American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis

Antibiotics in Uncomplicated Acute Diverticulitis: To Give or Not to Give?

“…A number of European guidelines, as well as the most recent American Gastroenterological Association Institute Guidelines on the Management of Acute Diverticulitis, advocate for the selective use of antibiotics, rather than routine use, in patients with AUD [40]. We have also suggested broad parameters in which to consider this conservative approach.…”

“…Therefore, pregnant patients, chronic kidney disease patients, collagen-vascular disease patients, those on chronic corticosteroid therapy, and septic patients should generally be treated with antibiotics when presenting with AUD [37][38][39]. For otherwise healthy patients, however, with a nontoxic presentation of AUD, antibiotic use should be selective [1,40] and likely adjudicated with a conversation with the patient.…”

Pushing the boundaries of the management of uncomplicated diverticulitis

“…The authors concluded that antibiotics did not accelerate recovery nor prevent complications or recurrence. Some recent guidelines already recommend a rather selective and individualized use of antibiotics based on this single study [3][4][5][6], although the American Gastroenterological Association technical review rated the quality of this evidence as low, because of risk of bias and imprecision [7]. Another study from the same investigators prospectively assessed outpatient management without antibiotics in patients with CTconfirmed uncomplicated diverticulitis [8].…”

“…However, an extensive review from the American Gastroenterological Association recommended against the use of mesalamine, rifaximin, and probiotics. While mesalamine was not shown to be effective enough, rifaximin and probiotics were not recommended due to the very low quality of evidence [6]. Therefore, high-quality studies are needed to assess the true efficacy of these agents.…”

Acute Diverticulitis and Subsequent Colonoscopy: Instigating an Old Discussion

“…While colonic diverticulosis will remain asymptomatic in a majority of people, about 20% will have clinical manifestations, with acute diverticulitis being the most frequent complication of diverticulosis [2]. The issue of performing a colonoscopy after an episode of acute diverticulitis remains controversial and, according to the recently published American Gastroenterology Association guidelines on the Management of Acute Diverticulitis, the quantification of the yield, risks and timing of colonoscopy after an episode of acute diverticulitis should be a research priority [3]. It was with great interest that we read the paper from Andrade et al [4] entitled "Routine colonoscopy after uncomplicated acute diverticulitis -challenging a putative indication," in which the authors conclude that as the prevalence of advanced colonic neoplasia found on colonoscopy in patients with uncomplicated diverticulitis is quite similar to the average-risk population, an episode of CT-diagnosed uncomplicated diverticulitis does not seem to be a recommendation for colonoscopy.…”