Most patients with uncomplicated diverticulitis recover following medical treatment and do not require surgical intervention.
Recurrent disease
Diverticular disease recurs in 5% to 11% of patients over 5 years following an episode of uncomplicated diverticulitis.[7]Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32.
https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00313-4
http://www.ncbi.nlm.nih.gov/pubmed/32381121?tool=bestpractice.com
Risk factors for recurrence seem to be younger age at presentation, female sex, Asian ethnicity, obesity, tobacco smoking, previous episode of recurrent disease, and abscess formation or complicated disease at index diagnosis.[7]Sartelli M, Weber DG, Kluger Y, et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 May 7;15(1):32.
https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00313-4
http://www.ncbi.nlm.nih.gov/pubmed/32381121?tool=bestpractice.com
[99]Hupfeld L, Burcharth J, Pommergaard HC, et al. Risk factors for recurrence after acute colonic diverticulitis: a systematic review. Int J Colorectal Dis. 2017 May;32(5):611-22.
http://www.ncbi.nlm.nih.gov/pubmed/28110383?tool=bestpractice.com
[100]Kang G, Son S, Shin YM, et al. Recurrence of uncomplicated diverticulitis: a meta-analysis. Medicina (Kaunas). 2022 Jun 2;58(6):758.
https://www.mdpi.com/1648-9144/58/6/758
http://www.ncbi.nlm.nih.gov/pubmed/35744021?tool=bestpractice.com
Recurrent disease is associated with high mortality, and response to therapy is less favorable.
Mesalamine, probiotics, or rifaximin are not recommended for the prevention of recurrent diverticulitis.[43]Peery AF, Shaukat A, Strate LL. AGA clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology. 2021 Feb;160(3):906-11.e1.
https://www.gastrojournal.org/action/showPdf?pii=S0016-5085%2820%2935512-8
http://www.ncbi.nlm.nih.gov/pubmed/33279517?tool=bestpractice.com
[59]Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al; Clinical Guidelines Committee of the American College of Physicians. Colonoscopy for diagnostic evaluation and interventions to prevent recurrence after acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians. Ann Intern Med. 2022 Mar;175(3):416-31.
https://www.acpjournals.org/doi/10.7326/M21-2711
http://www.ncbi.nlm.nih.gov/pubmed/35038270?tool=bestpractice.com
Evidence shows that mesalamine does not reduce the risk of recurrence.[101]Balk EM, Adam GP, Cao W, et al. Evaluation and management after acute left-sided colonic diverticulitis : a systematic review. Ann Intern Med. 2022 Mar;175(3):388-98.
https://www.acpjournals.org/doi/10.7326/M21-1646
http://www.ncbi.nlm.nih.gov/pubmed/35038269?tool=bestpractice.com
[
]
For people with diverticulitis, how does mesalamine (5-ASA) compare with placebo for prevention of recurrence?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1968/fullShow me the answer There is insufficient evidence for the use of rifaximin, mesalamine and rifaximin, combination balsalazide (a 5-aminosalicylic acid prodrug) and probiotics, or burdock tea.[59]Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al; Clinical Guidelines Committee of the American College of Physicians. Colonoscopy for diagnostic evaluation and interventions to prevent recurrence after acute left-sided colonic diverticulitis: a clinical guideline from the American College of Physicians. Ann Intern Med. 2022 Mar;175(3):416-31.
https://www.acpjournals.org/doi/10.7326/M21-2711
http://www.ncbi.nlm.nih.gov/pubmed/35038270?tool=bestpractice.com
[101]Balk EM, Adam GP, Cao W, et al. Evaluation and management after acute left-sided colonic diverticulitis : a systematic review. Ann Intern Med. 2022 Mar;175(3):388-98.
https://www.acpjournals.org/doi/10.7326/M21-1646
http://www.ncbi.nlm.nih.gov/pubmed/35038269?tool=bestpractice.com
Post-surgery
Following elective surgical treatment, up to 25% of patients continue to have ongoing pain or recurrent diverticulitis.[43]Peery AF, Shaukat A, Strate LL. AGA clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology. 2021 Feb;160(3):906-11.e1.
https://www.gastrojournal.org/action/showPdf?pii=S0016-5085%2820%2935512-8
http://www.ncbi.nlm.nih.gov/pubmed/33279517?tool=bestpractice.com