American Gastroenterological Association Institute Technical Review on the Management of Acute Diverticulitis

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

“…The classic presentation of acute diverticulitis is left lower quadrant abdominal pain, although the presenting symptoms can vary significantly and include abdominal fullness, fever, leukocytosis, change in bowel habit, nausea, vomiting, and urinary symptoms [1,16]. Furthermore, patients may have right-sided disease (or a redundant sigmoid colon that can drape towards the right) and may present with dominantly right-sided symptoms.…”

“…Over the past decade, however, there has been an emerging proposal that perhaps the process was more inflammatory than infectious, as well as an appropriate emphasis on antibiotic restraint due to resistance issues. Randomized controlled trials (RCTs) of withholding antibiotics in defined populations of patients have begun to emerge, and will be reviewed below, but were favorable enough that the recent American Gastroenterological Association's guidelines on the management of acute diverticulitis overtly recommended selective, rather than routine, use of antibiotics in patients with AUD [1]. These RCTs also prompted a change in several European society guidelines.…”

“…Diverticulosis coli is defined as the presence of sac-like protrusions in the colonic wall [1]. Over half of adults older than 70 years of age undergoing colonoscopy are noted to have incidental diverticulosis [2].…”

“…Over half of adults older than 70 years of age undergoing colonoscopy are noted to have incidental diverticulosis [2]. Manifestations and complications of diverticular disease include acute diverticulitis, symptomatic uncomplicated diverticular disease (with symptoms suggestive of diverticulitis in the absence of overt inflammation), diverticular bleeding, and segmental colitis associated with diverticulosis [1]. Acute diverticulitis, the subject of this article, is the manifestation of mucosal inflammation of a diverticulum [1] and occurs in about 4-5% of patients with diverticulosis [3,4].…”

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].…”