chronic diverticulitis involves surgery to remove the involved portions of the colon, usually the sigmoid colon, and then reconnecting the colon.

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

  https://www.healthline.com/health/diverticulitis

  That said, mild diverticulitis is usually not treated with antibiotics. […] You may require surgery if you develop a complication from diverticulitis or you experience multiple episodes that can’t be managed with other treatments. […] There are two main types of surgery used to treat diverticulitis: Bowel resection with anastomosis and Bowel resection with colostomy. […] Both procedures can be performed as open surgery or laparoscopic surgery. […] Along with dietary changes, the following home remedies may help improve diverticulitis symptoms. […] Some studies have found that certain strains of probiotics might help relieve or prevent symptoms of diverticulitis. […] Certain herbal extracts, including Curcuma longa L. and Boswellia serrata, may help reduce abdominal pain associated with diverticulitis. […] Some research suggests acupuncture may help relieve chronic abdominal pain associated with diverticulitis.

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

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

  Pain management is important. Morphine is acceptable for analgesia and is preferred over meperidine owing to the adverse effects associated with meperidine. […] The decision to proceed with elective surgery, typically at least 6 weeks after recovery from acute diverticulitis, should be made on a case-by-case basis. […] The classic three-stage surgical approach is rarely indicated at present because of its high associated morbidity and mortality. […] Increasing experience with laparoscopic techniques for colon resection suggests that some of its advantages include less pain, a smaller scar, and shorter recovery time. […] A lifelong high-fiber diet for those with asymptomatic diverticular disease may reduce the incidence of diverticulitis and its complications.

• #2 Diverticulitis: 7 Self-Care and Diet Tips for Managing a Flare

  https://www.medicalnewstoday.com/articles/home-remedies-for-diverticulitis

  Some people follow specific eating patterns to help ease the diverticulitis symptoms, while others use home remedies, such as a low fiber diet, for self-care. […] A doctor may recommend a temporary liquid diet to someone experiencing a symptom flare-up. […] Adopting a low fiber eating plan can also help ease diverticulitis symptoms. […] Symptoms will usually improve within around 24 days, after which point a person can try gradually adding small amounts of fiber again. […] After recovering from a bout of diverticulitis, it may be good for most individuals to increase fiber intake to soften stools and reduce the risk of future flares. […] Some research suggests that people with lower vitamin D levels may be more at risk of diverticulitis and its complications. […] A person can also take vitamin D as a supplement to increase their levels.

• #2 Does Diverticulitis Go Away? Timeline After Treatment

  https://www.verywellhealth.com/does-diverticulitis-go-away-7097971

  For those who already have had diverticulitis in the past, avoiding nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) and Aleve (naproxen), may be recommended. […] Diverticulitis, which is an acute (with sudden onset and typically short-term) problem, usually goes away with treatment. But the condition known as diverticulosis, which is the presence of diverticula in the colon, will not go away. In some cases, diverticular disease is treated through surgery, and the parts of the colon that have diverticula might be removed. However, there is a risk (about 15% at five years) of diverticular disease coming back. […] If symptoms aren’t getting better, it’s important to discuss them with a healthcare provider. A different type of treatment may be needed. […] A healthcare provider might suggest surgery when diverticulitis is complicated. This could mean that a related problem (such as an abscessa pocket of infection) has developed or if there’s a second flare-up close after the first one.

• #2 What Is Diverticulitis Supportive Therapy?

  https://www.healthline.com/health/diverticulitis-supportive-therapy

  Antibiotics are the primary treatment for diverticulitis, but supportive therapies at home may help as well. Supportive therapies for diverticulitis include things such as specialized diets and pain-relieving treatments. […] Supportive therapy steps you can take at home may help to relieve pain and lower inflammation. Supportive therapy includes self-care measures such as temporary specialized diets, heat therapy for pain relief, and resting. […] Supportive therapies for diverticulitis include: Over-the-counter (OTC) pain relievers: A doctor might prescribe OTC pain relievers to manage your symptoms. Liquid diet: A liquid diet can help ease symptoms of diverticulitis. Typically, it consists of beverages such as water, coffee, tea, juices, sports drinks, and soft drinks, along with broths, popsicles, and gelatin. In most cases, you’ll only be asked to follow a liquid for a few days. Low fiber diet: Low fiber diets can help lower inflammation. A low fiber diet is made up of skinless and seedless fruits and vegetables, eggs, dairy products, ground meat, white bread, pasta, and rice. After about 4 days of this diet, you’ll often be able to slowly start adding high fiber foods. Heating pads: Heating pads can be a great way to treat active diverticulitis pain.

