Diverticular disease is a very common condition in Australia with roughly 60% of 60 year olds found to have the condition. It is more common as you get older, but can also be found in younger population. Approximately 5% of people with diverticulosis may develop diverticulitis. Studies suggest that 17% will get a second attack five years later, and within this cohort 44% of these may get a third attack of diverticulitis at five years.
Altered neuromusculature, genetics, poor diet (including diet rich in processed food and red meat), smoking, obesity, physical inactivity, medications like NSAIDs and altered microbiome can precipitate attacks of diverticulitis. A diet rich in fibres, regular exercise, avoiding NSAIDS/smoking and weight management can help prevent attacks.
We would recommend colonoscopy after the first episode of diverticulitis or complicated diverticulitis. However, it may be deferred if colonoscopy has been performed recently (<1 year). Surgery is rarely required in diverticulitis. We recommend watching for complications and performing a CT scan to confirm the diagnosis.
In most cases, bowel rest or clear fluid diet may help resolve attacks of diverticulitis. We suggest using antibiotic treatment selectively rather than routinely in immunocompetent patients with mild uncomplicated diverticulitis. Antibiotics can be considered if patient is frail, immunocompromised, has long segment of diverticulitis, refractory symptoms, CRP >140 mg/L or WCC >15 .
