Colonic diverticular disease: clinical presentation, diagnosis, treatment, and prevention Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientific Society of Russia, and the North- West Society of Gastroenterologists and Hepatologists

   Clinical guidelines are intended for gastroenterologists, internists, and general practitioners and focus primarily on the management of patients with symptomatic uncomplicated diverticular disease, as well as on the primary and secondary prevention of acute diverticulitis and other complications of diverticular disease. Clinical guidelines were developed by the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientifi c Society of Russia, and the North-West Society of Gastroenterologists and Hepatologists. One of the reasons for creating new clinical guidelines is that the current guidelines on diverticular disease (2021) pay much more attention to complications of diverticular disease and surgical treatment of acute and chronic complications of the disease.

1. Skazyvaeva E. V., Sitkin S. I., Bakulin I. G., Avalueva E. B., Zhuravleva M. S., Skalinskaya M. I. [Diverticular disease of the colon: etiopathogenesis, diagnosis, treatment and prevention]. Moscow: Prima Print Publ., 2022. 73 p. (in Russ.) ISBN: 978–5–6046641–5–5.

2. Yamamichi N., Shimamoto T., Takahashi Y., et al. Trend and risk factors of diverticulosis in Japan: age, gender, and lifestyle/metabolic- related factors may cooperatively affect on the colorectal diverticula formation. PLoS One. 2015 Apr 10;10(4): e0123688. doi: 10.1371/journal.pone.0123688.

3. Gralnek I. M., Neeman Z., Strate L. L. Acute Lower Gastrointestinal Bleeding. N Engl J Med. 2017 Mar 16; 376 (11): 1054–1063. doi: 10.1056/NEJMcp1603455.

4. Boostrom S. Y., Wolff B. G., Cima R. R. et al. Uncomplicated diverticulitis, more complicated than we thought. J Gastrointest Surg. 2012 Sep; 16 (9): 1744–9. doi: 10.1007/s11605–012–1924–4.

5. Bharucha A. E., Parthasarathy G., Ditah I. et al. Temporal Trends in the Incidence and Natural History of Diverticulitis: A Population-Based Study. Am J Gastroenterol. 2015 Nov; 110 (11): 1589–96. doi: 10.1038/ajg.2015.302.

6. Strate L. L., Morris A. M. Epidemiology, Pathophysiology, and Treatment of Diverticulitis. Gastroenterology. 2019 Apr; 156 (5): 1282–1298.e1. doi: 10.1053/j.gastro.2018.12.033.

7. Tursi A. Current and Evolving Concepts on the Pathogenesis of Diverticular Disease. J Gastrointestin Liver Dis. 2019; 28: 225–223. doi: 10.15403/JGLD-184.

8. Strate L. L., Erichsen R., Baron J. A. et al. Heritability and familial aggregation of diverticular disease: a population-based study of twins and siblings. Gastroenterology. 2013; 144: 736–742. doi: 10.1053/j.gastro.2012.12.030.

9. Granlund J., Svensson T., Olén O. et al. The genetic influence on diverticular disease - a twin study. Aliment Pharmacol Ther. 2012; 35: 1103–1107. doi: 10.1111/j.1365-2036.2012.05069.x.

10. Sigurdsson S., Alexandersson, K. F., Sulem P. et al. Sequence variant in ARHGAP15, COLQ and FAM155A associate with diverticular disease and diverticulitis. Nat Commun. 2017; 8: 15789. doi:10.1038/ncomms15789.

11. Maguire L. H., Handelman S. K., Du X. et al. Genome-wide association analyses identify 39 new susceptibility loci for diverticular disease. Nat Genet. 2018; 50: 1359–1365. doi: 10.1038/s41588–018–0203-z.

12. Schafmayer C., Harrison J. W., Buch S. et al. Genome-wide association analysis of diverticular disease points towards neuromuscular, connective tissue and epithelial pathomechanisms. Gut. 2019; 68: 854–865. doi:10.1136/gutjnl-2018–317619.

13. Painter N. S. Diverticular disease of the colon. Br Med J. 1968 Aug 24;3(5616):475–9. doi: 10.1136/bmj.3.5616.475.

14. Golder M., Burleigh D. E., Ghali L. et al. Longitudinal muscle shows abnormal relaxation responses to nitric oxide and contains altered levels of NOS1 and elastin in uncomplicated diverticular disease. Colorectal Dis. 2007; 9: 218–228. doi: 10.1111/j.1463–1318.2006.01160.x.

15. Parks T. G., Connell A. M. Motility studies in diverticular disease of the colon. Gut. 1969; 10: 534–542. doi: 10.1136/gut.10.7.534.

16. Bassotti G., Battaglia E., Bellone G. et al. Interstitial cells of Cajal, enteric nerves, and glial cells in colonic diverticular disease. J Clin Pathol. 2005; 58: 973–977. doi: 10.1136/jcp.2005.026112.

17. Rao M., Rastelli D., Dong L. et al. Enteric glia regulate gastrointestinal motility but are not required for maintenance of the epithelium in mice. Gastroenterology. 2017; 153: 1068–1081. e7. doi: 10.1053/j.gastro.2017.07.002.

18. Böttner M., Barrenschee M., Hellwig I., et al. The enteric serotonergic system is altered in patients with iverticular disease. Gut. 2013; 62: 1753–1762. doi: 10.1136/gutjnl-2012–302660.

19. Egger B., Peter M. K., Candinas D. Persistent symptoms after elective sigmoid resection for diverticulitis. Dis Colon Rectum. 2008 Jul; 51 (7): 1044–8. doi: 10.1007/s10350–008–9234–3.

20. Humes D. J., Simpson J., Smith J., et al. Visceral hypersensitivity in symptomatic diverticular disease and the role of neuropeptides and low grade inflammation. Neurogastroenterol Motil. 2012 Apr; 24 (4): 318-e163. doi: 10.1111/j.1365–2982.2011.01863.x.

21. Bartho L., Benko R., Holzer-Petsche U., Holzer P., Undi S., Wolf M. Role of extrinsic afferent neurons in gastrointestinal motility. Eur Rev Med Pharmacol Sci. 2008 Aug; 12 Suppl 1: 21–31. PMID: 18924441.

22. Bartho L., Benko R., Holzer-Petsche U., Holzer P., Undi S., Wolf M. Role of extrinsic afferent neurons in gastrointestinal motility. Eur Rev Med Pharmacol Sci. 2008 Aug; 12 Suppl 1: 21–31. PMID: 18924441.

23. Clemens C. H., Samsom M., Roelofs J., van Berge Henegouwen G. P., Smout A. J. Colorectal visceral perception in diverticular disease. Gut. 2004 May; 53 (5): 717–22. doi: 10.1136/gut.2003.018093.

24. Pauza A. G., Rysevaite-Kyguoliene K., Malinauskas M. et al. Alterations in enteric calcitonin gene-related peptide in patients with colonic diverticular disease: CGRP in diverticular disease. Auton Neurosci. 2019 Jan; 216: 63–71. doi: 10.1016/j.autneu.2018.09.006.

25. Spiller R. C., Humes D. J., Campbell E. et al. The Patient Health Questionnaire 12 Somatic Symptom scale as a predictor of symptom severity nd consulting behaviour in patients with irritable bowel syndrome and symptomatic diverticular disease. Aliment Pharmacol Ther. 2010 Sep; 32 (6): 811–20. doi: 10.1111/j.1365–2036.2010.04402.x.

26. Humes D. J., Simpson J., Neal K. R. et al. Psychological and colonic factors in painful diverticulosis. Br J Surg. 2008 Feb; 95 (2): 195–8. doi: 10.1002/bjs.5962.

27. Painter N. S., Burkitt D. P. Diverticular disease of the colon: a deficiency disease of western civilization. Br Med J. 1971 May 22; 2 (5759):450–4. doi: 10.1136/bmj.2.5759.450.

28. Aldoori W. H., Giovannucci E. L., Rockett H. R., et al. A prospective study of dietary fiber types and symptomatic diverticular disease in men. J Nutr. 1998 Apr; 128 (4): 714–9. doi: 10.1093/jn/128.4.714.

29. Crowe F. L., Appleby P. N., Allen N. E., et al. Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians. BMJ. 2011 Jul 19; 343: d4131. doi: 10.1136/bmj.d4131.

30. Aune D., Sen A., Norat T., Riboli E. Dietary fi bre intake and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies. Eur J Nutr. 2020 Mar; 59 (2): 421–432. doi: 10.1007/s00394–019–01967-w.

31. Strate L. L., Liu Y. L., Syngal S. et al. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA. 2008 Aug 27; 300 (8): 907–14. doi: 10.1001/jama.300.8.907.

32. Maguire L. H., Song M., Strate L. E., Giovannucci E. L., Chan A. T. Higher serum levels of vitamin D are associated with a reduced risk of diverticulitis. Clin Gastroenterol Hepatol. 2013 Dec; 11 (12): 1631–5. doi: 10.1016/j.cgh.2013.07.035.

33. Maguire L. H., Song M., Strate L. L. et al. Association of geographic and seasonal variation with diverticulitis admissions. JAMA Surg. 2015 Jan; 150 (1): 74–7. doi: 10.1001/jamasurg.2014.2049.

34. Tursi A. Current and Evolving Concepts on the Pathogenesis of Diverticular Disease. J Gastrointestin Liver Dis. 2019; 28: 225–223. doi:10.15403/JGLD-184.

35. Maguire L. H., Song M., Strate L. L. et al. Association of geographic and seasonal variation with diverticulitis admissions. JAMA Surg. 2015 Jan; 150 (1): 74–7. doi: 10.1001/jamasurg.2014.2049.

36. Strate L. L., Liu Y. L., Syngal S. et al. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA. 2008 Aug 27; 300 (8): 907–14. doi: 10.1001/jama.300.8.907.

37. Strate L. L., Liu Y. L., Huang E. S. et al. Use of aspirin or non-steroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology. 2011 May; 140 (5): 1427–33. doi: 10.1053/j.gastro.2011.02.004.

38. Humes D. J., Fleming K. M., Spiller R. C. et al. Concurrent drug use and the risk of perforated colonic diverticular disease: a population- based case-control study. Gut. 2011 Feb; 60 (2): 219–24. doi: 10.1136/gut.2010.217281.

39. Strate L. L., Modi R., Cohen E. et al. Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol. 2012 Oct; 107 (10): 1486–93. doi: 10.1038/ajg.2012.194.

40. Barbara G., Cremon C., Barbaro M. R. et al. Treatment of Diverticular Disease With Aminosalicylates: The Evidence. J Clin Gastroenterol. 2016 Oct; 50 Suppl 1: S60–3. doi: 10.1097/MCG.0000000000000611.

41. Laghi L., Mastromarino P., Elisei W. et al. Impact of treatments on fecal microbiota and fecal metabolome in symptomatic uncomplicated diverticular disease of the colon: a pilot study. J Biol Regul Homeost Agents. 2018 Nov-Dec; 32 (5): 1421–1432.

42. Derrien M., Vaughan E. E., Plugge C. M., de Vos W. M. Akkermansia muciniphila gen. nov., sp. nov., a human intestinal mucin-degrading bacterium. Int J Syst Evol Microbiol. 2004 Sep; 54 (Pt 5): 1469–1476. doi: 10.1099/ijs.0.02873–0.

43. Biagi E., Nylund L., Candela M., et al. Through ageing, and beyond: gut microbiota and inflammatory status in seniors and centenarians. PLoS One. 2010 May 17; 5 (5): e10667. doi: 10.1371/journal.pone.0010667.

44. Daniels L., Budding A. E., de Korte N. et al. Fecal microbiome analysis as a diagnostic test for diverticulitis. Eur J Clin Microbiol Infect Dis. 2014 Nov; 33 (11): 1927–36. doi: 10.1007/s10096–014–2162–3.

45. Schieffer K. M., Sabey K., Wright J. R. et al. The microbial ecosystem distinguishes chronically diseased tissue from adjacent tissue in the sigmoid colon of chronic, recurrent diverticulitis patients. Sci Rep. 2017 Aug 16; 7 (1): 8467. doi: 10.1038/s41598–017–06787–8.

46. Kvasnovsky C. L., Leong L. E. X., Choo J. M., Abell G. C. J., Papagrigoriadis S., Bruce K. D., Rogers G. B. Clinical and symptom scores are signifi cantly correlated with fecal microbiota features in patients with symptomatic uncomplicated diverticular disease: a pilot study. Eur J Gastroenterol Hepatol. 2018 Jan; 30 (1): 107–112. doi: 10.1097/MEG.0000000000000995.

47. Peery A. F., Crockett S. D., Barritt A. S. Burden of Gastrointestinal, Liver, and Pancreatic Diseases in the United States. Gastroenterology. 2015 Dec; 149 (7): 1731–1741.e3. doi: 10.1053/j.gastro.2015.08.045.

48. Everhart J. E., Ruhl C. E. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology. 2009 Mar; 136 (3): 741–54. doi: 10.1053/j.gastro.2009.01.015.

49. Tursi A. Diverticulosis today: unfashionable and still under-researched. Therap Adv Gastroenterol. 2016 Mar; 9 (2): 213–28. doi: 10.1177/1756283X15621228.

50. Peery A. F., Crockett S. D., Barritt A. S. Burden of Gastrointestinal, Liver, and Pancreatic Diseases in the United States. Gastroenterology. 2015 Dec; 149 (7): 1731–1741.e3. doi: 10.1053/j.gastro.2015.08.045.

51. Peery A. F. Colonic Diverticula and Diverticular Disease: 10 Facts Clinicians Should Know. N C Med J. 2016 May-Jun; 77 (3): 220–2. doi: 10.18043/ncm.77.3.220.

52. 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 Dec; 11 (12): 1609–13. doi: 10.1016/j.cgh.2013.06.020.

