Optimizing Medical Management for Diverticular Disease: A Systematic Review and Gap Analysis

ABSTRACT Background Resolution of acute diverticulitis is often associated with ongoing gastrointestinal symptoms and risk for recurrent episodes. Surgical guidelines recommend individualized treatment options but medical management strategies have been inconsistently implemented in surgical practice. This study reviews the evidence for medical management to reduce episodes or decrease gastrointestinal symptoms to inform shared decision-making discussions with patients and identifies key evidence gaps for the medical management of diverticular disease. Methods PubMed, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched to identify randomized clinical trials on recurrent acute diverticulitis and symptomatic uncomplicated diverticular disease that studied medical treatment strategies including fiber supplementation, probiotics, mesalamine, and rifaximin. Two independent researchers screened references and assessed articles for eligibility. Outcomes of interest included patient-reported symptom improvement and diverticulitis recurrence. Results 27 of 485 unique articles identified in the electronic research met eligibility for inclusion. Three focused on fiber, three on probiotics, twelve on mesalamine, and nine on rifaximin with conflicting results. Conclusion Medical management options are available and may be helpful in some patients following resolution of acute diverticulitis to improve symptom burden and recurrent episodes of diverticulitis. Further investigation is needed to inform which subpopulation of patients are likely to benefit from different treatment strategies.