How to manage colonic diverticulitis

In the new AGA Clinical Practice Update on Medical Management of Colonic Diverticulitis: Expert Review, published in Gastroenterology, the authors provide 14 best practice advice statements to address key issues in clinical management. They cover everything from testing, to treatment, to how to best educate your patients.

Here a few of the best practice advice statements:

1. Computed tomography should be considered to confirm the diagnosis of diverticulitis in patients without a prior imaging confirmed diagnosis and to evaluate for potential complications in patients with severe presentations. Imaging should also be considered in those who fail to improve with therapy, are immunocompromised, or who have multiple recurrences and are contemplating prophylactic surgery in order to confirm the diagnosis and location(s) of disease.
2. Whether patients should have a colonoscopy after an episode of diverticulitis depends on the patient’s history, most recent colonoscopy, and disease severity and course. Colonoscopy is advised after an episode of complicated diverticulitis and after a first episode of uncomplicated diverticulitis but can be deferred if a recent (within 1 year) high quality colonoscopy was performed.
3. After an acute episode of diverticulitis, colonoscopy should be delayed by 6–8 weeks or until complete resolution of the acute symptoms, whichever is longer. Colonoscopy should be considered sooner if alarm symptoms are present.
4. In patients with a history of diverticulitis and chronic symptoms, ongoing inflammation should be excluded with both imaging and lower endoscopy. If there is no evidence of diverticulitis, visceral hypersensitivity should be considered and managed accordingly.
5. A clear liquid diet is advised during the acute phase of uncomplicated diverticulitis. Diet should advance as symptoms improve.

In the short video below, co-author Dr. Aasma Shaukat highlights key points from this Clinical Practice Update: