REVIEW article
Front. Surg.
Sec. Colorectal and Proctological Surgery
Risk-Stratified Pharmacologic Strategies for Secondary Prevention After Acute Diverticulitis: An Exploratory Narrative Review and Research Framework
Provisionally accepted
Michele Schiano di Visconte1*
Sonia Sarnari1
Dario Lo Monaco2
Antonio Brillantino3
Luigi Marano4
Pasquale Talento5
Angelo Guttadauro2- 1ULSS2 Marca Trevigiana, Treviso, Italy
- 2Universita degli Studi di Milano-Bicocca, Milan, Italy
- 3Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Naples, Italy
- 4Akademia Medycznych i Spolecznych Nauk Stosowanych, Elblag, Poland
- 5Azienda Unita Sanitaria Locale - IRCCS Tecnologie Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Reggio Emilia, Italy
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract Background Recurrent acute diverticulitis (RAD) affects up to one-third of patients after the first episode and is associated with impaired quality of life and increased healthcare burden. Although interest in pharmacological prophylaxis is increasing, adequately powered randomized trials have not shown consistent benefits for any agent. Aims Synthesize current evidence on pharmacological strategies for secondary prevention of diverticulitis, evaluate the potential of risk stratification and propose an exploratory framework to inform future studies. Methods We conducted a structured narrative review in accordance with the SANRA criteria, including randomized controlled trials, observational studies, systematic reviews and international guidelines published between 1995 and 2026. Studies on primary prevention or symptomatic uncomplicated diverticular disease (SUDD) were assessed separately as indirect evidence. Results Although subgroup analyses have suggested possible benefits in selected high-risk populations, large randomized trials have not demonstrated a reduction in recurrence with mesalazine or rifaximin. Evidence regarding probiotics remains inconclusive and is largely limited to SUDD. Currently, the major international guidelines do not recommend the use of pharmacological agents for routine 3 secondary prevention. Emerging data indicate that radiologic features, endoscopic severity (DICA score), and biomarker findings, may help identify patients at increased risk of recurrence. Conclusions Currently, no pharmacological therapy is available for the universal secondary prevention of diverticulitis. We propose a hypothesis-generating, risk-stratified framework that integrates clinical, endoscopic and radiological markers to support individualized trial design and patient selection. This approach may help guide future randomized studies and refine the preventive strategies.
Keywords: DICA score6, Diverticulitis1, Mesalazine4, probiotics5, Recurrence2, Rifaximin3, risk stratification7
Received: 18 Dec 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Schiano di Visconte, Sarnari, Lo Monaco, Brillantino, Marano, Talento and Guttadauro. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Michele Schiano di Visconte
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.