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Calls to change ‘age-old’ diverticulitis practices
A review of current guidelines for one of Australia’s most common gut disorders has found treatments should be chosen more wisely.
Diverticulitis presents as a severe episode of lower abdominal pain that is usually left-sided.
In particular, the Griffith University study recommends updating practices used to treat patients with uncomplicated diverticulitis and mild symptoms.
Dr James Innes, an emergency consultant who contributed to the review into the diagnosis and management of the disease, told newsGP the updated recommendations apply to GPs and emergency doctors alike.
‘For patients with a history of diverticulitis, and mild symptoms suggestive of recurrence, diagnosis does not need to be confirmed by CT scan,’ Dr Innes said.
‘Outpatient management can proceed, including; a couple of days of clear fluid diet followed by a low fibre diet until pain resolves; pain management with acetaminophen and antispasmodics; and instructions to return if symptoms worsen or do not improve after a few days.
‘Furthermore, routine colonoscopy six weeks post complicated diverticulitis is still warranted, but it is not necessary for uncomplicated diverticulitis cases, unless the patient meets other criteria as per the national bowel screening program.’
The review also found antibiotics provide no assistance for uncomplicated cases of diverticulitis and recommends their selective use on a case-by-case basis.
‘GPs should definitely be aware that antibiotics have not been shown to shorten recovery time or reduce pain from uncomplicated diverticulitis,’ Dr Innes said.
‘This is because diverticulitis is a condition of inflammation, but not always infection. Inflammation does not require antibiotics – just time and rest.
‘So, patients that require antibiotics for other purposes, or immunosuppressed patients, may still benefit from antibiotics if they have a bout of uncomplicated diverticulitis, but, for most, the risks would outweigh the benefits.’
One of the most common gastrointestinal disorders, diverticular disease is characterised by diverticulosis – the presence of mucosal and submucosal herniations or ‘pockets’ known as diverticula. Although largely asymptomatic, up to 50% of people 60 years and older have diverticula, around 4% of whom develop diverticulitis throughout their lifetime.
It presents as a severe episode of lower abdominal pain that is usually left-sided, accompanied by a low-grade fever, leucocytosis and change in bowel movements. Guidelines classify diverticulitis as complicated or uncomplicated, based on computed tomography (CT) images.
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