Acute diverticulitis Counseling and follow-up Elective colectomy Avoid performing routine elective prophylactic colonic resection in patients with an initial episode of acute uncomplicated diverticulitis. D Dietary modifications Consider a fiber-rich diet or fiber supplementation in patients with a history of acute diverticulitis. C Probiotics Consider avoiding the use of probiotics after acute uncomplicated diverticulitis. D Physical activity Consider advising patients with diverticular disease to undertake vigorous physical activity. C Nonsteroidal anti-inflammatory drugs Consider advising patients with a history of diverticulitis to avoid the use of nonsteroidal anti-inflammatoy drugs other than aspirin, if possible. C Follow-up AGA Q Has a high-quality examination of the colon recently been performed? Yes Individualize the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis. B No Consider performing a follow-up colonoscopy after resolution of acute diverticulitis, in appropriate candidates, to exclude the misdiagnosis of a colonic neoplasm if a high- quality examination of the colon has not been recently performed. C Elective colectomy Individualize the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis. B