SOURCE: Shah SD, Cifu AS. JAMA 2017;318:291-292.

Only a small fraction of patients with diverticular disease of the colon ever incur diverticulitis. That is, although as many as 60% of patients > 60 years of age have diverticuli, only 4% of them get diverticulitis. Much of the advice about treatment and prevention of diverticulitis and its recurrence has been based on opinion and/or low-quality evidence.

Some previously fundamental precepts, such as the universal need for antibiotic treatment in acute diverticulitis and suggested dietary alterations (e.g., increased fiber and avoidance of nuts, seeds, or popcorn) for prevention, are called into question by this most recent American Gastroenterological Association review.

Although “high-risk” groups who merit antibiotic administration are delineated (for instance, immunocompromised, significant comorbidities, pregnancy, sepsis), whether antibiotics improve outcomes in other populations with acute uncomplicated diverticulitis is much more uncertain.

Evolving insight into the pathology of acute diverticulitis is refocusing on inflammatory aspects of the disorder, as opposed to infectious links. Much uncertainty still surrounds the etiology and best management of acute diverticulitis.