Diverticular disease of the colon is a complex syndrome that includes several clinical conditions, each needing different therapeutic strategies. In patients with asymptomatic
diverticulosis, only a fiber-rich diet can be recommended in an attempt to reduce intraluminal pressure and slow down the worsening of the disease. Fiber supplementation is also indicated in symptomatic
diverticulosis in order to get symptom relief and prevent acute
diverticulitis. In this regard, the best results have been obtained by combination of soluble fiber, like
glucomannan, and poorly absorbed
antibiotics, like
rifaximin, given 7-10 days every month. For uncomplicated
diverticulitis the standard
therapy is liquid diet and oral antimicrobials, usually
ciprofloxacin and
metronidazole. Hospitalization, bowel rest, and intravenous
antibacterial agents are mandatory for complicated
diverticulitis. Haemorrhage is usually a self-limited event but may require endoscopic or surgical treatment. Once in remission, continuous fiber intake and intermittent course of
rifaximin may improve symptoms and reduce
diverticulitis recurrence. These preventive strategies will likely improve patients' quality of life and reduce management costs. A surgical approach in
diverticular disease is needed in 15-30% of cases and consists of removing the intestinal segment affected by
diverticula. It is indicated in diffuse
peritonitis,
abscesses,
fistulas,
stenosis and after the second to fourth attack of uncomplicated
diverticulitis. Young people and immunocompromised patients are more likely to be operated.