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Precision medicine approach required to follow-up of diverticulitis

Wed, 04/01/2020 - 08:12
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An editorial published in Gastrointestinal Endoscopy has challenged physicians and the US healthcare system to reconsider the current “one size fits all” care for diverticulitis and to employ a precision medicine approach to determine which patients should be referred for colonoscopy.

The editorial, ‘Colonoscopy after acute diverticulitis: from clinical epidemiology to clinical management. Are we there yet?’, by Regenstrief Institute research scientist, Dr Thomas F Imperiale, the Lawrence Lumeng Professor of Gastroenterology and Hepatology and Dr Eddie Krajicek, a fellow in gastroenterology, both at Indiana University School of Medicine, highlights what they term "sign posts" to support individualised decision-making and strongly recommends their use.

"While national guidelines equivocate, conventional care is to refer all individuals with diverticulitis for a colonoscopy," said Imperiale, who is a practicing gastroenterologist. "But employing the tools of health information technology, we can and should consider sign posts - such as the specific nature of the diverticulitis episode, preceding changes in bowel habit or other symptoms, personal and family medical histories, the dates and findings of previous colonoscopies - before making a decision to refer the patient for colonoscopy.”

"While an episode of diverticulitis may be a sentinel event that brings someone who may have been avoiding routine screening into the doctor's office and subsequently gets them into the colonoscopy suite, many patients who are automatically referred for a colonoscopy may not need one, which wastes colonoscopy resources. Taking a personalized, precision medicine approach uses healthcare resources wisely and provides better patient care," he said.

If a patient's primary care physician orders a colonoscopy without first asking sign post questions, Imperiale encourages patients to start a discussion to determine if colonoscopy is necessary.

To access the editorial, please click here