Dr Michael Sproat identifies five key learning points for primary care from the 2019 NICE guideline on the diagnosis and management of diverticular disease

Dr Michael Sproat

Read the related Guidelines summary

COVID-19 considerations

  • Diverticulitis is not expected to carry any increased risk for severe COVID-1914
  • On 4 April 2020, The British Society of Gastroenterology published COVID-19 guidance recommending that:15
    • all endoscopy except emergency and essential procedures should stop immediately
    • all symptomatic routine referrals should be deferred until further notice
  • Patients with suspected complicated acute diverticulitis should still be considered for urgent hospital assessment and contrast CT scan, despite the significant pressure on acute admissions at present.

CT=computed tomography

Implementation actions for STPs and ICSs

written by Dr David Jenner, GP, Cullompton, Devon

The following implementation actions are designed to support STPs and ICSs with the challenges involved with implementing new guidance at a system level. Our aim is to help you consider how to deliver improvements to healthcare within the available resources. 

  • Recognise that diverticular disease is very common particularly in older people; although it rarely causes morbidity it often gives rise to diagnostic concern as the symptoms overlap with those for intra-abdominal malignancy
  • Establish clear guidelines or a clinical pathway for the investigation and management of symptoms thought likely to be due to diverticar disease
  • Consider the provision of direct access to contrast CT examination for GPs
  • Ensure the availability of contrast CT for patients requiring hospital assessment for suspected diverticulitis
  • Publish in local formularies indications for suspected diverticulitis and choices for antibiotics, where appropriate, to treat the condition (see article Table 2).

STP=sustainability and transformation partnership; ICS=integrated care system; CT=computed tomography

Guidelines Learningcpd logo

After reading this article, ‘Test and reflect’ on your updated knowledge with our patient scenarios. We estimate that this activity will take you 30 minutes—worth 0.5 CPD credits.

References

  1. NICE. Diverticular disease: diagnosis and management. NICE Guideline 147. NICE, 2019. Available at: www.nice.org.uk/ng147
  2. Shahedi K, Fuller G, Bolus R et al. Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol 2013; 11 (12): 1609–1613.
  3. Sartelli M, Catena F, Ansaloni L et al. WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting. World J Emerg Surg 2016; 11: 37.
  4. Delvaux M. Diverticular disease of the colon in Europe: epidemiology, impact on citizen health and prevention. Aliment Pharmacol Ther  2003; 18: 71–74.
  5. Andeweg C, Mulder I, Felt-Bersma R et al. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg 2013; 30 (4–6): 278–292.
  6. Kang J, Hoare J, Tinto A et al. Diverticular disease of the colon – on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther 2003; 17 (9): 1189–1195.
  7. Bharucha A, Parthasarathy G, Ditah I et al. Temporal trends in the incidence and natural history of diverticulitis: a population-based study. Am J Gastroenterol 2015; 110 (11): 1589–1596.
  8. Bevan R, Lee T, Nickerson C et al. Non-neoplastic findings at colonoscopy after positive faecal occult blood testing: data from the English Bowel Cancer Screening Programme. J Med Screen 2014; 21 (2): 89–94.
  9. A Weizman, Nguyen G. Diverticular disease: epidemiology and management. Can J Gastroenterol 2011; 25 (7): 385–389.
  10. Kvasnovsky C, Papagrigoriadis S, Bjarnason I. Increased diverticular complications with nonsteroidal anti-inflammatory drugs and other medications: a systematic review and meta-analysis. Colorectal Dis 2014; 16 (6): 189–196.
  11. Chabok A, Påhlman L, Hjern F et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 2012; 99 (4): 532–539.
  12. Daniels L, Ünlü Ç, de Korte N et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg 2017; 104 (1): 52–61.
  13. van Dijk S, Daniels L, Ünlü Ç et al. Long-term effects of omitting antibiotics in uncomplicated acute diverticulitis. Am J Gastroenterol 2018; 113 (7): 1045–1052.
  14. Guts UK website. Update: Coronavirus Covid-19 and people with conditions affecting the gastro-intestinal system. Available at: gutscharity.org.uk/2020/03/update-coronavirus-covid-19-and-people-with-conditions-affecting-the-gastro-intestinal-system
  15. British Society for Gastroenterology website. Endoscopy activity and COVID-19: BSG and JAG guidance—update 03.04.20. Available at: www.bsg.org.uk/covid-19-advice/endoscopy-activity-and-covid-19-bsg-and-jag-guidance