Implementing AHRQ Effective Health Care Reviews

Helping Clinicians Make Better Treatment Choices

Diagnosis and Initial Management of Acute Colonic Diverticulitis

 

Am Fam Physician. 2021 Aug ;104(2):195-197.

Author disclosure: No relevant financial affiliations.

Key Clinical Issue

What are the benefits and harms of diagnostic testing, and what is the effectiveness of treatment options for acute colonic diverticulitis?

Evidence-Based Answer

Computed tomography (CT) accurately diagnoses acute diverticulitis and may make appropriate management more likely compared with clinical diagnosis alone. (Strength of Recommendation [SOR]: B, based on inconsistent or limited-quality patient-oriented evidence.) Misdiagnosis does not increase the risk of poor clinical outcomes. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) For patients with uncomplicated acute diverticulitis, outpatient management may be as effective as inpatient care, but there is insufficient evidence regarding important clinical outcomes, including treatment failure, mortality, and emergency surgery. (SOR: C, based on disease-oriented evidence.) Antibiotic treatment for patients with uncomplicated diverticulitis does not affect pain symptoms, length of hospitalization, recurrence risk, quality of life, or need for surgery compared with no antibiotic treatment. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) The evidence is insufficient to guide the choice of antibiotic regimen for patients who do receive antibiotics.1

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CLINICAL BOTTOM LINE

Summary of Key Findings and Strength of Evidence for Interventions for Acute Diverticulitis

InterventionNumber of studiesSummary of key findingsStrength of evidence

Computed tomography of the abdomen

8

Computed tomography of the abdomen can help diagnose acute diverticulitis.

Moderate

Hospitalization

6

Outpatient management of uncomplicated diverticulitis may be as effective as hospitalization. Evidence was insufficient for treatment failure, mortality, and the need for emergency surgery.

Low

Antibiotic therapy vs. no antibiotics

6

Antibiotic therapy does not improve clinical outcomes in uncomplicated acute diverticulitis.

Low


Information from reference 1.

CLINICAL BOTTOM LINE

Summary of Key Findings and Strength of Evidence for Interventions for Acute Diverticulitis

InterventionNumber of studiesSummary of key findingsStrength of evidence

Computed tomography of the abdomen

8

Computed tomography of the abdomen can help diagnose acute diverticulitis.

Moderate

Hospitalization

6

Outpatient management of uncomplicated diverticulitis may be as effective as hospitalization. Evidence was insufficient for treatment failure, mortality, and the need for emergency surgery.

Low

Antibiotic therapy vs. no antibiotics

6

Antibiotic therapy does not improve clinical outcomes in uncomplicated acute diverticulitis.

Low


Information from reference 1.

Practice Pointers

Colonic diverticulitis is caused by inflammation of abnormal outpouchings (diverticula) in the wall of the large intestine.1 Diverticulosis occurs in 5% to 15% of people older than 45 years and in 80% of those older than 85 years.2 For people with diverticulosis, the lifetime prevalence of developing acute diverticulitis is approximately 25%. Alterations in colonic wall resistance and motility and a low-fiber diet contribute to increased luminal pressure and bowel wall weakness. Aspirin, nonsteroidal anti-inflammatory drugs, obesity, lack of exercise, and increasing

Address correspondence to Dean Seehusen, MD, MPH, FAAFP, at dseehusen@msn.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Balk EM, Adam GP, Cao W, et al. Management of colonic diverticulitis. Comparative effectiveness review no. 233. (Prepared by the Brown Evidence-based Practice Center under contract no. 290-2015-00002-I.) AHRQ publication no. 20(21)-EHC025. Agency for Healthcare Research and Quality; October 2020. Accessed November 13, 2020. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/cer-233-diverticulitis-final-report.pdf...

2. Wilkins T, Embry K, George R. Diagnosis and management of acute diverticulitis. Am Fam Physician. 2013;87(9):612–620. Accessed June 1, 2021. https://www.aafp.org/afp/2013/0501/p612.html

3. Poola S, Ritchie M. Antibiotics for uncomplicated diverticulitis. Am Fam Physician. 2020;102(11):online. Accessed June 1, 2021. https://www.aafp.org/afp/2020/1201/od2.html

4. Kelly ME, Heeney A, Redmond CE, et al. Incidental findings detected on emergency abdominal CT scans: a 1-year review. Abdom Imaging. 2015;40(6):1853–1857.

5. Ko CW, Singh S, Feuerstein JD, et al.; American Gastroenterological Association Institute Clinical Guidelines Committee. AGA clinical practice guidelines on the management of mild-to-moderate ulcerative colitis. Gastroenterology. 2019;156(3):748–764.

6. Hall J, Hardiman K, Lee S, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum. 2020;63(6):728–747.

7. Gaber CE, Kinlaw AC, Edwards JK, et al. Comparative effectiveness and harms of antibiotics for outpatient diverticulitis: two nationwide cohort studies. Ann Intern Med. 2021;174(6):737–746.

The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to produce evidence to improve health care and to make sure the evidence is understood and used. A key clinical question based on the AHRQ Effective Health Care Program systematic review of the literature is presented, followed by an evidence-based answer based on the review. AHRQ's summary is accompanied by an interpretation by an AFP author that will help guide clinicians in making treatment decisions.

See the full review, clinician summary, and consumer summary.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Implementing AHRQ Effective Health Care Reviews published in AFP is available at https://www.aafp.org/afp/ahrq.

 

 

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