Management of Acute Diverticulitis

Project Summary Title and Description

Management of Acute Diverticulitis
Purpose of the Review The American College of Physicians (ACP) nominated the topic of management of acute diverticulitis to the Agency for Healthcare Research and Quality for systematic review. 45, 46 The ACP develops guidelines based on the needs of its members and the internal medicine community.47 The scope of the current systematic review was developed to support the ACP in its effort to create a new clinical practice guideline that will address diagnosis and staging of acute diverticulitis, nonsurgical treatment of acute diverticulitis, colorectal cancer screening in people with a history of diverticulitis, and interventions to prevent recurrence of acute diverticulitis. Specifically, (1) the systematic review will summarize existing systematic reviews on the test accuracy of CT imaging for diagnosis and staging of acute diverticulitis and conduct a de novo review of harms related to false positive, false negative, and incidental findings on CT imaging for suspected acute diverticulitis; (2) it will address effectiveness, comparative effectiveness, and harms of hospitalization for acute uncomplicated diverticulitis, antibiotics use for acute complicated or uncomplicated diverticulitis, and interventional radiology techniques for acute complicated diverticulitis; (3) it will review the benefits and harms of colonoscopy in people with a history of diverticulitis; and (4) it will evaluate pharmacologic, nonpharmacologic, and elective surgical interventions to prevent recurrent diverticulitis. Of note, this review will not evaluate the need for, or the choice of, surgery for the patient with acute diverticulitis. The intended audience includes guideline developers, clinicians and other providers of care for patients with diverticulitis, healthcare policy makers, and patients.
Authors of Report
Methodology description
Systematic Review
Funding Source