• #2 Diverticulitis Treatment: How to Treat It and Recovery Time

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

  Once you develop diverticula, they are there to stay unless you have them surgically removed, which is not usually done. You can minimize the chances of developing an infection by modifying your diet. If you have diverticulosis, your doctor may have you eat a high-fiber diet to make sure the bowels move regularly and to reduce the odds of getting diverticulitis. […] If you develop diverticulitis you need to see a doctor to make sure you recover completely and to avoid possible life-threatening complications. Diverticulitis is treated using diet modifications, antibiotics, and possibly surgery. […] Mild diverticulitis infection may be treated with stool softeners, a liquid diet, antibiotics to fight the infection, and possibly antispasmodic drugs. […] However, if you have had a perforation or develop a more severe infection, you will probably be hospitalized so you can receive intravenous (through a vein) antibiotics. […] If you have several attacks of acute diverticulitis, your doctor may want to remove the affected section of the intestine when you are free of symptoms. […] Whatever the treatment, the chances for a full recovery are very good if you receive prompt medical attention.

• #2 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.

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

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

  Most people won’t 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.

• #2 Management of acute diverticulitis – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/management-of-acute-diverticulitis/

  AGA suggests against routinely advising patients with a history of diverticulitis to avoid consumption of seeds, nuts and popcorn. […] AGA suggests against routinely advising patients with a history of diverticulitis to avoid the use of aspirin. […] AGA suggests advising patients with a history of diverticulitis to avoid the use of nonaspirin NSAIDs if possible. […] AGA recommends against the use of mesalamine after acute uncomplicated diverticulitis. […] AGA suggests against the use of rifaximin after acute uncomplicated diverticulitis. […] AGA suggests against the use of probiotics after acute uncomplicated diverticulitis. […] AGA suggests advising patients with diverticular disease to consider vigorous physical activity.

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

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

  Elective colon resection is generally not offered to immunocompetent patients with a history of uncomplicated diverticulitis, regardless of the number of past episodes. However, surgery may be offered to those patients who travel extensively, and patients who live in remote areas of the country without ready access to medical care. […] After the complete resolution of symptoms associated with acute diverticulitis, 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. […] 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. Patients should also refrain from chronic or excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin unless prescribed for cardiovascular purposes.

• #2 Does Diverticulitis Go Away? Timeline After Treatment

  https://www.verywellhealth.com/does-diverticulitis-go-away-7097971

  Different drugs have been tested to see if they might be helpful in treating or preventing diverticulitis flare-ups. There’s no evidence that antibiotics, Asacol (mesalamine), or probiotics are helpful in treating or preventing diverticulitis. […] However, some of the diet and lifestyle changes that have a growing level of evidence to support them include: Eating enough dietary fiber, Getting enough exercise, Maintaining an appropriate weight, Stopping smoking. […] Having a diverticulum carries a risk of developing an inflammatory condition called diverticulitis. Uncomplicated diverticulitis might be treated at home, but complicated diverticulitis might need treatment in the hospital with medications and/or surgery.

• #2 Diverticulitis treatment – La Crosse – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/locations/la-crosse/services-and-treatments/colon-and-rectal-surgery/conditions-and-treatments/diverticulitis

  Diverticulitis Treatment in La Crosse […] Treatment of diverticulitis depends on the severity of your signs and symptoms. If your symptoms are mild, you may be treated at home with antibiotics to treat the infection and a liquid diet to help your bowel heal. […] Your health care team may recommend surgery to treat your diverticulitis if: […] You have had multiple episodes of diverticulitis. […] There are two main types of surgery: […] Your health care provider may recommend colonoscopy six weeks after you recover from diverticulitis, especially if you haven’t had the test in the previous year.

