EAES-SAGES guideline updates recommendations for diverticular disease management

An EAES-SAGES multi-society clinical practice guideline update addresses symptomatic uncomplicated diverticular disease (SUDD), uncomplicated diverticulitis, and complicated diverticulitis. A systematic review identified 27 randomized trials and cohort studies providing very low to moderate certainty evidence. An international multidisciplinary panel, including patient partners, used the GRADE evidence-to-decision framework to formulate recommendations.

For SUDD, the panel suggests rifaximin or mesalamine over standard supportive care. For uncomplicated diverticulitis, it suggests no routine antibiotics. Elective resection is suggested over observation for patients with persistent symptoms following an episode of recurrent uncomplicated diverticulitis. After recovery from a first episode of uncomplicated diverticulitis, the panel suggests no routine follow-up colonoscopy.

For patients recovering from a first episode of diverticulitis complicated by an abscess, the panel suggests elective resection over surveillance. It judged that many patients would place high value on reducing recurrence at one year, while acknowledging missing evidence for prioritized outcomes, including 30-day major complications, emergency surgery, one-year stoma-free survival, and one-year quality of life.

All five recommendations are conditional. The panel encourages patient-centered discussions of alternatives because values and preferences vary. The limited certainty of the evidence and gaps in important clinical outcomes are central caveats when applying these recommendations.