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ACP Releases Two New Clinical Guidelines on the Diagnosis and Management of Diverticulitis

Guidelines highlight opportunity to manage most patients with uncomplicated disease in outpatient settings and to initially manage select patients without antibiotics. Patients with complicated disease should be referred for colonoscopy after initial episode if they have not had a recent colonoscopy.

PHILADELPHIA, January 18, 2022—The two new ACP clinical guidelines published today in Annals of Internal Medicine are based on the best available evidence on the clinical benefits and harms, test accuracy, patient values and preferences, and consideration of costs. The clinical guidelines also include input from two Clinical Guidelines Committee (CGC) public members and a seven-member CGC Public Panel, who provide layperson perspectives on values and preferences.

Diverticulitis is an inflammation of the diverticula, small, bulging pouches in the lining of large intestine (colon) and acute diverticulitis episodes are usually uncomplicated. Uncomplicated diverticulitis refers to localized inflammation, whereas complicated diverticulitis refers to inflammation associated with an abscess, phlegmon, fistula, obstruction, bleeding, and perforation.

In Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis, ACP’s clinical guideline:

  • Suggests clinicians use abdominal CT imaging for patients when there is diagnostic uncertainty in a patient with suspected acute left-sided colonic diverticulitis.
  • Suggests that clinicians manage most patients with acute left-sided colonic diverticulitis in an outpatient setting.
  • Suggests that clinicians initially manage select patients acute uncomplicated left-sided colonic diverticulitis without antibiotics.

In Colonoscopy for Diagnostic Evaluation and Interventions to Prevent Recurrence After Acute Left-Sided Colonic Diverticulitis, ACP clinical guideline also:

  • Suggests that clinicians refer patients for a colonoscopy after an initial episode of complicated left-sided colonic diverticulitis in patients who have not had recent colonoscopy.
  • Recommends against clinicians using mesalamine to prevent recurrent diverticulitis.
  • Suggests that clinicians discuss elective surgery to prevent recurrent diverticulitis after initial treatment in patients who have either uncomplicated diverticulitis that is persistent or recurs frequently or complicated diverticulitis. The informed decision whether or not to undergo surgery should be personalized based on a discussion of potential benefits, harms, costs, and patient’s preferences.

“Diverticulitis is an increasingly common condition that physicians are treating in patients,” said George M. Abraham, MD, MPH, MACP, President, ACP. “These clinical guidelines are important topics to better understand how best to address the best course of treatment for patients, focused on management in an outpatient setting, with fewer drugs, to help improve a condition that can often result in quality-of-life issues and can lead to more series conditions if not treated appropriately. As always, it’s critical to understand the benefits, potential harms and best use in counseling patients on treatment options.”

A related video featuring ACP president George M. Abraham, MD, MPH, MACP, is available here.

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About the American College of Physicians

The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 161,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on TwitterFacebook, and Instagram.

ACP Media Contact: Andrew Hachadorian, (215) 351-2514, AHachadorian@acponline.org