• #2

  https://www.asge.org/home/resources/key-resources/blog/view/practical-solutions/2023/09/27/case-8–acute-uncomplicated-diverticulitis

  Colonoscopy is not indicated in acute diverticulitis and should actually be avoided in this setting due to increased risk of perforation. Once the acute attack has resolved (approximately 6-8 weeks), colonoscopy should be done to rule out underlying malignancy if one was not performed in the past year. […] Acute uncomplicated diverticulitis can commonly be managed as an outpatient. Antibiotic treatment can be used selectively rather than routinely in immunocompetent patients with mild uncomplicated diverticulitis. Initial treatment in this group consists of pain control and liquid diet. Diet can be advanced to regular as tolerated. […] Antibiotic treatment is advised in patients with uncomplicated diverticulitis who have comorbidities or are frail, present with refractory symptoms or vomiting or have a CRP 140 mg/L or baseline WBC 15 x 109 cells per/L.

• #2 Acute Diverticulitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459316/

  Inpatient management of diverticulitis requires intravenous antibiotics, intravenous fluids, and pain management. Again, antibiotics should cover gram-negative rods and anaerobes and be given for three to 5 days before switching to oral antibiotics for a ten to 14-day course. Bowel rest is preferred in patients requiring inpatient admission. Typically, defervescence and improvement in leukocytosis should be observed for two to four days of hospitalization, if not an alternative diagnosis or complications should be suspected. Prompt surgical evaluation should be considered.

• #2 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

  Some patients with diverticulitis will develop associated abscesses and may benefit from antibiotics alone or a procedure to drain the infection. […] Guidelines for elective surgery: recommended for patients with complications such as fistula, obstruction, or strictures. For patients with recurrent episodes, elective surgery may improve quality of life. […] Guidelines for emergency surgery: still required in 15 to 32 percent of patients hospitalized for diverticulitis. The guideline addresses factors to consider in deciding whether to create a stoma or restore bowel continuity in patients undergoing emergency surgery. […] When expertise is available, a minimal approach to colectomy [colon surgery] for diverticulitis is preferred, the Guideline Committee writes.

• #2 Colonic diverticular disease. Treatment and prevention | Gastroenterología y Hepatología

  https://www.elsevier.es/es-revista-gastroenterologia-hepatologia-14-articulo-colonic-diverticular-disease-treatment-prevention-S021057051500103X

  Approximately 15% of patients with ACD will develop an abscess. […] Peritonitis is the most serious complication, with a mortality of 14%. […] After one episode of ACD, about a third will have a second ACD, and after a second episode, a further third will have another attack. […] Recent data show that natural history of ACD is much more benign that thought in the past. […] The long term risk of relapse is more lower than previously believed, and the long term risks of subsequent emergency surgery […] Therefore, a policy of elective surgery after ACD does not decrease the likelihood of further surgery

• #2 Diverticulitis Flare Up: More Conservative Treatment Now Recommended | University Hospitals

  https://www.uhhospitals.org/blog/articles/2021/12/diverticulitis-flare-up-more-conservative-treatment-now-recommended

  Diverticulitis is a painful and unpredictable gastrointestinal disease that often requires aggressive treatment. About 200,000 people are hospitalized every year in the United States for the disease, according to the National Institutes of Health. […] While patients can develop severe complications from diverticulitis that require surgery, doctors have taken a more conservative approach to treating milder cases. New guidelines from the American Gastroenterological Association call for less emphasis on antibiotics and surgery for mild cases. […] Antibiotics have been a primary treatment for diverticulitis. But UH colorectal surgeon Trevor Teetor, MD, says recent evidence shows antibiotics are unnecessary for patients with mild cases and no complications. […] Antibiotics are still recommended for patients with other medical conditions who have concerning symptoms or who have complications, he says.

