Diverticulitis: A Primer for Primary Care Providers
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Expires July 31, 2019
Treatment of this common complication of diverticular disease is predicated on whether the presentation signals uncomplicated or complicated disease. While some uncomplicated cases require hospitalization, many are amenable to primary care outpatient, and often conservative, management. The longstanding practice of antibiotic treatment of uncomplicated cases is now considered a selective, rather than a routine, option.
Historically, patients with diverticulitis were advised to avoid eating nuts, corn, popcorn, and seeds to reduce the risk for complications. But studies have found no support for this caution. In a 2008 large, prospective study of men without known diverticular disease, the researchers found no association between nut, corn, or popcorn ingestion and diverticulitis; in fact, increased nut intake was specifically associated with a lower risk for diverticulitis.15
Smoking
Smoking has been linked to diverticulitis and has been associated with a threefold risk for complications, including severe diverticulitis.16,17 An increased risk for recurrent episodes has also been found in smokers following surgical intervention.17
Medications
NSAIDs, corticosteroids, and opioids have been associated with an increased risk for perforated diverticulitis.18,19 A significant association has been found between NSAID use and severity of diverticulitis, including perforation; one study reported a relative risk of 1.25 (95% confidence interval, 10.5 to 1.47) for diverticulitis with regular use of aspirin (≥ 2x/wk).20,21
More frequent steroid use has been found in patients with complicated diverticulitis, compared to patients with uncomplicated disease (7.3% vs 3.3%; P = .015).22 A systematic review of five studies comparing patients with and without steroid use showed significantly higher odds of diverticular perforation in patients taking a steroid.23 Pooled data showed significantly increased odds of perforation and abscess formation with use of an NSAID (odds ratio [OR], 2.49), steroid (OR, 9.08), or opioid (OR, 2.52).22
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