Individual research recommendation details

Recommendation ID

NG147/3

Question

What is the most clinically and cost-effective treatment for diverticular disease?

Any explanatory notes
(if applicable)

Why the committee made the recommendations
Very limited evidence was identified on a high fibre diet, antibiotics, aminosalicylates, probiotics, symbiotics and laxatives and there was no evidence on non-steroidal anti-inflammatory drugs (NSAIDs). The evidence that was available didn't help the committee to understand the impact of these interventions on the progression of disease or people's quality of life. The committee used formal consensus methods together with their expertise and knowledge to make recommendations on diet and lifestyle advice and how to manage pain and cramping.

Bulk-forming laxatives are effective as they help to soften the stool and can also help to solidify loose stools in people with constipation. Paracetamol is indicated for pain and the committee highlighted the importance of avoiding NSAIDs and opioid analgesia because of the risk of diverticular perforation. Some people experience abdominal cramping, and anti-spasmodics may help with this.

In line with best practice in antimicrobial stewardship, the committee made a recommendation not to use antibiotics in the absence of acute diverticulitis.

Having a greater understanding of how best to manage symptoms and prevent the disease developing into acute diverticular disease could have a positive impact on a person's health and wellbeing. It could also help avoid potential subsequent treatment costs. The committee therefore made a research recommendation in this area.

These recommendations are about managing the symptoms of diverticular disease rather than preventing progression to acute diverticulitis. However, the development of acute diverticulitis was included as an outcome in this review and in the research recommendation that was developed, because the committee considered it to be a critical factor for decision making. The committee noted the importance of considering alternative causes and further investigations in people with persistent symptoms or who do not respond to treatment.

How the recommendations might affect practice
The recommendations reflect current practice.

Full details of the evidence and the committee's discussion are in evidence review D: management of diverticular disease.

Source guidance details

Comes from guidance

Diverticular disease: diagnosis and management

Number

NG147

Date issued

November 2019

Other details