[Diverticular disease - clinical patterns and treatment]

Area of Science:

• Gastroenterology
• Medical Imaging
• Clinical Guidelines

Context:

• Recent advancements in diagnosing and treating diverticulosis, diverticular disease, and diverticulitis have necessitated updated clinical guidelines.
• The German Society for Surgery (DGVS) and the German Society for Gastroenterology (DGAV) have released a new guideline summarizing current evidence.

Purpose:

• To outline the essentials of the new guideline for medical practice regarding diverticulitis diagnosis and treatment.
• To highlight the importance of cross-sectional imaging (US or CT) for confirming diverticulitis diagnoses.
• To introduce a new classification system (Classification of Diverticular Disease, CDD) for all forms of diverticular disease.

Summary:

• A diagnosis of diverticulitis requires confirmation by ultrasonography (US) or computed tomography (CT), with US being the preferred primary method due to practicability and radiation safety.
• CRP levels are considered superior to WBC and temperature for assessing inflammation.
• The new Classification of Diverticular Disease (CDD) aids in distinguishing differential diagnoses and guides treatment, focusing on severity and complications rather than solely on recurrent episodes.
• Conservative treatment may be suitable for uncomplicated cases, while antibiotics remain crucial for complicated disease or high-risk patients.

Impact:

• The guideline provides a standardized approach to diagnosing and classifying diverticular disease, improving patient management.
• It emphasizes a shift in surgical indications for diverticulitis, prioritizing severity and complications over recurrence frequency.
• Enhanced understanding and application of the CDD classification can lead to more precise and individualized treatment strategies, potentially improving patient outcomes.