• #2 Evolving Approaches to Diverticulitis Give Surgeons a Gut Check in Management Options | ACS

  https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2023/november-december-2023-volume-108-issue-11/evolving-approaches-to-diverticulitis-give-surgeons-a-gut-check-in-management-options/

• #2 Diverticulitis: Practice Essentials, Background, Pathophysiology

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

  The management of patients with diverticulitis depends on their presentation severity, presence of complications, and comorbid conditions. […] Uncomplicated diverticulitis can be managed medically and in an ambulatory setting. Complicated disease requires a more aggressive approach that can often require urgent or elective surgery, and treatments that are specific to the complication itself (ie, abscess drainage). […] Antibiotics have been the mainstay of therapy for most patients with acute diverticulitis, but more recently, their necessity has been questioned, especially in mild, uncomplicated disease. […] Patients with clinically mild diverticulitis, typically with Hinchey stage 0 and Ia disease, are considered uncomplicated and can be treated with the following outpatient regimen: clear liquid diet for 2-3 days; advancement to low fiber as tolerated; 7-10 days of oral (PO) broad-spectrum antimicrobial therapy on a case-by-case basis; acetaminophen and antispasmodics for pain.

• #2 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.

• #2 Evolving Approaches to Diverticulitis Give Surgeons a Gut Check in Management Options | ACS

  https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2023/november-december-2023-volume-108-issue-11/evolving-approaches-to-diverticulitis-give-surgeons-a-gut-check-in-management-options/

  Today, we need to keep in mind that there are patients who do well with a primary anastomosis. […] Another controversial area in the surgical management of diverticulitis is laparoscopic versus the more traditional open surgery, particularly for emergent cases. […] With minimally invasive surgery, the operation is conducted through small incisions and is generally linked to shorter hospital stays and fewer complications, as well as less pain for the patient. […] Use your judgment and individualized treatment, rather than a one-size-fits-all thought process, Dr. Fichera said. […] If we have supporting evidence, it helps us educate patients as far as what they can do for themselves to change their diet or other risk factors, Dr. Denoya said. […] You still need to use your judgment and engage in individualized treatment, Dr. Fichera stated.

• #3 Diverticulitis: Practice Essentials, Background, Pathophysiology

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

  The management of patients with diverticulitis depends on their presentation severity, presence of complications, and comorbid conditions. […] Uncomplicated diverticulitis can be managed medically and in an ambulatory setting. Complicated disease requires a more aggressive approach that can often require urgent or elective surgery, and treatments that are specific to the complication itself (ie, abscess drainage). […] Antibiotics have been the mainstay of therapy for most patients with acute diverticulitis, but more recently, their necessity has been questioned, especially in mild, uncomplicated disease. […] Patients with clinically mild diverticulitis, typically with Hinchey stage 0 and Ia disease, are considered uncomplicated and can be treated with the following outpatient regimen: clear liquid diet for 2-3 days; advancement to low fiber as tolerated; 7-10 days of oral (PO) broad-spectrum antimicrobial therapy on a case-by-case basis; acetaminophen and antispasmodics for pain.

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

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

  No oral antibiotics—Antibiotics used to be the cornerstone of diverticulitis treatment. However, such practice was largely based upon retrospective studies and clinical experience rather than high-quality evidence. In an open-label randomized trial (DINAMO) of 480 patients with imaging-confirmed uncomplicated diverticulitis whose symptoms were adequately controlled in the emergency department, outpatient treatment with or without amoxicillin-clavulanic acid resulted in similarly low rates of unscheduled return visits or hospitalization. […] Our suggestion for the selective use of antibiotics to treat uncomplicated diverticulitis is consistent with recommendations from the American Gastroenterological Association (AGA), American Society of Colon and Rectal Surgeons (ASCRS), European Association of Endoscopic Surgery (EAES)/Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and American College of Physicians (ACP).

• #3 Management of acute diverticulitis – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/management-of-acute-diverticulitis/

  Recommendations for all aspects of the management of acute uncomplicated diverticulitis, from follow-up colonoscopies to medications to diet and lifestyle interventions. […] AGA suggests that antibiotics should be used selectively, rather than routinely, in patients with acute uncomplicated diverticulitis. […] AGA suggests that colonoscopy 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. […] AGA suggests against elective colonic resection in patients with an initial episode of acute uncomplicated diverticulitis. The decision to perform elective prophylactic colonic resection in this setting should be individualized. […] AGA suggests a fiber-rich diet or fiber supplementation in patients with a history of acute diverticulitis.

