Acute diverticulitis in 2024: current evidence to prevent onset and recurrence

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Clinical Medicine

Background:

• Rising global prevalence of acute diverticulitis (AD) necessitates efficient clinical management strategies.
• Increasing healthcare costs associated with AD demand optimized diagnostic and treatment protocols.
• This review synthesizes evidence to guide effective AD management and explore innovative therapies.

Purpose of the Study:

• To review current evidence for efficient clinical management of acute diverticulitis.
• To highlight potential innovative therapeutic strategies for AD.
• To standardize diagnostic and treatment approaches for AD.

Main Methods:

• Systematic literature search conducted from October 2014 to October 2024.
• Adherence to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
• Analysis of existing evidence on AD diagnosis, treatment, and prevention.

Main Results:

• Accurate diagnosis of AD is achievable through medical history, physical examination, and laboratory data, potentially reducing reliance on radiology.
• CT scan with intravenous contrast remains the gold standard for AD diagnosis and staging, crucial for identifying complications.
• Interventions targeting modifiable risk factors reduce AD incidence, but current therapies (antibiotics, probiotics, mesalazine) yield disappointing results.
• Emerging evidence suggests targeting colonic oxidative imbalance, linked to ischemia-reperfusion injury, as a novel therapeutic strategy for AD.

Conclusions:

• Despite advancements in AD management over the past decade, further research is essential.
• Continued efforts are needed to significantly improve AD management and reduce associated healthcare expenditures.
• Exploring novel therapeutic targets, such as colonic oxidative imbalance, holds promise for future AD treatment.