Ricerc@Sapienza

Diverticular disease (DD) is a highly prevalent disease in
western industrialized countries that encompasses a complex
set of disorders. Because of its complexity and heterogeneity,
both from a pathogenic and a clinical point of view, the
management of this disease represent a challenge in clinical
practice. This review aims to analyze and summarize the most
recent evidence on the medical strategies for DD, considering
separately the different stages of the disease, from prevention
of diverticula formation to treatment of acute diverticulitis and
prevention of recurrences. Based on some evidence, dietary
fiber is useful to prevent diverticula formation and in
diverticulosis, with no pharmacological treatment in these
settings. Treatment of symptomatic uncomplicated diverticular
disease as well as primary prevention of acute diverticulitis is
based on probiotics, fibres, mesalazine and rifaximin,
individually or as combination therapy, although a standard
approach has not yet been defined. On the contrary, in acute
diverticulitis (AD) recent acquisitions have clarified and
standardized the role of systemic antibiotics, reserving its use
only to complicated forms and in selected cases of
uncomplicated disease. Secondary prevention of AD is
essentially based on mesalazine and rifaximin but, despite
promising results, no strong evidence have been produced. To
date, grey areas remain in the medical management of DD.