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Abstract
<p class="first" id="d5502954e89">Colonic diverticulitis is a painful gastrointestinal
disease that recurs unpredictably
and can lead to chronic gastrointestinal symptoms. Gastroenterologists commonly care
for patients with this disease. The purpose of this Clinical Practice Update is to
provide practical and evidence-based advice for management of diverticulitis. We reviewed
systematic reviews, meta-analyses, randomized controlled trials, and observational
studies to develop 14 best practices. In brief, computed tomography is often necessary
to make a diagnosis. Rarely, a colon malignancy is misdiagnosed as diverticulitis.
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.
In patients with a history of diverticulitis and chronic symptoms, alternative diagnoses
should be excluded with both imaging and lower endoscopy. Antibiotic treatment can
be used selectively rather than routinely in immunocompetent patients with mild acute
uncomplicated diverticulitis. Antibiotic treatment is strongly advised in immunocompromised
patients. To reduce the risk of recurrence, patients should consume a high-quality
diet, have a normal body mass index, be physically active, not smoke, and avoid nonsteroidal
anti-inflammatory drug use except aspirin prescribed for secondary prevention of cardiovascular
disease. At the same time, patients should understand that genetic factors also contribute
to diverticulitis risk. Patients should be educated that the risk of complicated diverticulitis
is highest with the first presentation. An elective segmental resection should not
be advised based on the number of episodes. Instead, a discussion of elective segmental
resection should be personalized to consider severity of disease, patient preferences
and values, as well as risks and benefits.
</p>