53. Jeyarajah S., Faiz O., Bottle A., Aylin P., Bjarnason I., Tekkis P. P., Papagrigoriadis S. Diverticular disease hospital admissions are increasing, with poor outcomes in the elderly and emergency admissions. Aliment Pharma col Ther. 2009 Dec 1; 30 (11–12): 1171–82. doi: 10.1111/j.1365–2036.2009.04098.x.

54. Binda G. A., Mataloni F., Bruzzone M., et al. Trends in hospital admission for acute diverticulitis in Italy from 2008 to 2015. Tech Coloproctol. 2018 Aug; 22 (8): 597–604. doi: 10.1007/s10151–018–1840-z.

55. Clinical guidelines. diverticular disease. 2021. Approved by the Ministry of Health of the Russian Federation. (in Russ.) Available at: https://cr.minzdrav.gov.ru/recomend/179_2 Accessed: 06/ 25/ 2021.

56. Schieffer K. M., Kline B. P., Yochum G. S., Koltun W. A. Pathophysiology of diverticular disease. Expert Rev Gastroenterol Hepatol. 2018 Jul; 12 (7): 683–692. doi: 10.1080/17474124.2018.1481746.

57. Skazyvaeva E. V., Avalueva E. B., Sitkin S. I., Bakulin I. G., Skalinskaya M. I. Diverticular disease of the colon. Farmateka. 2017; (S5): 22–30. (in Russ.)

58. Böhm S. K, Kruis W. Lifestyle and other risk factors for diverticulitis. Minerva Gastroenterol Dietol. 2017 Jun; 63 (2): 110–118. doi: URL: https://pubmed.ncbi.nlm.nih.gov/28150481/

59. Aune D., Sen A., Leitzmann M. F. et al. Tobacco smoking and the risk of diverticular disease – a systematic review and meta-analysis of prospective studies. Colorectal Dis. 2017 Jul; 19 (7): 621–633. doi: 10.1111/codi.13748.

60. Hjern F., Johansson C., Mellgren A. et al. Diverticular disease and migration – the influence of acculturation to a Western lifestyle on diverticular disease. Aliment Pharmacol Ther. 2006 Mar 15; 23 (6): 797–805. doi: 10.1111/j.1365–2036.2006.02805.x.

61. Liu P. H., Cao Y., Keeley B. R. et al. Adherence to a Healthy Lifestyle is Associated With a Lower Risk of Diverticulitis among Men. Am J Gastroenterol. 2017 Dec; 112 (12): 1868–1876. doi: 10.1038/ajg.2017.398.

62. Tursi A. Current and Evolving Concepts on the Pathogenesis of Diverticular Disease. J Gastrointestin Liver Dis. 2019; 28: 225–223. doi:10.15403/JGLD-184.

63. Kechagias A., Sofi anidis A., Zografos G. et al. Index C-reactive protein predicts increased severity in acute sigmoid diverticulitis. Ther Clin Risk Manag. 2018 Oct 2;14:1847–1853. doi: 10.2147/TCRM.S160113.

64. Tursi A. Biomarkers in diverticular diseases of the colon. Dig Dis. 2012; 30 (1): 12–8. doi: 10.1159/000335695.

65. Tursi A., Brandimarte G., Elisei W. et al. Faecal calprotectin in colonic diverticular disease: a case-control study. Int J Colorectal Dis. 2009 Jan; 24 (1): 49–55. doi: 10.1007/s00384–008–0595–9.

66. Jeger V., Pop R., Forudastan F., Barras J. P., Zuber M., Piso R. J. Correction to: Jeger V., et al. Is there a role for procalcitonin in differentiating uncomplicated and complicated diverticulitis in order to reduce antibiotic therapy? Swiss Med Wkly. 2018 Sep 24; 148: w14673. doi: 10.4414/smw.2018.14673.

67. Tursi A., Scarpignato C., Strate L. L. et al. Colonic diverticular disease. Nat Rev Dis Primers. 2020 Mar 26; 6 (1): 20. doi: 10.1038/s41572–020–0153–5.

68. Niikura R., Nagata N., Shimbo T. et al. Colonoscopy can miss diverticula of the left colon identifi ed by barium enema. World J Gastroenterol. 2013 Apr 21; 19 (15): 2362–7. doi: 10.3748/wjg.v19.i15.2362.

69. Andeweg C. S., Wegdam J. A., Groenewoud J., et al. Toward an evidence- based step-up approach in diagnosing diverticulitis. Scand J Gastroenterol. 2014 Jul; 49 (7): 775–84. doi: 10.3109/00365521.2014.908475.

70. Bor R., Fábián A., Szepes Z. Role of ultrasound in colorectal diseases. World J Gastroenterol. 2016 Nov 21; 22 (43): 9477–9487.