• #3

  https://www.asge.org/home/resources/key-resources/blog/view/practical-solutions/2023/09/27/case-8–acute-uncomplicated-diverticulitis

  Colonoscopy is not indicated in acute diverticulitis and should actually be avoided in this setting due to increased risk of perforation. Once the acute attack has resolved (approximately 6-8 weeks), colonoscopy should be done to rule out underlying malignancy if one was not performed in the past year. […] Acute uncomplicated diverticulitis can commonly be managed as an outpatient. Antibiotic treatment can be used selectively rather than routinely in immunocompetent patients with mild uncomplicated diverticulitis. Initial treatment in this group consists of pain control and liquid diet. Diet can be advanced to regular as tolerated. […] Antibiotic treatment is advised in patients with uncomplicated diverticulitis who have comorbidities or are frail, present with refractory symptoms or vomiting or have a CRP 140 mg/L or baseline WBC 15 x 109 cells per/L.

• #3

  https://www.asge.org/home/resources/key-resources/blog/view/practical-solutions/2023/09/27/case-8–acute-uncomplicated-diverticulitis

  The common antibiotic therapy for acute uncomplicated diverticulitis treated in the outpatient setting is ciprofloxacin 500 mg by mouth every 12 hours and metronidazole 500 mg by mouth every eight hours for 10 to 14 days. […] Inpatient criteria for acute uncomplicated diverticulitis include sepsis, severe abdominal pain or peritonitis, age older than 70, significant comorbidities, immunosuppression, intolerance of oral intake and failed outpatient therapy. […] If patients meet the criteria for inpatient management of acute uncomplicated diverticulitis, the management consists of intravenous antibiotics, intravenous fluids, pain control and bowel rest (consider a liquid diet). […] Inpatient antibiotics include Piperacillin 3.375 grams IV every six hours or Ciprofloxacin 400 mg IV every 12 hours with Metronidazole 500 mg IV every eight hours. IV antibiotics are continued until symptoms improve, typically 3 to 5 days, and then patients are transitioned to oral antibiotics once the patient is tolerating oral intake. Total antibiotic therapy (IV + PO) is 10 to 14 days. […] Discharge criteria include normalization of vital signs, resolution of severe abdominal pain, resolution of significant leukocytosis and tolerance of oral diet.

• #3 Diverticular Disease – Core EM

  https://coreem.net/core/diverticular-disease/

  Inpatient management: Start IV broad spectrum coverage of gram negative and anaerobic bacteria. Agents to consider include piperacillin-tazobactam or a combination of metronidazole plus a cephalosporin or a fluoroquinolone. Patients should be kept on a clear liquid diet or complete bowel rest for the first several days of admission, depending on severity. Intravenous resuscitation with crystalloid is indicated in volume depleted patients and maintenance fluids should be given for patients kept NPO. IV pain control in patients who are unable to tolerate oral medications.

• #3 Colonic Diverticulitis – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/diverticular-disease/colonic-diverticulitis

  Antibiotics were traditionally recommended for all cases of acute diverticulitis whether or not they were complicated. However, data suggest that antibiotics may not improve outcome in uncomplicated diverticulitis; therefore, patients who are otherwise healthy and have uncomplicated sigmoid diverticulitis can sometimes be safely managed without antibiotics; antibiotic therapy should be considered on a case-by-case basis. […] Antibiotic therapy should be used for patients with acute complicated diverticulitis, immunosuppression, sepsis, or significant comorbidities. […] CT-guided percutaneous or endoscopic ultrasound-guided drainage is becoming the standard of care for larger abscesses (over 3 cm in diameter), for abscesses that do not resolve with antibiotics, and/or for clinical deterioration.

• #3 Diverticulitis: Practice Essentials, Background, Pathophysiology

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

  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; meperidine is associated with adverse effects; nonsteroidal anti-inflammatory drugs and corticosteroids have been associated with a greater risk of colonic perforation; 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 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, and immunocompromised status.

