Diverticular disease: A therapeutic overview

Table 1 Current classification of diverticular disease of the colon

Classification	Description
Asymptomatic diverticulosis	Patients with diverticula and the absence of any sign or symptom of diverticular inflammation
Symptomatic uncomplicated	Patients with diverticula who experience symptoms, but without signs of diverticular inflammation
diverticular diseae
Symptomatic recurrent	Patients with diverticula who experience recurrent symptoms (more than 1 attack per year) but without signs of
diverticular disease	diverticular inflammation
Complicated	Patients with diverticula who experience symptoms and demonstrate signs of diverticular inflammation with further
diverticular disease	complications (hemorrhage, abscess, phlegmon, perforation, purulent and fecal peritonitis, strictures, fistulas)

Table 2 Symptomatic diverticular disease: Current therapeutic approach

Symptomatic uncomplicated	Uncomplicated diverticulitis	Complicated diverticulitis
Fibers	Mild + familiar support	Abscess
Spasmolytics	Outpatients treatment	Drainage (CT)
Anti-cholinergic	Liquid diet	Drainage + surgery
Antibiotics	Oral antibiotics	Perforation and fistulas
Not recommended (ACG, ASCRS Guidelines)	Improvement within 2/3 d	Surgery
Rifaximin	Severe, comorbidity, elderly, immunodepression	Acute obstruction
	Inpatients treatment	Conservative therapy
	"Bowel rest"	Chronic obstruction
	I.V. antibiotics	Endoscopic treatment
	Oral antibiotics at discharging (ACG, ASCRS Guidelines)	Surgery
		Bleeding
		Conservative therapy
		Angiography
		Colonoscopy
		Surgery

Table 3 Current antibiotic therapy in acute diverticulitis

Route	Antibiotic
Oral route	Amoxycillin + clavulanic acid
	Sulphametoxazole-trimethoprim + metronidazole
	Chinolone + metronidazole
Intravenous route	Metronidazole + aminoglycosidic (e.g. gentamicin)
	Clindamycin
	Aztreonam
	Third generation cephalosporins
	Second generation cephalosporins
	Association of severalβ-lactamase inhibitors (e.g.
	ampicillin-sulbactam)