Diverticulitis is a population health problem: Lessons and gaps in strategies to implement and improve contemporary care

Abstract

The disease burden of diverticulitis is high across inpatient and outpatient settings, and the prevalence of diverticulitis has increased. Historically, patients with acute diverticulitis were admitted routinely for intravenous antibiotics and many had urgent surgery with colostomy or elective surgery after only a few episodes. Several recent studies have challenged the standards of how acute and recurrent diverticulitis are managed, and many clinical practice guidelines (CPGs) have pivoted to recommend outpatient management and individualized decisions about surgery. Yet the rates of diverticulitis hospitalizations and operations are increasing in the United States, suggesting there is a disconnect from or delay in adoption of CPGs across the spectrum of diverticular disease. In this review, we propose approaching diverticulitis care from a population level to understand the gaps between contemporary studies and real-world practice and suggest strategies to implement and improve future care.

Keywords: Clinical guidelines; Diverticular disease; Diverticulitis; Elective; Emergent surgery; Hospitalization.

Figure 1

Historical understanding of diverticulitis as a progressive disease and summary of recent challenges to the progressive disease model.

Figure 2

Modernized understanding of diverticular disease via a relapsing-remitting model and summary of ongoing controversies and gaps in the literature in diverticular disease.