How can you help prevent a recurrence of diverticulitis?
1 small study of oral enterovaccine
An oral polybacterial lysate suspension designed to stimulate gut secretion of immunoglobulin A was investigated in a study of 83 patients with recurrent diverticulitis. In the treated group, 4.6% (2/43) of patients had recurrent diverticulitis during the 3 months of the study, compared with 12.5% (5/40) of the untreated group (P<.05).4
Prophylactic surgery rarely helps
No randomized trials have compared surgical with medical therapy to prevent recurrent diverticulitis. Extensive retrospective literature fails to support elective surgery after a second episode. Sixty-eight percent to 96% of patients requiring surgery for diverticulitis-associated perforation or abscess had no previous symptoms and couldn’t be helped by prophylactic surgery,5 and diverticulitis symptoms persisted after bowel resection in 27% to 33% of patients.5
One large retrospective study followed 3165 patients for 6 to 12 years after hospitalization for diverticulitis. Of the patients treated nonoperatively, 13% had a single recurrence and 4% had multiple recurrences; the annual recurrence rate was approximately 2%. The authors concluded that routine elective colectomy is rarely indicated after a first episode of uncomplicated acute diverticulitis.6
A decision analysis using a Markov model found that performing a colectomy after a fourth, rather than a second, episode of diverticulitis would result in somewhat fewer deaths and colostomies, equivalent quality-adjusted years of life, and cost savings per patient of $1035 to $5429. The results held for both older and younger patients.7
Recommendations
The American Society of Colon and Rectal Surgeons (ASCRS) concludes that recommendations for elective sigmoid colectomy after recovery from acute diverticulitis should be made on a case-by-case basis.8 Computed tomography to grade the severity of a first attack may help determine the need for surgery. The ASCRS guidelines mention that long-term fiber supplementation may prevent recurrences of diverticulitis in most patients.
The American College of Gastroenterology Practice Parameters Committee states that prophylactic surgery may be recommended for recurrent attacks of diverticulitis, but generally isn’t indicated after a single uncomplicated episode.9 The group also notes that high-fiber diets may decrease the development of colonic diverticulosis, but no consistent data exist regarding fiber to prevent recurrent diverticulitis.
