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Diverticulitis

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Key Points Î Acute diverticulitis is defined as clinically evident macroscopic inflammation of a diverticulum or diverticula. Î Acute diverticulitis occurs in <10% of patients with diverticulosis. Î 10–20% of those patients will have complicated disease, defined as an abscess, perforation, fistula, or colonic obstruction. Î 10–25% of patients who have a first attack of diverticulitis will have a subsequent recurrence. Î Antibiotics are often prescribed for acute diverticulitis, but can often be avoided in mild cases. Î A colonoscopy should generally be performed after resolution of acute diverticulitis if not recently done. Î The AGA suggests a fiber-rich diet and physical activity after resolution of acute diverticulitis. GRADE Strength of Recommendations and Implications Grade Implications of strong and conditional (weak) guideline recommendations Strong • Patients: Most individuals in this situation would want the recommended course of action and only a small proportion would not. • Clinicians: Most individuals should receive the recommended course of action. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences. Conditional (weak) • Patients: The majority of individuals in this situation would want the suggested course of action, but many would not. • Clinicians: Different choices will be appropriate for different patients. Decision aids may well be useful in helping individuals making decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working toward a decision. Reprinted with permission from Sultan et al. Clin Gastroenterol Hepatol. 2013;11:329–332. AGA Institute Guideline on the Management of Acute Diverticulitis

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