The American College of Gastroenterology (ACG) just released a new 2026 guideline on colonic diverticulitis, a common disease that accounts for approximately 1.7 million clinic visits and  179,000 hospitalizations in the United States each year. The clinical guideline features fourteen evidence-based recommendations for managing diverticulitis in the outpatient gastroenterology setting. The ACG colonic diverticulitis guideline also provides a list of key concepts for clinicians and a patient summary outline for patients. 

Today, we are highlighting the fourteen recommendations included in the ACG guideline, Colonic Diverticulitis. Consult the full-text version of the guideline for the complete look at the rationale behind these recommendations.

2026 ACG Colonic Diverticulitis Recommendations

Colonoscopy:

  • We recommend colonoscopy after recovery from an episode of complicated diverticulitis to rule out a missed cancer or premalignant lesion.
  • We suggest colonoscopy after recovery from an episode of uncomplicated diverticulitis to rule out a missed cancer or premalignant lesion in patients with alarm symptoms or in those not current with colon cancer screening.

Routine Antibiotics:

  • We suggest against routine antibiotics for low-risk patients with acute uncomplicated diverticulitis. Antibiotic use is appropriate for patients with high-risk features, immunocompromise, frailty, or inability to ensure safe outpatient management.

Diet:

  • We suggest a healthy diet (high in fruits, vegetables, whole grains and legumes with limited consumption of red meat, processed grains, trans fats, and sweets) in patients with a history of diverticulitis to reduce the risk of recurrence.
  • In patients with a history of diverticulitis, we suggest against the avoidance of nut, corn, seed, or popcorn consumption to reduce the risk of recurrence.

NSAIDs:

  • Unless there is a clinical indication, we suggest patients avoid regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) after recovery from an episode of diverticulitis to reduce the risk of recurrence.

Smoking/Alcohol:

  • In patients with a history of diverticulitis who smoke, we suggest smoking cessation to reduce the risk of recurrence.
  • In patients with a history of diverticulitis who consume heavy alcohol, we suggest moderation to reduce the risk of recurrence.

Overweight/Obesity:

  • In patients with a history of diverticulitis who are overweight or obese, we suggest weight loss to reduce the risk of recurrence.

Physical Activity:

  • We suggest regular physical activity in patients with a history of diverticulitis to reduce the risk of recurrence.

Surgical Referral:

  • In patients with recurrent, uncomplicated diverticulitis that significantly impairs quality of life, we suggest surgical referral to discuss the risks and benefits of elective colon resection.

Probiotics, Mesalamine, Rifaximin:

  • In patients with a history of acute diverticulitis, we recommend against the use of probiotics to reduce the risk of recurrence.
  • We recommend against the use of mesalamine in patients with a history of acute diverticulitis to reduce the risk of recurrence.
  • We recommend against the use of rifaximin in patients with a history of acute diverticulitis to reduce the risk of recurrence.

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