Author Insights: Less Aggressive Treatment May Be Warranted for Many Cases of Diverticulitis

Arden M. Morris, MD, MPH, an associate professor of surgery, University of Michigan Health System, Ann Arbor, and colleagues found in a systematic review that less aggressive strategies for treating diverticulitis may be appropriate for many patients. (Image: Michigan MultiMedia)

Arden M. Morris, MD, MPH, an associate professor of surgery, University of Michigan Health System, Ann Arbor, and colleagues found in a systematic review that less aggressive strategies for treating diverticulitis may be appropriate for many patients. (Image: Michigan MultiMedia)

Recent research suggests that recommendations offered in current national clinical guidelines for treating patients with sigmoid diverticulitis may overstate the need for aggressive antibiotic and surgical interventions. This finding comes from a systematic review published today in JAMA.

Diverticulitis is a common digestive disease caused by inflammation of small pouches called diverticula that can form anywhere in the digestive system but are most often found in the sigmoid colon, the part of the large intestine that attaches to the rectum. Most cases of uncomplicated diverticulitis resolve without the need for any treatment; if diverticulitis remains, antibiotics may be prescribed. If a patient experiences recurring acute attacks, the treating physician may order a computed tomography (CT) scan to distinguish uncomplicated diverticulitis from complicated diverticulitis, a condition involving such complications as ruptured diverticula or abscess that may require surgery.

The JAMA researchers analyzed 80 articles regarding the diagnosis and management of diverticulitis published between January 1, 2000, and March 31, 2013. They found, contrary to previous thought, that the risk of septic peritonitis is reduced rather than increased with each recurrence of diverticulitis. Their analysis also found that treatment with antibiotics and fiber consumption were not as beneficial as previously thought and that surgery for chronic disease is not always warranted.

Lead author, Arden M. Morris, MD, MPH, associate professor of surgery at the University of Michigan Health System in Ann Arbor, discusses her team’s findings.

news@JAMA: Why did you do this review?

Dr Morris: The knowledge we have about diverticulitis has changed very extensively in the last 10 years. But the dissemination of knowledge has been traditionally extremely slow, and the guidelines have not necessarily kept up with these changes.

news@JAMA: What has brought about these changes in knowledge?

Dr Morris: In the past we made clinical decisions not necessarily by imaging the patient, but by basing it on the physical exam and history and then opening up the belly. CT scans are of substantially higher quality than they were 10 years ago, allowing us to make decisions without the need for opening up the patient. Secondly, we now have these fantastic clinical databases we can mine to guide our decision-making processes and not base our decisions just on the protocols at our own institutions or through discussions with our colleagues.

news@JAMA: Are the primary care physicians who refer patients to you for the treatment of diverticulitis aware of these changes in the knowledge surrounding the condition?

Dr Morris: I have a very busy surgery practice and most of the patients we see come in quoting information from their primary care physicians that is outdated. So we need forums like JAMA and others to disseminate this information.

news@JAMA: You found that for many cases of diverticulitis, less aggressive treatment strategies may be warranted than were used in the past. But that doesn’t hold true for all patients presenting with this condition, does it?

Dr Morris: Some people really do need an operation for their diverticulitis—some are truly sick or don’t improve with medical therapy—and it can be a very serious situation.



Categories: Colorectal Surgery, Gastroenterology, Gastrointestinal Diseases