Diverticular Disease: Evolving Concepts in Classification, Presentation, and Management

Sasan Mosadeghi; Taft Bhuket; Neil Stollman

Disclosures

Curr Opin Gastroenterol. 2015;31(1):50-55. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Diverticular disease is the most commonly reported finding at the time of colonoscopy and one of the most common gastrointestinal indications for hospitalization. Much of our previous understanding of diverticular disease has recently been challenged.

Recent findings There is emerging evidence that the long-accepted hypothesis of diverticulosis as a consequence of fiber deficiency may be more complex than commonly thought, with recent evidence suggesting that high-fiber diet and frequent bowel movements are associated with a greater and not lower prevalence of diverticular disease. There is also emerging support for the concept of low-grade inflammation in symptomatic uncomplicated diverticular disease (SUDD), and the role of anti-inflammatory treatment with mesalamine is being actively investigated. Additionally, elective 'prophylactic' surgery after diverticulitis, previously considered after a second confirmed diverticulitis episode, is being increasingly deferred.

Summary The pathogenesis of diverticular disease is likely multifactorial and complex. More studies are needed to evaluate the role of fiber in the pathogenesis and treatment of diverticular disease. The search for an effective medical therapy for SUDD and to prevent recurrent diverticulitis is being actively investigated. The efficacy of mesalamine does not appear to be strong data supported.

Introduction

Diverticular disease is the sixth leading outpatient gastrointestinal diagnosis in the United States, accounting for about 2.6 million visits in 2009,[1] and is one of the most common reasons for hospitalization, with 313 000 first-listed and 815 000 all-listed diagnoses.[2] It is also the most commonly reported finding at colonoscopy, identified in over 40% of all exams and in more than 70% of patients older than 80 years.[2] Further, the incidence seems to be increasing in both Europe and the United States,[3–6] and the rate of hospitalizations because of diverticular diseases rose greater than 15% between 1996 and 2004,[2] accounting for $2.6 billion per year in inpatient costs.[1] In this article, we will review the recently published literature concerning pathogenesis, risk factors, and treatments of diverticular disease.

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