ACP releases two new clinical guidelines on the diagnosis and management of diverticulitis

by American College of Physicians

According to two new clinical guidelines from the American College of Physicians (ACP), uncomplicated diverticulitis can be treated in an outpatient setting without antibiotics. Patients with complicated disease should be referred for colonoscopy after an initial episode if they have not had a recent colonoscopy. Published in Annals of Internal Medicine, the guidelines are based on the best available evidence on the clinical benefits and harms, test accuracy, patient values and preferences, and consideration of costs. The clinical guidelines also include input from two public members of the organization's Clinical Guidelines Committee (CGC) and a seven-member CGC Public Panel, who provide layperson perspectives on values and preferences.

29 jan 2022--Diverticulitis is an inflammation of the diverticula, small, bulging pouches in the lining of large intestine (colon) and acute diverticulitis episodes are usually uncomplicated. Uncomplicated diverticulitis refers to localized inflammation, whereas complicated diverticulitis refers to inflammation associated with an abscess, phlegmon, fistula, obstruction, bleeding, and perforation.

In Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis, ACP suggests that clinicians:

• use abdominal CT imaging for patients when there is diagnostic uncertainty in a patient with suspected acute left-sided colonic diverticulitis;
• manage most patients with acute left-sided colonic diverticulitis in an outpatient setting;
• and initially manage select patients acute uncomplicated left-sided colonic diverticulitis without antibiotics.

In Colonoscopy for Diagnostic Evaluation and Interventions to Prevent Recurrence After Acute Left-Sided Colonic Diverticulitis, ACP suggests that clinicians:

• refer patients for a colonoscopy after an initial episode of complicated left-sided colonic diverticulitis in patients who have not had recent colonoscopy;
• do not use mesalamine to prevent recurrent diverticulitis;
• and discuss elective surgery to prevent recurrent diverticulitis after initial treatment in patients who have either uncomplicated diverticulitis that is persistent or recurs frequently or complicated diverticulitis. The informed decision whether or not to undergo surgery should be personalized based on a discussion of potential benefits, harms, costs, and patient's preferences.

The new, evidence-based guidelines are based on systematic reviews conducted by the Brown Evidence-based Practice Center, funded by the Agency for Healthcare Research and Quality (AHRQ). The researchers extracted study data and risk of bias on the diagnosis, treatment, and management of acute left-sided diverticulitis and all studies were assessed for quality of evidence.

According to ACP, these clinical guidelines are important because diverticulitis is increasingly common in patients seen by internal medicine physicians. ACP's advice addresses the best course of treatment for patients, focused on management in an outpatient setting, with fewer drugs, to help improve a condition that can often result in quality-of-life issues and can lead to more series conditions if not treated appropriately.

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More information: Ethan M. Balk et al, Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis, Annals of Internal Medicine (2021). DOI: 10.7326/M21-1645

Ethan M. Balk et al, Evaluation and Management After Acute Left-Sided Colonic Diverticulitis, Annals of Internal Medicine (2022). DOI: 10.7326/M21-1646

Obesity may increase risk of diverticulitis

NEW YORK , 04 feb 2009 – Obese people appear to be at increased risk for diverticulitis and for bleeding diverticula, results of a new study indicate.

Diverticula are small pouches that form in the lining of the colon and are very common in older adults. Diverticulitis occurs when the diverticula become inflamed and infected, which can be a serious, even life-threatening, problem. Diverticula may also bleed, which can be an equally serious problem.

"A number of digestive diseases have been associated with obesity," note Dr. Lisa L. Strate, of the University of Washington School of Medicine, Seattle, and colleagues. "Some of the obesity-related (factors) believed to play a role in these disorders may also influence diverticular complications, most notably the link between obesity and chronic inflammation."

To investigate further, the team examined data for 47,228 men enrolled in the Health Professionals Follow-up study. They were between the ages of 40 and 75 years and free of diverticular disease when the study began in 1986 and were followed until 2004.

A total of 801 cases of diverticulitis and 383 cases of diverticular bleeding occurred during follow-up, according to the report, published in the journal Gastroenterology.

The analysis showed that obese men were 78 percent more likely to develop diverticulitis and 219 percent more likely to develop diverticular bleeding than were normal weight men.

Similarly, a big waistline increased the odds of diverticulitis and diverticular bleeding by 56 and 96 percent, respectively.

Lastly a high waist-to-hip ratio was also linked to both problems, regardless of whether the man was obese or not.

"An association between body fat and diverticular complications has important clinical implications," they conclude, "given the increasing prevalence of these disorders and the considerable risk of recurrent complications."

SOURCE: Gastroenterology, January 2009.