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Treatments for diverticular disease and diverticulitis

Non-steroidal drugs should be avoided as there is a significant association between their use and episodes of diverticulitis and diverticula associated segmental colitis.


Diets high in fibre have conventionally been regarded as a way of preventing diverticular disease, however a growing body of evidence suggests the picture may be slightly more complex. High fibre diets do not appear to change the risk of uncomplicated diverticular disease, however once diverticulae are established a diet high in fibre does appear to reduce the risk of diverticulitis and its ensuing complications. Whilst obesity and a sedentary lifestyle are associated with diverticular complications it is unclear what role these have in simple diverticular disease. Similarly the role of exercise is unclear.



In patients with diverticular inflammation – diverticulitis, with associated pain and upset antibiotics have formed the cornerstone of treatment for several decades, however recent studies suggest the inflammation may be the driver for symptoms rather than infection per se. Two randomised controlled studies of uncomplicated diverticular disease (without abscess or perforation) have showed no advantage to the administration of antibiotics. Similarly a recant retrospective analysis suggested no advantage to the administration of antibiotics in uncomplicated diverticular disease with both re-admission rates (2%) and recurrence rates in the following 12 months (12%) being similar in both antibiotic treated and untreated groups.



Faecal stasis is known to alter the colonic microbiome. Changes in microbiome have been described in patients with diverticular disease, but this are not entirely consistent. A recent meta-analysis of 764 patients suggested probiotics may reduce the severity of symptoms and the likelihood of recurrence of uncomplicated diverticular disease. However there usefulness in reducing the rate of complications is uncertain. Current guidance does not recommend them.


Surgery is a serious undertaking in any patient, it is not without risk and is therefore not recommended for patients with either diverticulosis or uncomplicated diverticulitis. It may be life-saving in patients with complications of diverticulitis such as perforation and fistula formation. Nevertheless the balance of risk should be assessed on an individual basis.


 The symptoms of acute diverticulitis may overlap with those of colonic cancer and therefore many guidelines suggest colonoscopy should be considered in patients who have not undergone colonoscopy previously. Some authorities would suggest a colonoscopy within the preceding three to five years, should counter any need for colonoscopy but the exact optimal interval is yet to be

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