Key Questions

1. KEY QUESTION 2 KQ 2: What are the benefits and harms of various treatment options for the treatment of acute diverticulitis? KQ 2a. For patients with acute uncomplicated diverticulitis, what are the effectiveness and harms of hospitalization versus outpatient management of the acute episode? • Do the effects and harms vary by patient characteristics, presentation or course of illness, or other factors? KQ 2b. For patients with acute uncomplicated or complicated diverticulitis, what are the effects, comparative effects, and harms of antibiotics? • Do the effects and harms vary between patients with complicated or uncomplicated diverticulitis? • Do the (comparative) effects and harms vary by route of administration of antibiotics, type of antibiotic, and duration of course of antibiotics? • Do the (comparative) effects and harms vary by patient characteristics, presentation or course of illness, or other factors? KQ 2c. For patients with acute complicated diverticulitis, what are the effects and harms of interventional radiology procedures compared with conservative management? • Do the effects and harms vary by patient characteristics, presentation or course of illness, or other factors?
2. KEY QUESTION 4 KQ 4: What are the effects, comparative effects, and harms of pharmacological interventions (e.g., mesalamine), non-pharmacological interventions (e.g., medical nutrition therapy), and elective surgery to prevent recurrent diverticulitis? • Do the (comparative) effects and harms vary by patient characteristics, course of illness, or other factors?
3. KQ 3: What are the benefits and harms of colonoscopy (or other colon imaging test) following an episode of acute diverticulitis? KQ 3a. What is the incidence of malignant and premalignant colon tumors found by colonoscopy, and what is the incidence of colon cancer mortality among patients undergoing screening? KQ 3b. What are the procedure-related and other harms of colonoscopy or CT colonography? KQ 3c. What is the frequency of inadequate imaging due to intolerance or technical feasibility? • Do the benefits and harms vary by patient characteristics, course of illness, or other factors?
4. KQ 1: In CT imaging for the diagnosis or staging of acute diverticulitis, KQ 1a. What is the test accuracy of CT imaging for the diagnosis or staging of acute diverticulitis? KQ 1b. What are the effects of CT imaging on clinical outcomes and changes in clinical management? KQ 1c. What are the downstream outcomes related to false positive or false negative CT readings of acute uncomplicated or complicated diverticulitis KQ 1d. For patients presenting with acute abdominal pain, with the possibility of acute diverticulitis, what are the downstream outcomes related to incidental findings (e.g., liver mass) • Does the accuracy or do the effects vary by patient characteristics, presentation of illness, or other factors?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis.2012
Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis.2017
Prospective randomized trial comparing short-term antibiotic therapy versus standard therapy for acute uncomplicated sigmoid diverticulitis.2010
Antibiotics alone instead of percutaneous drainage as initial treatment of large diverticular abscess.2015
Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis.2009
Treatment of acute uncomplicated diverticulitis without antibiotics: risk factors for treatment failure.
Outpatient versus hospitalization management for uncomplicated diverticulitis: a prospective, multicenter randomized clinical trial (DIVER Trial).2014
Conservative Treatment in Diverticulitis Patients with Pericolic Extraluminal Air and the Role of Antibiotic Treatment.2019
Outpatient treatment of uncomplicated acute diverticulitis: Impact on healthcare costs.2013
Population-based study of outcomes following an initial acute diverticular abscess.
Applicability, safety and efficiency of outpatient treatment in uncomplicated diverticulitis.2012
Mild colonic diverticulitis can be treated without antibiotics. A case-control study.2012
Elective surgery for diverticulitis is associated with high risk of intestinal diversion and hospital readmission in older adults.2010
Surgery versus conservative management for recurrent and ongoing left-sided diverticulitis (DIRECT trial): an open-label, multicentre, randomised controlled trial.2017
National Trends in Short-term Outcomes Following Non-emergent Surgery for Diverticular Disease.2016
Outcomes of laparoscopic versus open colectomy in elective surgery for diverticulitis.2011
A comparison of outcomes of emergent, urgent, and elective surgical treatment of diverticulitis.2015
Are there differences in outcome after elective sigmoidectomy for diverticular disease and for cancer? A national inpatient study.2017
Laparoscopy improves short-term outcomes after surgery for diverticular disease.2010
Mesalamine did not prevent recurrent diverticulitis in phase 3 controlled trials.-A
Antibiotic treatment for uncomplicated and mild complicated diverticulitis: outpatient treatment for everyone.2017
Surgery After an Initial Episode of Uncomplicated Diverticulitis: Does Time to Resection Matter?2019
The impact of delaying elective resection of diverticulitis on laparoscopic conversion rate.2015
Do the risks of emergent colectomy justify nonoperative management strategies for recurrent diverticulitis?2009
Outpatient treatment for acute uncomplicated diverticulitis.2013
Diverticulitis Diagnosed in the Emergency Room: Is It Safe to Discharge Home?2017
A randomized double-blind placebo-controlled trial of a multi-strain probiotic in treatment of symptomatic uncomplicated diverticular disease.-B2017
Mesalamine did not prevent recurrent diverticulitis in phase 3 controlled trials. -B(PREVENT2)2014
Effects of Burdock tea on recurrence of colonic diverticulitis and diverticular bleeding: An open-labelled randomized clinical trial.