• #3 Diverticulitis Treatment & Surgery | ACE Specialist Clinic

  https://acesurgery.sg/24-7-emergency/acute-diverticulitis/

  Antibiotics are prescribed for acute diverticulitis primarily to combat bacterial infection within the diverticular pouches of the colon. […] Surgery is not required for mild cases of diverticulitis. Our surgeon may prescribe antibiotics and painkillers to alleviate the infection and keep the patient hydrated and nourished with an intravenous (IV) drip. […] For the treatment of severe acute diverticulitis, which is accompanied by complications, surgery will often be recommended. […] Colectomy surgery involves removing the diseased portion of the large intestine through keyhole or the traditional open surgical methods. […] Laparoscopic Colectomy: A type of keyhole surgery where the surgeon removes the diseased section of the large intestine, by using surgical tools guided by a camera, after making several small incisions in the patient’s abdomen. This surgical method usually results in a relatively short recovery time and minimises scarring.

• #3 Diverticular disease of the colon – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/diverticular-disease-of-the-colon

  Bowel rest is also important for acute diverticulitis. For home treatment, that means sticking to a diet of clear liquids for a few days, then gradually adding soft solids and moving to a more normal diet over a week or two. […] Because diverticulitis tends to recur, prevention is always part of the treatment plan. And for people with any form of colonic diverticular disease, that means a high-fiber diet.

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

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

  Elective colon resection is generally not offered to immunocompetent patients with a history of uncomplicated diverticulitis, regardless of the number of past episodes. However, surgery may be offered to those patients who travel extensively, and patients who live in remote areas of the country without ready access to medical care. […] After the complete resolution of symptoms associated with acute diverticulitis, 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. […] 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. Patients should also refrain from chronic or excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin unless prescribed for cardiovascular purposes.

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

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

  Colonoscopy and dietary modification—All patients who are symptom free should undergo colonoscopy after six to eight weeks to rule out colon cancer unless one has been performed in the previous year. A high-fiber diet and a healthy lifestyle are also recommended to reduce the risk of recurrence, but not avoidance of nuts, corn, and seeds.

• #3 Evolving Approaches to Diverticulitis Give Surgeons a Gut Check in Management Options | ACS

  https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2023/november-december-2023-volume-108-issue-11/evolving-approaches-to-diverticulitis-give-surgeons-a-gut-check-in-management-options/

  The prevalence of diverticulitis continues to rise particularly in industrialized countries, with nearly 3 million Americans diagnosed with the condition and 200,000 hospitalized each year. […] Despite the expansive occurrence of this disease, standardized prevention and treatment continue to elude clinicians although new recommendations for managing these patients are continually explored and debated. […] Both sides of the debate have important data to support what they are doing. […] Once considered a disease predominantly occurring in older patients, the incidence of diverticulitis continues to increase in all age groups, including patients in the third and fourth decades of life around the globe, leading surgeons to consider novel treatment approaches, including selective rather than routine use of antibiotics for uncomplicated cases or the use of laparoscopic surgery when advisable.

• #3 Evolving Approaches to Diverticulitis Give Surgeons a Gut Check in Management Options | ACS

  https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2023/november-december-2023-volume-108-issue-11/evolving-approaches-to-diverticulitis-give-surgeons-a-gut-check-in-management-options/

  Today, we need to keep in mind that there are patients who do well with a primary anastomosis. […] Another controversial area in the surgical management of diverticulitis is laparoscopic versus the more traditional open surgery, particularly for emergent cases. […] With minimally invasive surgery, the operation is conducted through small incisions and is generally linked to shorter hospital stays and fewer complications, as well as less pain for the patient. […] Use your judgment and individualized treatment, rather than a one-size-fits-all thought process, Dr. Fichera said. […] If we have supporting evidence, it helps us educate patients as far as what they can do for themselves to change their diet or other risk factors, Dr. Denoya said. […] You still need to use your judgment and engage in individualized treatment, Dr. Fichera stated.

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