Abstract
Purpose of ReviewSince the treatment of acute diverticulitis has become more conservative over the last years, knowledge of conservative treatment strategies is increasingly important.Recent FindingsSeveral treatment strategies that previously have been imposed as routine treatment are now obsolete. Uncomplicated diverticulitis patients can be treated without antibiotics, without bed rest, and without dietary restrictions; and a selected group of patients can be treated as outpatients. Also, patients with isolated pericolic extraluminal air can be treated conservatively as well. Whereas some patient subgroups have been suggested to suffer from a more virulent disease course or higher recurrence rates, current evidence does not support all traditional understandings. Patients on immunosuppression or non-steroidal anti-inflammatory drugs seem to have a higher risk of complicated diverticulitis, but young patients do not. Data on the risk of recurrent diverticulitis in young patients is conflicting but the risk seems comparable to elderly patients. Besides the traditional treatments, several new treatment strategies have emerged but have failed thus far. Mesalazine does not have any beneficial effect on preventing recurrent diverticulitis based on current literature. Rifaximin and probiotics have been studied insufficiently in acute diverticulitis patients to conclude on their efficacy.SummaryThis review provides an overview of recent developments in conservative treatment strategies of acute diverticulitis and discusses the latest evidence on patient subgroups that have been suggested to suffer from an aberrant disease course.
Highlights
The incidence of diverticulosis and its complication acute diverticulitis is increasing worldwide and is imposing a growing burden on national healthcare systems [1]
Dietary restrictions and bed rest have no place in the treatment of acute diverticulitis any more
Omitting antibiotics for uncomplicated diverticulitis has shown to be safe, and antibiotics should not be used in these patients routinely
Summary
The incidence of diverticulosis and its complication acute diverticulitis is increasing worldwide and is imposing a growing burden on national healthcare systems [1]. There has been a strong tendency towards a more conservative treatment of acute diverticulitis, resulting in an expansion of knowledge about conservative treatment options and development of new treatment strategies [2]. This tendency is pointed out in the role of antibiotics in uncomplicated diverticulitis, outpatient rather than inpatient treatment, and pharmacological therapies that may replace surgery to prevent recurrent diverticulitis. This review discusses the latest evidence on conservative treatment strategies for acute diverticulitis
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