title: Diverticular disease: guidelines of the german society for gastroenterology, digestive and metabolic diseases and the german society for general and visceral surgery.
abstract: BACKGROUND
  Diverticular disease is one of the most common disorders of the gastrointestinal tract. 28-45% of the population develop colonic diverticula, while about 25% suffer symptoms and about 5% complications.
  
  
  OBJECTIVE
  To create formal guidelines for diagnosis and management.
  
  
  METHODS
  Six working groups with 44 participants analyzed key questions in subject areas assigned to them. Following a systematic literature search, 451 publications were included. Consensus was obtained by agreement within the working groups, two Delphi processes and a guideline conference.
  
  
  RESULTS
  Targeted management of diverticular disease requires a classificatory diagnosis. A new classification was created. In addition to the clinical examination, intestinal ultrasound or computed tomography is the determining factor. Interval colonoscopy is recommended to exclude comorbidities. A low-fiber diet, obesity, lack of exercise, smoking and immunosuppression have an adverse impact on diverticulosis. This can lead to diverticulitis. Antibiotics are no longer recommended in uncomplicated diverticulitis if no risk factors such as immunosuppression are present. If close monitoring is ensured, uncomplicated diverticulitis can be treated on an outpatient basis. Complicated diverticulitis should be treated in hospital, involving broad-spectrum antibiotic therapy, where necessary abscess drainage, and surgery, if possible laparoscopically. In the case of chronic relapsing diverticulitis, the risk of perforation decreases with each episode, so that surgery is no longer recommended after the second episode but only following individual assessment.
  
  
  CONCLUSIONS
  New findings on diverticular disease call into question the overuse of antibiotics and excessive indications for surgery. Targeted treatment requires a precise diagnosis and intensive interdisciplinary cooperation.
authors.affiliation: Evangelisches Krankenhaus Kalk, Köln, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kruis
authors.forename: Christoph-Thomas
authors.initials: CT
authors.lastname: Germer
authors.forename: Ludger
authors.initials: L
authors.lastname: Leifeld
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003113:Colonoscopy / Q000592:standards; D004238:Diverticulitis / Q000145:classification* / Q000175:diagnosis* / Q000628:therapy*; D043963:Diverticulosis, Colonic / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005762:Gastroenterology / Q000592:standards; D005858:Germany; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis; D008297:Male; D012955:Societies, Medical; D001747:Urinary Bladder Fistula / Q000175:diagnosis; D014624:Vaginal Fistula / Q000175:diagnosis
chemical_list: D000900:Anti-Bacterial Agents