In a majority of patients, colonic diverticula remain asymptomatic (diverticulosis), whereas, some patients develop abdominal symptoms (symptomatic uncomplicated diverticular disease - SUDD) and complications as acute diverticulitis (AD).

The aim of a recent article published in Drugs in Context was to summarize the latest evidence and clinical implication in treatment of diverticular disease (DD), focusing attention on treatments of diverticulosis, SUDD, and AD together with the primary and secondary prevention of diverticulitis.

The authors conducted a review based on latest evidence related to the treatment of DD over the last 10 years. It was found that during the past 5 years, six countries had issued guidelines on DD with differences with respect to covered topics and recommendations regarding treatments. It was reported that despite the lack of rationale for drug use in patients with asymptomatic diverticulosis, there is limited evidence supporting the increase in dietary fiber to reduce the risk of DD. To achieve symptomatic relief in SUDD patients, several therapeutic strategies with fiber, probiotics, rifaximin and mesalazine have been proposed. In the management of AD, recent guidelines suggest a selective rather than routine use of antibiotics in uncomplicated AD. However, the use of antibiotics were crucial in the management of complicated cases. The authors also reported that for primary and secondary prevention of AD, the efficacy of rifaximin and mesalazine has been acknowledged.

It was inferred that the treatment of DD poses a challenge in clinical practice, especially concerning management of SUDD and primary and secondary prevention of AD.