Diverticulitis

Also known as: diverticular disease · diverticulosis

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United StatesACG/AGA/AASLD

Current

ACG Clinical Guideline: Colonic Diverticulitis

American College of Gastroenterology (ACG) · 2026

This ACG guideline gives evidence-based recommendations for managing colonic diverticulitis in the outpatient gastroenterology setting, covering diagnosis, antibiotic use, follow-up colonoscopy and prevention of recurrence.

The guideline suggests against routine antibiotics for low-risk patients with acute uncomplicated diverticulitis. source
It supports CT imaging to confirm the diagnosis, particularly at first presentation, and colonoscopy after recovery in defined groups. source

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EuropeUEG/EASL

Current

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

European Society of Coloproctology (ESCP) · 2020

ESCP's guideline summarises evidence on managing diverticular disease of the colon, written primarily as guidance for surgeons but intended for a broader clinical audience.

The guideline contains 38 evidence-based consensus statements covering the spectrum of diverticular disease. source
It was developed as an international, multidisciplinary effort involving several surgical specialties. source

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US vs EU key differences

The two converge on selective antibiotics: the ACG guideline recommends against routine antibiotics for low-risk uncomplicated diverticulitis, and the ESCP guideline likewise reserves antibiotics for immunocompromised or septic patients. source
Follow-up colonoscopy policy differs: ESCP advises colon examination at least 6 weeks after the episode for essentially all medically treated patients (exempting only those symptom-free after a single CT-verified uncomplicated episode, or scoped within 3 years), while the ACG guideline recommends it for complicated disease and only suggests it in uncomplicated cases with alarm symptoms or overdue colorectal cancer screening. source
The ACG guideline adds explicit lifestyle-prevention advice, including that patients need not avoid nuts, seeds, corn or popcorn, alongside physical activity, weight management and limiting NSAIDs. source
Version currency differs by roughly six years: the US guideline is a 2026 document, while the European Society of Coloproctology statements date to 2020. source

What changed recently

US2021 → 20262026-07-01
ACG replaced its 2021 diverticular disease guideline with a document focused on colonic diverticulitis, formalising selective rather than routine antibiotics for low-risk acute uncomplicated disease and listing the high-risk features (immunocompromise, frailty, unsafe outpatient care) that still warrant them. It also recommends against probiotics, mesalamine and rifaximin for recurrence prevention, drops nut/seed/popcorn avoidance, and limits post-recovery colonoscopy to complicated disease or patients with alarm features or overdue screening.
source ↗curation confidence 90%

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