Diverticular Disease

Abstract

Diverticular disease of the colon is an age-related disease with a progressive increase in prevalence as age advances. It is not surprising that with the global trend of the world’s older population continuing to grow, diverticular disease is increasing in incidence and is expected to increase further. The pathophysiology of colonic diverticulosis as we understand today is the consequence of a prolonged intake of fiber-depleted diet, characteristic of the diet in the Western world. In spite of all efforts to promote a high-fiber diet, there is no increase in fiber consumption in affluent nations, while in many developing nations, as a result of Westernization of diet, there is a decrease in dietary fiber consumption. The net result is that what was once exclusively a Western disease has currently become a global problem.

Although mostly asymptomatic, the clinical manifestations include episodes of left lower quadrant abdominal pain resembling irritable bowel syndrome, uncomplicated diverticulitis, complicated diverticulitis, fistula formation, stricture, and rarely peritonitis and liver abscess. A major development in the alternate pathogenesis of diverticulitis is the observation of segmental colitis resembling Crohn’s disease. Diverticulosis is the most frequent cause of lower gastrointestinal bleeding. Endoscopic therapy with epinephrine injection, multipolar or heat probe coagulation, placement of endoclips, and band ligation, and angiographic treatment through the use of intra-arterial infusion of vasopressin (TAE) are options in management. Endoscopic therapy have modified the management options reducing the need for surgery.