Visceral Hypersensitivity After Acute Diverticulitis

Prevalence and Persistence

Approximately 32-45% of patients continue to experience chronic abdominal symptoms at 1-2 years following an acute episode of diverticulitis 1, 2
Approximately 45% of patients report periodic abdominal pain at 1-year follow-up after uncomplicated acute diverticulitis 1, 2, 3, 4

Before attributing symptoms to visceral hypersensitivity, exclude ongoing inflammation or complications with both imaging and endoscopy 1, 2, 3
Obtain a CT scan of abdomen/pelvis with oral and IV contrast to exclude ongoing diverticular inflammation, stricture, fistula, or abscess 1, 2, 3
Perform colonoscopy 6-8 weeks after symptom resolution to exclude alternative diagnoses including ischemic colitis, inflammatory bowel disease, constipation, and malignancy 1, 2, 3

Young age (<50 years) and pain score ≥8 on visual analog scale at presentation are predictors of chronic visceral hypersensitivity 5

Reassure patients that ongoing symptoms are common and attributable to visceral hypersensitivity, and that symptoms do not indicate ongoing infection or structural damage 1, 2

Use a low to modest dose of a tricyclic antidepressant as first-line pharmacologic therapy for visceral hypersensitivity 1, 2, 3, 4

Do not assume symptoms will spontaneously resolve with time alone, as the evidence shows persistence at 1-2 years in a substantial proportion of patients 1
Do not repeatedly treat with antibiotics, as visceral hypersensitivity is not an infectious or inflammatory process requiring antimicrobial therapy 1
Do not skip the imaging and endoscopy workup, as it is necessary to exclude ongoing diverticular inflammation, stricture, fistula, and alternative diagnoses before diagnosing visceral hypersensitivity 1, 2, 3