71. Kruis W., Germer C. T., Leifeld L.; German Society for Gastroenterology, Digestive and Metabolic Diseases and The German Society for General and Visceral Surgery. Diverticular disease: guidelines of the german society for gastroenterology, digestive and metabolic diseases and the german society for general and visceral surgery. Digestion. 2014; 90 (3): 190–207. doi: 10.1159/000367625.

72. Min J. H., Kim H. C., Kim S. W. et al. Th e value of initial sonography compared to supplementary CT for diagnosing right-sided colonic diverticulitis. Jpn J Radiol. 2017 Jul; 35 (7): 358–365. doi: 10.1007/s11604–017–0646–7.

73. Farag Soliman M., Wüstner M., Sturm J., Werner A., Diehl S. J., Düber C., Post S. Primärdiagnostik der akuten Sigmadivertikulitis. Sonografie versus Computer-tomografie, eine prospektive Studie [Primary diagnostics of acute diverticulitis of the sigmoid]. Ultraschall Med. 2004 Sep; 25 (5): 342–7. German. doi: 10.1055/s-2004–813381.

74. Puylaert J. B. Ultrasound of colon diverticulitis. Dig Dis. 2012; 30 (1): 56–9. doi: 10.1159/000336620.

75. Nielsen K. et al. The Limited Role of Ultrasound in the Diagnostic Process of Colonic Diverticulitis. World J Surg. 2014 Jul; 38 (7): 1814–8. doi: 10.1007/s00268–013–2423–9.

76. Dickerson E. C., Chong S. T., Ellis J. H. et al. Recurrence of Colonic Diverticulitis: Identifying Predictive CT Findings-Retrospective Cohort Study. Radiology. 2017 Dec; 285 (3): 850–858. doi: 10.1148/radiol.2017161374.

77. Lembcke B. J., Strobel D., Dirks K. et al. Statement of the section internal medicine of the DEGUM – ultrasound obtains pole position for clinical imaging in acute diverticulitis. Ultraschall Med. 2015 Apr; 36 (2): 191–5. doi: 10.1055/s-0034–1369761.

78. Mounce L. T. A., Price S., Valderas J. M. et al. Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records. Br J Cancer. 2017 Jun 6; 116 (12): 1536–1543. doi: 10.1038/bjc.2017.127.

79. Papi C., Ciaco A., Koch M. et al. Efficacy of rifaximin in the treatment of symptomatic diverticular disease of the colon. A multicentre dou-ble-blind placebo-controlled trial. Aliment Pharmacol Ther. 1995 Feb; 9 (1): 33–9. doi: 10.1111/j.1365–2036.1995.tb00348.x.

80. Schieffer K. M., Sabey K., Wright J. R. et al. The microbial ecosystem distinguishes chronically diseased tissue from adjacent tissue in the sigmoid colon of chronic, recurrent diverticulitis patients. Sci Rep. 2017 Aug 16; 7 (1): 8467. doi: 10.1038/s41598–017–06787–8.

81. Barbara G., Scaioli E., Barbaro M. R. et al. Gut microbiota, metabolome and immune signatures in patients with uncomplicated diverticular disease. Gut. 2017 Jul; 66 (7): 1252–1261. doi: 10.1136/gutjnl-2016–312377.

82. Kurpad A. V., Shetty P. S. Effects of antimicrobial therapy on faecal bulking. Gut. 1986 Jan; 27 (1): 55–8. doi: 10.1136/gut.27.1.55.

83. Frieri G., Pimpo M. T., Scarpignato C. Management of colonic diverticular disease. Digestion. 2006;73 Suppl 1: 58–66. doi: 10.1159/000089780.

84. Ponziani F. R., Zocco M. A., D’Aversa F., Pompili M., Gasbarrini A. Eubiotic properties of rifaximin: Disruption of the traditional concepts in gut microbiota modulation. World J Gastroenterol. 2017 Jul 7; 23 (25): 4491–4499. doi: 10.3748/wjg.v23.i25.4491.

85. Gatta L., Scarpignato C. Systematic review with meta-analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth. Aliment Pharmacol Ther. 2017 Mar; 45 (5): 604–616. doi: 10.1111/apt.13928.

86. Stallinger S., Eller N., Högenauer C. Non-interventional study evaluating efficacy and tolerability of rifaximin for treatment of uncomplicated diverticular disease. Wien Klin Wochenschr. 2014 Jan; 126 (1–2): 9–14. doi: 10.1007/s00508–013–0447–7.

87. Latella G., Scarpignato C. Rifaximin in the management of colonic diverticular disease. Expert Rev Gastroenterol Hepatol. 2009 Dec; 3 (6): 585–98. doi: 10.1586/egh.09.63.

88. Bianchi M., Festa V., Moretti A. et al. Meta-analysis: long-term therapy with rifaximin in the management of uncomplicated diverticular disease. Aliment Pharmacol Ther. 2011 Apr; 33 (8): 902–10. doi: 10.1111/j.1365–2036.2011.04606.x.

89. Copaci I., Constantinescu G., Mihăilă M. et al. Efficacy of Rifaximin-a vs Dietary Fiber on the Evolution of Uncomplicated Colonic Diverticular Disease. Surg Gastroenterol Oncol. 2019; 24: 233–240. doi: 10.21614/sgo-24–5–233.

90. Moniuszko A., Rydzewska G. The effect of cyclic rifaximin therapy on symptoms of diverticular disease from the perspective of the gastroenterology outpatient clinic: a “real-life” study. Prz Gastroenterol. 2017; 12 (2): 145–151. doi: 10.5114/pg.2017.68167.

91. Picchio M., Elisei W., Brandimarte G. et al. Mesalazine for the Treatment of Symptomatic Uncomplicated Diverticular Disease of the Colon and for Primary Prevention of Diverticulitis: A Systematic Review of Randomized Clinical Trials. J Clin Gastroenterol. 2016 Oct; 50 Suppl 1: S64–69. doi: 10.1097/MCG.0000000000000669.

92. Krokowicz L., Stojcev Z., Kaczmarek B. F., et al. Microencapsulated sodium butyrate administered to patients with diverticulosis decreases incidence of diverticulitis – a prospective randomized study. Int J Colorectal Dis. 2014 Mar; 29 (3): 387–93. doi: 10.1007/s00384–013–1807–5.

93. Scarpignato C., Bertelé A., Tursi A. Probiotics for the Treatment of Symptomatic Uncomplicated Diverticular Disease: Rationale and Current Evidence. J Clin Gastroenterol. 2016 Oct; 50 Suppl 1: S70–3. doi: 10.1097/MCG.0000000000000641.

94. Lahner E., Bellisario C., Hassan C. et al. Probiotics in the Treatment of Diverticular Disease. A Systematic Review. J Gastrointestin Liver Dis. 2016 Mar; 25 (1): 79–86. doi: 10.15403/jgld.2014.1121.251.srw.

95. Tursi A., Brandimarte G., Elisei W., et al. Randomised clinical trial: mesalazine and / or probiotics in maintaining remission of symptomatic uncomplicated diverticular disease – a double- blind, randomised, placebo-controlled study. Aliment Pharmacol Ther. 2013 Oct; 38 (7): 741–51. doi: 10.1111/apt.12463.

96. Turco F., Andreozzi P., Palumbo I., et al. Bacterial stimuli activate nitric oxide colonic mucosal production in diverticular disease. Protective effects of L. casei DG® (Lactobacillus paracasei CNCM I-1572). United European Gastroenterol J. 2017; 5 (5): 715-724. doi: 10.1177/2050640616684398.

97. Cirocchi R., Randolph J. J., Binda G. A. Is the outpatient management of acute diverticulitis safe and eff ective? A systematic review and meta-analysis. Tech Coloproctol. 2019 Feb; 23 (2): 87–100. doi: 10.1007/s10151–018–1919–6.

98. Stam M. A., Draaisma W. A., van de Wall B. J. et al. An unrestricted diet for uncomplicated diverticulitis is safe: results of a prospective diverticulitis diet study. Colorectal Dis. 2017 Apr; 19 (4): 372–377. doi: 10.1111/codi.13505.

99. Van de Wall B. J., Draaisma W. A., van Iersel J. J. et al. Dietary restrictions for acute diverticulitis: evidence-based or expert opinion? Int J Colorectal Dis. 2013 Sep; 28 (9): 1287–93. doi: 10.1007/s00384–013–1694–9.

100. Chabok A., Påhlman L., Hjern F. et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr; 99 (4): 532–9. doi: 10.1002/bjs.8688.

101. 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. Dutch Diverticular Disease (3D) Collaborative Study Group. Br J Surg. 2017 Jan; 104 (1): 52–61. doi: 10.1002/bjs.10309.

102. Tandon A., Fretwell V. L., Nunes Q. M., et al. Antibiotics versus no antibiotics in the treatment of acute uncomplicated diverticulitis – a systematic review and meta-analysis. Colorectal Dis. 2018 Jan 11. doi: 10.1111/codi.14013.

103. Emile S. H., Elfeki H., Sakr A. et al. Management of acute uncomplicated diverticulitis without antibiotics: a systematic review, meta-analysis, and meta-regression of predictors of treatment. Tech Coloproctol. 2018 Jul; 22 (7): 499–509. doi: 10.1007/s10151–018–1817-y.

104. van Dijk S. T., Daniels L., Ünlü Ç., de Korte N., van Dieren S., Stockmann H. B., Vrouenraets B. C., Consten E. C., van der Hoeven J. A., Eijsbouts Q. A., Faneyte I. F., Bemelman W. A., Dijkgraaf M. G., Boermeester M. A.; Dutch Diverticular Disease (3D) Collaborative Study Group. Long-Term Effects of Omitting Antibiotics in Uncomplicated Acute Diverticulitis. Am J Gastroenterol. 2018 Jul; 113 (7): 1045–1052. doi: 10.1038/s41395–018–0030-y.

105. Slim K., Joris J., Beyer-Berjot L. The end of antibiotics in the management of uncomplicated acute diverticulitis. J Visc Surg. 2019 Oct; 156 (5): 373–375. doi: 10.1016/j.jviscsurg.2019.10.001.

106. Rottier S. J., van Dijk S. T., Ünlü Ç., van Geloven A. A. W., Schreurs W. H., Boermeester M. A. Complicated Disease Course in Initially Computed Tomography-Proven Uncomplicated Acute Diverticulitis. Surg Infect (Larchmt). 2019 Sep; 20 (6): 453–459. doi: 10.1089/sur.2018.289.

107. Stollman N., Smalley W., Hirano I.; AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis. Gastroenterology. 2015 Dec; 149 (7): 1944–9. doi: 10.1053/j.gastro.2015.10.003.

108. Bolkenstein H. E., Consten E. C. J., van der Palen J., van de Wall B. J. M., Broeders I. A. M. J., Bemelman W. A., Lange J. F., Boermeester M. A., Draaisma W. A.; Dutch Diverticular Disease (3D) Collaborative Study Group. Long-term Outcome of Surgery Versus Conservative Management for Recurrent and Ongoing Complaints After an Episode of Diverticulitis: 5-year Follow-up Results of a Multicenter Randomized Controlled Trial (DIRECT-Trial). Ann Surg. 2019 Apr; 269 (4): 612–620. doi: 10.1097/SLA.0000000000003033.

109. Jaung R., Kularatna M., Robertson J. P., Vather R., Rowbotham D., MacCormick A. D., Bissett I. P. Uncomplicated Acute Diverticulitis: Identifying Risk Factors for Severe Outcomes. World J Surg. 2017 Sep; 41 (9): 2258–2265. doi: 10.1007/s00268–017–4012–9.

110. Shabanzadeh D. M., Wille-Jørgensen P. Antibiotics for uncomplicated diverticulitis. Cochrane Database Syst Rev. 2012 Nov 14; 11: CD009092. doi: 10.1002/14651858. CD009092.pub2.

111. Schug-Pass C., Geers P., Hügel O., Lippert H., Köckerling F. Prospective randomized trial comparing short-term antibiotic therapy versus standard therapy for acute uncomplicated sigmoid diverticulitis. Int J Colorectal Dis. 2010 Jun; 25 (6): 751–9. doi: 10.1007/s00384–010–0899–4.

112. Evans J., Kozol R., Frederick W., Voytavich A., Pennoyer W., Lukianoff A., Lardner J. Does a 48-hour rule predict outcomes in patients with acute sigmoid diverticulitis? J Gastrointest Surg. 2008 Mar; 12 (3): 577–82. doi: 10.1007/s11605–007–0405–7.

113. Gregersen R., Mortensen L. Q., Burcharth J., Pom mergaard H. C., Rosenberg J. Treatment of patients with acute colonic diverticulitis complicated by abscess formation: A systematic review. Int J Surg. 2016 Nov; 35: 201–208. doi: 10.1016/j.ijsu.2016.10.006.

114. Young-Fadok T. M. Diverticulitis. N Engl J Med. 2018 Oct 25; 379 (17): 1635–1642. doi: 10.1056/NEJMcp1800468.

115. Galetin T., Galetin A., Vestweber K. H., Rink A. D. Systematic review and comparison of national and international guidelines on diverticular disease. Int J Colorectal Dis. 2018 Mar; 33 (3): 261–272. doi: 10.1007/s00384–017–2960-z.

116. Cirocchi R., Afshar S., Di Saverio S., et al. A historical review of surgery for peritonitis secondary to acute colonic diverticulitis: from Lockhart- Mummery to evidence-based medicine. World J Emerg Surg. 2017 Mar 9; 12:14. doi: 10.1186/s13017–017–0120-y.

117. Biondo S. The diminishing role of surgery for acute diverticulitis. Br J Surg. 2019 Mar; 106 (4): 308–309. doi: 10.1002/bjs.11133.

118. Vaghiri S., Prassas D., Knoefel W. T., Krieg A. The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis. Langenbecks Arch Surg. 2022 Dec; 407 (8): 3259–3274. doi: 10.1007/s00423–022–02698-z.

119. Stollman N., Magowan S., Shanahan F. et al. A randomized controlled study of mesalamine aft er acute diverticulitis: results of the DIVA trial. J Clin Gastroenterol. 2013 Aug; 47 (7): 621–9. doi: 10.1097/MCG.0b013e31828003f6.

120. Khan R. M. A., Ali B., Hajibandeh S. et al. Effect of mesalazine on recurrence of diverticulitis in patients with symptomatic uncomplicated diverticular disease: a meta-analysis with trial sequential analysis of randomized controlled trials. Colorectal Dis. 2018 Jun; 20 (6): 469–478. doi: 10.1111/codi.14064.

121. Nespoli L., Lo Bianco G., Uggeri F. et al. Effect of oral mesalamine on inflammatory response in acute uncomplicated diverticulitis. World J Gastroenterol. 2015 Jul 21; 21 (27): 8366–72. doi: 10.3748/wjg.v21.i27.8366.

122. Lanas A., Ponce J., Bignamini A. et al. One year intermittent rifaximin plus fibre supplementation vs. fibre supplementation alone to prevent diverticulitis recurrence: a proof-of-concept study. Dig Liver Dis. 2013 Feb; 45 (2): 104–9. doi: 10.1016/j.dld.2012.09.006.

123. Festa V., Spila Alegiani S., Chiesara F., Moretti A., Bianchi M., Dezi A., Traversa G., Koch M. Retrospective comparison of long-term ten-day / month rifaximin or mesalazine in prevention of relapse in acute diverticulitis. Eur Rev Med Pharmacol Sci. 2017 Mar; 21 (6): 1397–1404. PMID: 28387885.

124. Tursi A., Brandimarte G., Daffinà R. Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon. Dig Liver Dis. 2002 Jul; 34 (7): 510–5. doi: 10.1016/s1590–8658(02)80110–4.

125. Tutelyan V. A., Nikityuk D. B., Pogozheva A. V., Shestopalova A. E., Popova T. S. [Adult Nutrition Innovation: An annual publication with a catalog]. Issue 1. Moscow: Medical Information Agency LLC Publ., 2021. 176 p. (in Russ.)

126. Smolyansky B. L., Liflyandsky V. G. Dietology. [The newest guide for doctors]. Moscow: EKSMO Publ. 2003, 816 p.

127. [Dietary fiber is an important component of a healthy diet]. (in Russ.) Available at: https://77.rospotrebnadzor.ru/index.php/doc/infdoc/9031pishchevye- volokna-vazhnyj-komponent-zdorovogo-pitaniya Access: 05. 05. 2022.

128. Butorova L.I. [Diverticular disease of the colon: clinical forms, diagnosis and treatment: a guide for doctors]. Moscow: 4 TE Art Publ., 2011. 48 p. (in Russ.)

129. Ardatskaya M. D. Diverticular disease of the colon: resolved and unresolved issues. Meditsinskiy sovet = Medical Council. 2017; (15): 68–75. (In Russ.) doi: 10.21518/2079–701X-2017–15–68–75.

130. Radchenko V. G., Safronenkova I. G., Seliverstov P. V., Sitkin S. I., Teterina L. A. [Dietary fiber in clinical practice]. Clinical perspectives of gastroenterology, hepatology. 2010; (1): 20–27. (in Russ.)

131. Pilat T. L., Bezrukavnikova L. M., Kolyaskina M. M., Bessonov V. V., Anvarul N. A., Khanferyan R. A. Study of effectiveness of detoxing impact of the complex detox nutrition program on functional parameters of the organism. Therapy. 2020; 6 (2): 156–163. (in Russ.) doi: 10.18565/therapy.2020.2.156–163.

132. Pilat T. L., Kuzmina L. P., Izmerova I. I. [Detox nutrition]. Moscow: GEOTAR-Media Publ., 2012. 688 p. (in Russ.)

133. Pilat T. L., Khanferian R. A. Specialized dietary preventive and therapeutic products as a means of increasing the efficiency of gastrointestinal diseases pharmacotherapy. Therapy. 2020; 6 (6): 212–218. (in Russ.) doi: 10.18565/therapy.2020.6.212–218.

134. Pilat T. L., Kuzmina L. P., Lashina E. L., Kolyaskina M. M., Bezrukavnikova L. M., Bessonov V. V., Korosteleva M. M., Gurevich K. G., Lagutina N. P., Khanferyan R. A. Experience of application of specialized food product of dietary therapeutic and dietary preventive nutrition in case of inflammatory diseases of gastrointestinal tract. Meditsinskiy sovet = Medical Council. 2020; (4): 107–113. (In Russ.) doi: 10.21518/2079–701X-2020–4–107–113.

135. Srivastava G. S., Smith A. N., Painter N. S. Sterculia bulk-forming agent with smooth- muscle relaxant versus bran in diverticular disease. Br Med J. 1976 Feb 7; 1 (6005): 315–8. doi: 10.1136/bmj.1.6005.315.