Risk factors for mortality and morbidity after elective sigmoid resection for diverticulitis: prospective multicenter multivariate analysis of 582 patients.2004
Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies.2016
Multicentre study of non-surgical management of diverticulitis with abscess formation.2019
Laparoscopic "fast-track" sigmoidectomy for diverticulitis disease in Germany. Results of a prospective quality assurance program.2010
Uncomplicated diverticulitis, more complicated than we thought.2012
Prospective randomized clinical trial assessing the efficacy of a short course of intravenously administered amoxicillin plus clavulanic acid followed by oral antibiotic in patients with uncomplicated acute diverticulitis.2010
One-day versus four-day antibiotic treatment for acute right colonic uncomplicated diverticulitis: A randomized clinical trial.2019
Prospective randomized clinical trial of uncomplicated right-sided colonic diverticulitis: antibiotics versus no antibiotics.2019
Conservative treatment of acute colonic diverticulitis: are antibiotics always mandatory?2007
Randomized, prospective comparison of cefoxitin and gentamicin-clindamycin in the treatment of acute colonic diverticulitis.-- Not Found --
Randomised clinical trial: mesalazine versus placebo in the prevention of diverticulitis recurrence. -A
Randomised clinical trial: mesalazine versus placebo in the prevention of diverticulitis recurrence. -B2017
Specific Factors Predict the Risk for Urgent and Emergent Colectomy in Patients Undergoing Surgery for Diverticulitis.2018
Intermittent treatment with mesalazine in the prevention of diverticulitis recurrence: a randomised multicentre pilot double-blind placebo-controlled study of 24-month duration.2013
One year intermittent rifaximin plus fibre supplementation vs. fibre supplementation alone to prevent diverticulitis recurrence: a proof-of-concept study.2013
Prospective Creation and Validation of the PREVENTT (Prediction and Enaction of Prevention Treatments Trigger) Scale for Surgical Site Infections (SSIs) in Patients With Diverticulitis.2019
Randomized clinical trial of elective resection versus observation in diverticulitis with extraluminal air or abscess initially managed conservatively2018
Tumour Characteristics of Patients with Colorectal Cancer after Acute Uncomplicated Diverticulitis.2018
Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon.2002
Balsalazide and/or high-potency probiotic mixture (VSL#3) in maintaining remission after attack of acute, uncomplicated diverticulitis of the colon.2007
Routine screening for colon cancer after conservative treatment of diverticulitis.2012
Yield of colonoscopy after recent CT-proven uncomplicated acute diverticulitis: a comparative cohort study.2015
Is there anything we can modify among factors associated with morbidity following elective laparoscopic sigmoidectomy for diverticulitis?2016
Underlying Colorectal Cancer Was Rarely Detected After an Episode of Acute Diverticulitis: a Retrospective Analysis of 225 Patients.2019
Is early colonoscopy beneficial in patients with CT-diagnosed diverticulitis?2013
Colonoscopy following nonoperative management of uncomplicated diverticulitis may not be warranted.2013
Role of endoscopy after an acute episode of diverticulitis: analysis of a cohort of Portuguese patients from a tertiary referral center.2015
Colonoscopy after the first episode of acute diverticulitis: challenging management paradigms.2016
Routine Colonoscopy after Acute Uncomplicated Diverticulitis - Challenging a Putative Indication.2017
Diagnostic impact of routine colonoscopy following acute diverticulitis: A multicenter study in 808 patients and controls.2014
Risk of colon cancer after computed tomography-diagnosed acute diverticulitis: is routine colonoscopy necessary?2014
Is early colonoscopy after CT-diagnosed diverticulitis still necessary?2017
Determinants of treatment and outcomes of diverticular abscesses.2019
Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded?2011
Do we need colonoscopy following acute diverticulitis detected on computed tomography to exclude colorectal malignancy?2014
The feasibility and risk of early colonoscopy in acute diverticulitis: a prospective controlled study.2007
Retrospective comparison of long-term ten-day/month rifaximin or mesalazine in prevention of relapse in acute diverticulitis.2017
Long-term safety of once-daily multimatrix mesalazine: A pooled clinical trials analysis2014
Routine lower gastrointestinal endoscopy for radiographically confirmed acute diverticulitis. In whom and when is it indicated?2018
Short-term Intravenous Antibiotic Treatment in Uncomplicated Diverticulitis Does Not Increase the Risk of Recurrence Compared to Long-term Treatment.2015
Prevalence of colorectal cancer in acute uncomplicated diverticulitis and the role of the interval colonoscopy.2018
Outpatient treatment of acute diverticulitis: rates and predictors of failure.2010
An 18-Year Nationwide Cohort Study on The Association Between Diverticulitis and Colon Cancer.2017
A randomized controlled study of mesalamine after acute diverticulitis: results of the DIVA trial.2013
Follow up colonoscopy may be omissible in uncomplicated left-sided acute diverticulitis diagnosed with CT- a retrospective cohort study.
Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial.2020
Findings on Colonoscopy after Diverticulitis: A Multicenter Review.2019
The Necessity of a Colonoscopy after an Acute Diverticulitis Event in Adults Less Than 50 Years Old.2019
Risk of Emergency Surgery or Death After Initial Nonoperative Management of Complicated Diverticulitis in Scotland and Switzerland.2020
Relationship Between Diverticular Disease and Incisional Hernia After Elective Colectomy: a Population-Based Study.2020
Colonoscopy and flexible sigmoidoscopy for follow-up of patients with left-sided diverticulitis.2020
Is routine colonoscopy necessary for patients who have an unequivocal computerised tomography diagnosis of acute diverticulitis?2020

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