New medical strategies for the management of acute diverticulitis

Abstract

Acute diverticulitis, defined as acute inflammation of a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians. There have been advances in the medical treatments offered to patients in recent years. Factors predisposing individuals to the development of acute diverticulitis include obesity, smoking, lack of physical activity and medication use, such as NSAIDs. Although widely used, there is limited evidence on the efficacy of individual antibiotic regimens and antibiotic treatment may not be required in all patients. Mesalazine seems to be the only effective treatment for the primary prevention of acute diverticulitis. Finally, evidence of effective measures for the prevention of recurrence is lacking. Furthermore, high-quality randomized controlled trials are required for medical treatments in patients with acute diverticulitis, if management is to be evidence based.

Keywords:

• acute diverticulitis
• fiber
• mesalazine
• primary prevention
• probiotics
• rifaximin
• secondary prevention
• treatment

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Acute diverticulitis of the colon is the inflammation of the diverticula located in the colon.

• It occurs in approximately 15% of patients with symptomatic diverticular disease (and, therefore, in less than 5% of patients having diverticulosis). The vast majority (80%) of patients suffers from an uncomplicated disease (inflammation limited to the colonic wall), while a complicated form of the disease (abscesses, stenosis, perforation) affects no more than 20% of those patients.

• Acute diverticulitis is characterized by acute abdominal pain located in the left lower abdominal quadrant. It is generally associated with significant raised C-reactive protein, less frequently with leucocytosis and/or fever.

• Abdominal CT scan is the gold standard in diagnosing acute diverticulitis. Intestinal ultrasonography may be also useful as first-line diagnosing tool in pose correct diagnosis.

• Current treatment is based on support therapy and antibiotics. However, recent studies found questionable the use of antibiotics in uncomplicated disease to reach both remission and prevention of disease recurrence.

• At present, no treatment seems to be effective in preventing recurrence of the disease.

• Colonoscopy following acute diverticulitis has to be performed at 8 weeks following acute episode in order to exclude colorectal cancer in newly diagnosis and in complicated disease.