- Acute diverticulitis is defined as clinically evident macroscopic inflammation of a diverticulum or diverticula.
- Acute diverticulitis occurs in <10% of patients with diverticulosis.
- 10–20% of those patients will have complicated disease, defined as an abscess, perforation, fistula, or colonic obstruction.
- 10–25% of patients who have a first attack of diverticulitis will have a subsequent recurrence.
- Antibiotics are often prescribed for acute diverticulitis, but can often be avoided in mild cases.
- A colonoscopy should generally be performed after resolution of acute diverticulitis if not recently done.
- The AGA suggests a fiber-rich diet and physical activity after resolution of acute diverticulitis.
AGA Recommendations for the Management of Acute Diverticulitis
|Recommendation||Strength of recommendation||Quality of evidence|
|The AGA suggests that antibiotics should be used selectively, rather than routinely, in patients with acute uncomplicated diverticulitis.||Conditional||Low|
|The 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.||Conditional||Low|
|The 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.||Conditional||Very Low|
|The AGA suggests a ﬁber-rich diet or ﬁber supplementation in patients with a history of acute diverticulitis.||Conditional||Very Low|
|The AGA suggests against routinely advising patients with a history of diverticulitis to avoid consumption of seeds, nuts, and popcorn.||Conditional||Very Low|
|The AGA suggests against routinely advising patients with a history of diverticulitis to avoid the use of aspirin.||Conditional||Low|
|The AGA suggests advising patients with a history of diverticulitis to avoid the use of nonaspirin NSAIDs if possible.||Conditional||Very Low|
|The AGA recommends against the use of mesalamine after acute uncomplicated diverticulitis.||Strong||Moderate|
|The AGA suggests against the use of rifaximin after acute uncomplicated diverticulitis.||Conditional||Very Low|
|The AGA suggests against the use of probiotics after acute uncomplicated diverticulitis.||Conditional||Very Low|
|The AGA suggests advising patients with diverticular disease to consider vigorous physical activity.||Conditional||Very Low|
Visit gastro.org/guidelinesapp to learn about the AGA Clinical Guidelines App. Available for download on the iTunes and Google Play Store.