Diverticulitis Flare Up: More Conservative Treatment Now Recommended

Diverticulitis is a painful and unpredictable gastrointestinal disease that often requires aggressive treatment. About 200,000 people are hospitalized every year in the United States for the disease, according to the National Institutes of Health.

Diverticulitis occurs when small pouches form in the colon and become inflamed. Symptoms of diverticulitis may include abdominal pain and tenderness, fever, nausea and constipation and they often are irregular.

While patients can develop severe complications from diverticulitis that require surgery, doctors have taken a more conservative approach to treating milder cases. New guidelines from the American Gastroenterological Association call for less emphasis on antibiotics and surgery for mild cases.

Antibiotics Likely To Be Unnecessary

Antibiotics have been a primary treatment for diverticulitis. But UH colorectal surgeon Trevor Teetor, MD, says recent evidence shows antibiotics are unnecessary for patients with mild cases and no complications.

“We always thought acute cases involved an immediate infection,” Dr. Teetor says. “Now we understand it involves inflammation, which does not necessarily need antibiotics.”

Antibiotics are still recommended for patients with other medical conditions who have concerning symptoms or who have complications, he says.

Surgery for Diverticulitis

Guidelines around surgery have also changed. Surgery is no longer recommended based solely on the number of episodes, Dr. Teetor says.

“Surgeons should advise elective surgery to remove diseased segments of the colon on a case-by-case basis,” he says. “Factors to consider include disease severity, patient quality of life, and the benefits and risks. Chronic gastrointestinal symptoms may not improve with surgery.”

Dietary changes often help patients with diverticulitis. During flare-ups, “bowel rest” through a clear liquid diet can be recommended. If a patient cannot return to solid foods in three to five days or is feeling worse, a follow-up appointment should be scheduled immediately, Dr. Teetor says.

Reducing Your Risk

A vegetarian diet and a simple, high-fiber diet, rich in fruits, vegetables, legumes and whole grains, are associated with decreased diverticulitis risk. And contrary to myths, corn, popcorn, berries and nuts do not increase risk.

To further reduce risk, patients are encouraged to participate in vigorous exercise, stop smoking, maintain a healthy weight (obesity increases risk) and watch alcohol consumption. While drinking alcohol generally is not a risk factor, alcoholism does increase risk. Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) and opiate analgesics should also be avoided.

“There seems to be a general consensus that uncomplicated diverticulitis has been historically overtreated,” Dr. Teetor says. “We now have a better understanding of the disease process and a greater focus on inflammation rather than infection. Trends point toward less use of antibiotics and less emphasis on surgery, all of which brings improved patient outcomes.” 

Related Links

The team of digestive health experts at University Hospitals is experienced in treating diseases and disorders that affect the small and large intestine. From conditions such as constipation and diarrhea, to inflammatory bowel disease and colorectal cancer, we provide the most advanced treatment and follow-up care for our patients. Learn more about services for treatment of conditions of the small and large intestine at University Hospitals.