ACP Issues Two Guidelines for Acute Left-Sided Colonic Diverticulitis
Guidelines address diagnosis and management, use of diagnostic colonoscopy in complicated disease, and interventions to prevent recurrence
TUESDAY, Jan. 18, 2022 (HealthDay News) -- Two sets of guidelines have been developed: one for the diagnosis and management of acute left-sided colonic diverticulitis and a second for the role of colonoscopy for diagnostic evaluation and interventions to prevent recurrence of acute left-sided colonic diverticulitis; the guidelines were published online Jan. 18 in the Annals of Internal Medicine.
Amir Qaseem, M.D., Ph.D., from the American College of Physicians (ACP) in Philadelphia, and colleagues provide clinical recommendations on the diagnosis and management of acute left-sided colonic diverticulitis in adults. A systematic review on diagnosis and management was conducted, and guidelines were developed based on the strength of the evidence. ACP suggests the use of abdominal computed tomography imaging in the case of diagnostic uncertainty in a patient with suspected acute left-sided colonic diverticulitis. It is suggested that clinicians manage most patients with acute uncomplicated left-sided colonic diverticulitis in an outpatient setting. Furthermore, the guideline suggests select patients can be managed initially without antibiotics.
In a second guideline, Qaseem and colleagues developed clinical recommendations on the role of colonoscopy for diagnostic evaluation of colorectal cancer after a presumed diagnosis of acute left-sided colonic diverticulitis and interventions to prevent recurrence after initial treatment. ACP suggests that patients who have not undergone recent colonoscopy should be referred for a colonoscopy after an initial episode of complicated left-sided colonic diverticulitis. The guideline recommends against use of mesalamine to prevent recurrent diverticulitis. In addition, ACP suggests clinicians discuss elective surgery for the prevention of recurrent diverticulitis after initial treatment in patients with uncomplicated diverticulitis that is persistent or recurs frequently; this suggestion also applies to patients with 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," Qaseem and colleagues write in the second guideline.