title: Symptomatic Treatment for Uncomplicated Acute Diverticulitis: A Prospective Cohort Study.
abstract: BACKGROUND
  Even though evidence for nonantibiotic treatment of uncomplicated diverticulitis exists, it has not gained widespread adoption.
  
  
  OBJECTIVE
  The aim of this prospective single-arm study was to analyze the safety and efficacy of symptomatic (nonantibiotic) treatment for uncomplicated diverticulitis during a 30-day follow-up period.
  
  
  METHODS
  This study is a single-arm prospective trial (ClinicalTrials.gov ID NCT02219698).
  
  
  METHODS
  This study was performed at an academic teaching hospital functioning as both a tertiary and secondary care referral center.
  
  
  METHODS
  Patients, who had CT-verified uncomplicated acute colonic diverticulitis (including diverticulitis with pericolic air), were evaluated for the study. Patients with ongoing antibiotic therapy, immunosuppression, suspicion of peritonitis, organ dysfunction, pregnancy, or other infections requiring antibiotics were excluded.
  
  
  METHODS
  Symptomatic in- or outpatient treatment consisted of mild analgesics (nonsteroidal anti-inflammatory drug or paracetamol).
  
  
  METHODS
  The incidence of complicated diverticulitis was the primary outcome.
  
  
  RESULTS
  Overall, 161 patients were included in the study, and 153 (95%) completed the 30-day follow-up. Four (3%) of these patients were misdiagnosed (abscess in the initial CT scan). A total of 14 (9%) patients had pericolic air. Altogether, 140 (87%) patients were treated as outpatients, and 4 (3%) of them were admitted to the hospital during the follow-up. None of the patients developed complicated diverticulitis or required surgery, but, 2 days (median) after inclusion, antibiotics were given to 14 (9%, 6 orally, 8 intravenously) patients.
  
  
  CONCLUSIONS
  This study is limited by the lack of a comparison group and by the relatively short follow-up.
  
  
  CONCLUSIONS
  Symptomatic treatment of uncomplicated diverticulitis without antibiotics is safe and effective.
authors.affiliation: 1 Department of Abdominal Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland 2 Department of Transplantation and Liver Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Juha P
authors.initials: JP
authors.lastname: Mali
authors.forename: Panu J
authors.initials: PJ
authors.lastname: Mentula
authors.forename: Ari K
authors.initials: AK
authors.lastname: Leppäniemi
authors.forename: Ville J
authors.initials: VJ
authors.lastname: Sallinen
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004239:Diverticulitis, Colonic / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen