Colorectal
Signal score, how each part rates
ActionabilityPrevalenceStakesEvidence strengthNovelty
See the full rubric →ACG Clinical Guideline: Colonic Diverticulitis.
Clinical takeawayIn immunocompetent patients with mild, CT-confirmed uncomplicated left-sided diverticulitis who are non-toxic (no SIRS, CRP under 140 mg/L, WBC under 15), tolerating oral intake, and safe for outpatient care, manage without antibiotics; reserve antibiotics for immunocompromise, frailty, significant comorbidity, systemic inflammation, or refractory symptoms.
What it foundComputed tomography imaging is essential for diverticulitis diagnosis, especially at first presentation or in severe cases; colonoscopy post-recovery is recommended for complicated cases and suggested for uncomplicated cases with alarm symptoms or inadequate CRC screening.
ContextRefines prior practice by deprioritizing antibiotics for low-risk uncomplicated cases (supported by RCTs) and clarifying imaging/colonoscopy roles. Challenges historical dietary restrictions (e.g., nuts/seeds). Confirms surgery referral for select recurrent cases.
Refinessuggested applicable standard· U.S. Multi-Society Task Force on Colorectal Cancer (Rex DK, Boland CR, Dominitz JA, et al.), "Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2017
Decision at stakewhether to perform colonoscopy after diverticulitis
U.S. Multi-Society Task Force on Colorectal Cancer (Rex DK, Boland CR, Dominitz JA, et al.), "Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2017 · reviewed 2026-07-23 ↗Begin average-risk colorectal cancer screening at age 45 using a patient-centered shared-decision modality choice, colonoscopy every 10 years (preferred) or annual FIT as Tier 1 options, with multi-target stool DNA every 3 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 to 10 years as Tier 2 alternatives. A positive stool-based test requires diagnostic colonoscopy, and stool tests should not be ordered for patients who would decline follow-up colonoscopy. Generally stop at age 75 with individualized decisions for ages 76-85 and no screening beyond 85.
Peery AF … Grover S · American Journal of Gastroenterology · IF 14.9 · PubMed ↗