Diverticula (mucosal outpouching through the wall of the colon) affect over 5% of adults aged 40 years and older, but only 10-25% of affected people will develop symptoms such as lower abdominal pain. Recurrent symptoms are common, and 5% of people with diverticula eventually develop complications such as perforation, obstruction, haemorrhage, fistulae, or abscesses.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: treatments for uncomplicated diverticular disease; treatments to prevent complications; and treatments for acute diverticulitis? We searched: Medline, Embase, The Cochrane Library and other important databases up to July 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 13 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: antispasmodics, bran, elective surgery, increasing fibre intake, ispaghula husk, lactulose, medical treatment, mesalazine, methylcellulose, rifaximin, surgery.
Diverticula (mucosal outpouching through the wall of the colon) affect over 5% of adults aged 40 years and older, but only 10-25% of affected people will develop symptoms such as lower abdominal pain.
Recurrent symptoms are common, and 5% of people with diverticula eventually develop complications such as perforation, obstruction, haemorrhage, fistulae, or abscesses.Use of non-steroidal anti-inflammatory drugs, corticosteroids, and opiate analgesics have been associated with an increased risk of perforation of diverticula, while calcium antagonists may protect against these complications.
Dietary fibre supplementation, and laxatives such as methylcellulose and lactulose are widely used to treat uncomplicated diverticular disease, but we don't know whether they reduce symptoms or prevent complications.
Antibiotics (rifaximin) plus dietary fibre supplementation may improve symptoms more than fibre alone, but increase the risk of adverse effects.We don't know whether mesalazine is also beneficial at improving symptoms in uncomplicated diverticular disease, or at reducing complications after acute diverticulitis, as no good-quality studies have been found.We don't know whether elective open or laparoscopic colonic resection improve symptoms in people with uncomplicated diverticular disease.
Acute diverticulosis is often treated with intravenous fluids, limiting oral intake, and broad spectrum antibiotic use. However, we don't know whether such medical treatment improves symptoms and cure rates in people with acute diverticulitis.
Surgery is usually performed for people with peritonitis caused by perforated acute diverticulitis, but we don't know whether it improves outcomes compared with no surgery, or if any one surgical technique is better at preventing complications.