ABSTRACT Introduction Colonic diverticulosis is the most common structural abnormality of the colon in developed countries, with an increasing global prevalence. Approximately 20–25% of affected individuals develop symptoms, collectively referred to as diverticular disease. Given its wide clinical spectrum, evolving pathophysiological insights and growing disease burden, updated guidance is essential. Methods This International Consensus, developed by 32 experts from 14 countries through a structured Delphi process based on the PICO framework and GRADE methodology, provides evidence-based recommendations across five domains: epidemiology and pathogenesis; clinical features; diagnosis; medical therapy; and surgical management. Results Key statements define diverticulosis as the presence of diverticula without symptoms and diverticular disease as diverticula associated with symptoms or complications. High dietary fibre intake is protective whereas smoking, obesity and the use of non-steroidal anti-inflammatory drugs, corticosteroids, opioids or immunotherapy increase risk. Imaging is essential in suspected acute diverticulitis: ultrasound may be appropriate in experienced hands, while CT remains preferred for complicated cases. Diverticulosis itself requires no treatment. In symptomatic uncomplicated diverticular disease, dietary fibre, selected probiotics, mesalazine and rifaximin may help relieve symptoms. Routine antibiotic use is not recommended for acute uncomplicated diverticulitis, and elective surgery should be individualised, prioritising quality of life considerations over episode count. Conclusions These Consensus statements aim to standardise and optimise the diagnosis, management and prevention of diverticular disease across diverse healthcare systems, while highlighting research priorities such as microbiome characterisation, genetic risk profiling and longterm outcomes of selective antimicrobial and surgical strategies
Global guidelines on diverticular disease of the colon: the Fiesole Consensus report / Tursi, Antonio; Brandimarte, Giovanni; Di Mario, Francesco; Ma, Wenjie; Kupcinskas, Juozas; Regula, Jaroslaw; Maconi, Giovanni; Malfertheiner, Peter; Barbara, Giovanni; Stollman, Neil; Papagrigoriadis, Savvas; Golda, Thomas; Amato, Antonio; Bafutto, Mauro; Bassotti, Gabrio; A Binda, Gian; Biondo, Sebastiano; Crafa, Pellegrino; Dumitrascu, Dan; Elisei, Walter; Flor, Nicola; Ann Gwee, Kok; James Humes, David; Kessoku, Takaomi; Kruis, Wolfgang; Lahat Angel Lanas, Adi; Atsushi Nakajima, 28; Marcello Picchio, 29; C Spiller, 30 Robin; 31, ; Athena Adamopoulos, 32; Carmelo Scarpignato34, 33. - In: GUT. - ISSN 0017-5749. - 0(2025), pp. 1-28. [10.1136/gutjn]
Global guidelines on diverticular disease of the colon: the Fiesole Consensus report
Giovanni Brandimarte;Francesco Di Mario;Pellegrino CrafaWriting – Review & Editing
;
2025-01-01
Abstract
ABSTRACT Introduction Colonic diverticulosis is the most common structural abnormality of the colon in developed countries, with an increasing global prevalence. Approximately 20–25% of affected individuals develop symptoms, collectively referred to as diverticular disease. Given its wide clinical spectrum, evolving pathophysiological insights and growing disease burden, updated guidance is essential. Methods This International Consensus, developed by 32 experts from 14 countries through a structured Delphi process based on the PICO framework and GRADE methodology, provides evidence-based recommendations across five domains: epidemiology and pathogenesis; clinical features; diagnosis; medical therapy; and surgical management. Results Key statements define diverticulosis as the presence of diverticula without symptoms and diverticular disease as diverticula associated with symptoms or complications. High dietary fibre intake is protective whereas smoking, obesity and the use of non-steroidal anti-inflammatory drugs, corticosteroids, opioids or immunotherapy increase risk. Imaging is essential in suspected acute diverticulitis: ultrasound may be appropriate in experienced hands, while CT remains preferred for complicated cases. Diverticulosis itself requires no treatment. In symptomatic uncomplicated diverticular disease, dietary fibre, selected probiotics, mesalazine and rifaximin may help relieve symptoms. Routine antibiotic use is not recommended for acute uncomplicated diverticulitis, and elective surgery should be individualised, prioritising quality of life considerations over episode count. Conclusions These Consensus statements aim to standardise and optimise the diagnosis, management and prevention of diverticular disease across diverse healthcare systems, while highlighting research priorities such as microbiome characterisation, genetic risk profiling and longterm outcomes of selective antimicrobial and surgical strategiesI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
