Korean Experts Make Series of Recommendations for Managing Acute Colonic Diverticulitis

The Korean Association for the Study of Intestinal Diseases (KASID) has arrived at a Delphi consensus on best practices for the diagnosis and management of acute colonic diverticulitis. The findings, published in Intestinal Research, offer region-specific guidance for a disease that is becoming more prevalent in Asia.

Acute colonic diverticulitis is generally mild, but complications can be severe when they arise. Should complications require surgical interventions such as colectomy, the effects on long-term morbidity and mortality may be significant, and the costs in terms of healthcare resource utilization and quality of life are likely to be high.

How the guidelines were developed

KASID created a task force of 11 experts in intestinal diseases to offer guidance on managing acute colonic diverticulitis in a region-specific context. The first meeting was held in August 2021. In total, 12 clinical questions were selected to be addressed via a modified Delphi method. A literature search was performed and the quality of evidence assessed before the panel arrived at a series of recommendations.

Key recommendations

One recommendation graded as “strong” was that immunocompromised patients with acute colonic diverticulitis should receive “active and careful treatment” because of their increased risk of morbidity and mortality. Abdominal CT scans have high diagnostic accuracy and should be considered a diagnostic modality of choice, and they are also highly useful in evaluating complications. Following recovery, patients are advised to undergo a screening colonoscopy, given the increased prevalence of colorectal cancer in this population.

The Korean experts also issued two recommendations against specific interventions. They were “strongly against” the use of mesalazine for preventing recurrence or managing persistent symptoms, and they strongly advised against using rifaximin to prevent recurrence or manage persistent symptoms in patients who have a history of acute colonic diverticulitis but have recovered.

“The guideline development committee surveyed Korean clinicians and patients and incorporated expert consensus to ensure practical applicability within the Korean clinical context,” the authors wrote. “We hope that these clinical practice guidelines will contribute to the provision of high-quality, evidence-based care for patients with acute colonic diverticulitis.”

Clinical guidelines are constantly evolving, which makes it challenging for physicians to stay current. Vera Health is a free clinical search engine that helps keep your practice aligned with the latest evidence.

Reference

Lee JG, Park YE, Chang JY, et al. Evidence-based clinical practice guidelines for diagnosis and medical management of acute colonic diverticulitis developed by the Korean Association for the Study of Intestinal Diseases (KASID). Intest Res. Published online June 8, 2026. doi:10.5217/ir.2025.00299