Look inside the management of colonic diverticular rebleeding: a systematic review

Background: Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding in adults and carries a significant risk of recurrence. However, there are many uncertainties regarding the management of the prevention of diverticular rebleeding. Objectives: To review the current evidence on the potential role of lifestyle, pharmacological and endoscopic treatments and to discuss the unmet needs in the prevention of colonic diverticular rebleeding. Design: A systematic review. Data sources and methods: Based on the identified Patients-Interventions-Comparators-Outcomes questions, a detailed and comprehensive literature search was conducted, from inception to 12 January 2024, without language restriction, according to the modified Preferred Reporting Items for Systematic review and Meta-Analyses reporting guidelines. Results: We did not find any dietary or lifestyle interventions (fibre intake, smoking, physical activity, alcohol consumption, BMI) to prevent colonic diverticular rebleeding. We also did not find any interventional studies of specific pharmacological treatments (such as rifaximin, mesalazine or probiotics) to prevent diverticular rebleeding. Data comparing endoscopic and conservative approaches used during the index episode come from observational studies and show conflicting results. Finally, there is a paucity of data regarding the timing of resumption of antiplatelet and anticoagulant therapy after an episode of colonic diverticular bleeding, and this remains to be determined. Conclusion: This review highlights the paucity of data on the possible role of lifestyle, pharmacological and endoscopic treatments in the prevention of colonic diverticular rebleeding and advocates future studies aimed at finding effective therapeutic strategies.