ACUTE DIVERTICULITIS TWO NEW GUIDELINES
A sac-like protrusion of the colon wall is referred to as a diverticulum inflammation brought on by a diverticulum's micro-perforation resulting in acute diverticulitis. Almost 10% to 25% of patients with diverticulosis may also have diverticulitis.
DIVERTICULITIS
Simple
Uncomplicated
The ACP1 has released two new clinical guidelines on diverticulitis
Deals with diagnosis and treatment
Complicated 1 2 Deals with colonoscopy following diverticulitis episodes and actions to avoid recurrence
The recommendations only apply to acute diverticulitis on the left side. The target audience is all clinicians, and the target patient population is adults with recent acute left-sided colonic diverticulitis episodes.
Suggests that clinicians refer patients for a colonoscopy after an initial episode of complicated left-sided colonic diverticulitis in patients who have not had a recent colonoscopy 1
Recommends against clinicians using mesalamine to prevent recurrent diverticulitis 2
Suggests that clinicians discuss elective surgery to prevent recurrent diverticulitis after initial treatment in patients with either uncomplicated diverticulitis that is persistent or reoccurs frequently or complicated diverticulitis
KEY POINTS1,2
Type of Recommendation and Evidence
Conditional recommendation; low-certainty evidence
Strong recommendation; high-certainty evidence
Conditional recommendation; low-certainty evidence
Three Important Recommendations1
• The authors recommend computed tomography (CT) for patients with suspected diverticulitis "where there is diagnostic doubt," but they do not detail what constitutes diagnostic certainty.
• Patients with uncomplicated diverticulitis who are immunocompetent, generally healthy, and do not show signs of a systemic inflammatory response can be treated as outpatients. Results of multiple randomised trials show that such people do not usually need antibiotic medication.
• Patients with regularly recurrent diverticulitis (i.e., three bouts within two years) or those who experience protracted "smouldering" episodes (i.e., lasting >3 months) should talk about elective surgery.
• The authors support using a collaborative decision-making process based on patient preferences. The ACP found no evidence to support any dietary or pharmaceutical interventions to stop diverticulitis from recurring.
Comparison of these recommendations with those in a 2021 Clinical Practice Update from the American Gastroenterological Association (AGA):1,3
• Both groups endorse selective management of uncomplicated diverticulitis without antibiotics.
Differences between these recommendations with those in a 2021 Clinical Practice Update from the American Gastroenterological Association (AGA)
ACP
Colonoscopy is recommended in patients who receive clinical diagnoses of acute left-sided diverticulitis
Does not recommend colonoscopy for those with uncomplicated diverticulitis
CONCLUSION
AGA
CT scanning routinely for patients who have never had an imaging-confirmed diagnosis of acute diverticulitis
Colonoscopy after the first episode of uncomplicated diverticulitis recommended
These recommendations are largely sound, even though almost all of them are given the status "conditional," which denotes "appreciable uncertainty" regarding the distribution of benefit, burden, and risk.
