The Fiesole Consensus report

The Fiesole Consensus Report refers to an international set of guidelines and recommendations on the diagnosis, management, and prevention of diverticular disease. This consensus was developed by a group of 32 experts from 14 countries, employing a structured Delphi process that adheres to the PICO (Population, Intervention, Comparison, Outcome) framework and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. The report is designed to standardize care and provide evidence-based guidance for clinicians dealing with this increasingly prevalent condition.

### Key Highlights of the Fiesole Consensus Report:

#### 1. **Definitions and Epidemiology**

• **Diverticulosis**: The presence of colonic diverticula (small pouches in the colon wall) without associated symptoms.
• **Diverticular disease**: When diverticula are associated with symptoms or complications such as inflammation or infection.
• Diverticulosis is the most common structural abnormality of the colon in developed countries, with an increasing prevalence worldwide.
• Approximately 20–25% of individuals with diverticulosis develop symptoms that fall under diverticular disease.

#### 2. **Risk Factors**

• High dietary fiber intake is protective against diverticular disease.
• Risk factors include:
• Smoking
• Obesity
• Use of certain medications such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, opioids, and immunotherapy agents.

#### 3. **Diagnosis**

• Imaging is critical for diagnosing suspected acute diverticulitis.
• **Ultrasound**: May be appropriate when performed by experienced clinicians.
• **CT Scans**: Preferred for diagnosing complicated cases of diverticulitis.
• Diverticulosis itself does not require any specific treatment or imaging unless symptoms or complications arise.

#### 4. **Management of Diverticular Disease**

• **Symptomatic Uncomplicated Diverticular Disease (SUDD)**:
• Dietary fiber, selected probiotics, mesalazine, and rifaximin may help alleviate symptoms.
• **Acute Uncomplicated Diverticulitis**:
• Routine antibiotic use is *not* recommended.
• **Complicated Diverticulitis**:
• Imaging is essential to guide management.
• **Elective Surgery**:
• Should be individualized based on the patient's quality of life rather than the number of episodes of diverticulitis.

#### 5. **Surgical Management**

• Surgery is reserved for cases where complications arise or when symptoms significantly impair quality of life.
• Decisions should prioritize the patient's preferences and overall well-being.

#### 6. **Research Priorities**

• The report emphasizes the need for further research into:
• Microbiome characterization in diverticular disease.
• Genetic risk profiling to better understand individual susceptibility.
• Long-term outcomes of selective antimicrobial and surgical strategies.

### Conclusion

The Fiesole Consensus Report aims to provide a comprehensive and standardized approach to the diagnosis, treatment, and prevention of diverticular disease. By integrating the latest evidence and expert opinions, the report seeks to optimize patient outcomes across diverse healthcare systems. It also identifies critical gaps in knowledge and highlights areas for future research, ensuring that the management of diverticular disease continues to evolve in alignment with emerging scientific insights.