Abstract
Diverticulosis and its major complications, diverticulitis and diverticular bleeding, are increasingly common indications for hospitalization and outpatient visits. Recent publications in the field of diverticular disease have challenged long-standing disease concepts and management strategies. This article will highlight studies which have helped to clarify the contribution of genetic factors, fiber consumption and medication use to the development of diverticular disease, the role of antibiotics in the treatment of acute diverticulitis, and the association between diverticulitis, irritable bowel syndrome, and colon cancer.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Everhart JE, Ruhl CE. Burden of digestive diseases in the united states part II: Lower gastrointestinal diseases. Gastroenterology. 2009;136(3):741–54. doi:10.1053/j.gastro.2009.01.015.
Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975;4(1):53–69.
Shahedi K, Fuller G, Bolus R, Snyder BJ, Cohen ER, Vu M, et al. Progression from incidental diverticulosis to acute diverticulitis. Gastroenterology. 2012;142(5):S-144.
Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the united states: 2012 update. Gastroenterology. 2012;143(5):1179–87. doi:10.1053/j.gastro.2012.08.002. e1-3.
Nguyen GC, Sam J, Anand N. Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the united states. World J Gastroenterol. 2011;17(12):1600–5. doi:10.3748/wjg.v17.i12.1600.
Strate LL, Liu YL, Syngal S, Aldoori WH, Giovannucci EL. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA. 2008;300(8):907–14. doi:10.1001/jama.300.8.907.
Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology. 2009;136(1):115–22. doi:10.1053/j.gastro.2008.09.025. e1.
Hjern F, Wolk A, Hakansson N. Obesity, physical inactivity, and colonic diverticular disease requiring hospitalization in women: A prospective cohort study. Am J Gastroenterol. 2012;107(2):296–302. doi:10.1038/ajg.2011.352.
Rosemar A, Angeras U, Rosengren A. Body mass index and diverticular disease: A 28-year follow-up study in men. Dis Colon Rectum. 2008;51(4):450–5. doi:10.1007/s10350-007-9172-5.
Granlund J, Svensson T, Olen O, et al. The genetic influence on diverticular disease - a twin study. Aliment Pharmacol Ther. 2012. doi:10.1111/j.1365-2036.2012.05069.x.
Strate LL, Erichsen R, Baron JA, et al. Heritability and familial aggregation of diverticular disease: A population-based study of twins and siblings. Gastroenterology. 2013;144(4):736–42. doi:10.1053/j.gastro.2012.12.030. e1.
Painter NS, Burkitt DP. Diverticular disease of the colon: A deficiency disease of western civilization. Br Med J. 1971;2(5759):450–4.
Sheth AA, Longo W, Floch MH. Diverticular disease and diverticulitis. Am J Gastroenterol. 2008;103(6):1550–6. doi:10.1111/j.1572-0241.2008.01879.x.
Jacobs DO. Clinical practice. diverticulitis. N Engl J Med. 2007;357(20):2057–66.
Crowe FL, Appleby PN, Allen NE, Key TJ. Diet and risk of diverticular disease in oxford cohort of european prospective investigation into cancer and nutrition (EPIC): Prospective study of british vegetarians and non-vegetarians. BMJ. 2011;343:d4131. doi:10.1136/bmj.d4131.
•• Peery AF, Barrett PR, Park D, et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology. 2012;142(2):266–72. doi:10.1053/j.gastro.2011.10.035. This study found that increased fiber consumption and frequent bowel movements had an increased risk of diverticulosis, challenging the conception that low-fiber diets and constipation contribute to the development of diverticulosis.
Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Willett WC. Use of acetaminophen and nonsteroidal anti-inflammatory drugs: A prospective study and the risk of symptomatic diverticular disease in men. Arch Fam Med. 1998;7(3):255–60.
Strate LL, Liu YL, Huang ES, Giovannucci EL, Chan AT. Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology. 2011;140(5):1427–33. doi:10.1053/j.gastro.2011.02.004.
Humes DJ, Fleming KM, Spiller RC, West J. Concurrent drug use and the risk of perforated colonic diverticular disease: A population-based case–control study. Gut. 2011;60(2):219–24. doi:10.1136/gut.2010.217281.
Parks TG. Post-mortem studies on the colon with special reference to diverticular disease. Proc R Soc Med. 1968;61(9):932–4.
Rafferty J, Shellito P, Hyman NH, Buie WD. Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006;49(7):939–44. doi:10.1007/s10350-006-0578-2.
Swank HA, Vermeulen J, Lange JF, et al. The ladies trial: Laparoscopic peritoneal lavage or resection for purulent peritonitis and hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitis in perforated diverticulitis (NTR2037). BMC Surg. 2010;10:29–2482. doi:10.1186/1471-2482-10-29. 10-29.
Thornell A, Angenete E, Gonzales E, et al. Treatment of acute diverticulitis laparoscopic lavage vs. resection (DILALA): Study protocol for a randomised controlled trial. Trials. 2011;12:186–6215. doi:10.1186/1745-6215-12-186. 12-186.
Floch MH. A hypothesis: Is diverticulitis a type of inflammatory bowel disease? J Clin Gastroenterol. 2006;40 Suppl 3:S121–5.
Hjern F, Josephson T, Altman D, et al. Conservative treatment of acute colonic diverticulitis: Are antibiotics always mandatory? Scand J Gastroenterol. 2007;42(1):41–7. doi:10.1080/00365520600780650.
de Korte N, Kuyvenhoven JP, van der Peet DL, Felt-Bersma RJ, Cuesta MA, Stockmann HB. Mild colonic diverticulitis can be treated without antibiotics. A case–control study. Colorectal Dis. 2012;14(3):325–30. doi:10.1111/j.1463-1318.2011.02609.x.
• Chabok A, Pahlman L, Hjern F, Haapaniemi S, Smedh K. AVOD Study Group. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012;99(4):532–9. doi:10.1002/bjs.8688. This randomized, multicenter trial in Sweden found that patients with acute uncomplicated diverticulitis could be managed safely and effectively without antibiotics. There were no differences in the number of diverticular complications (abscess, perforation) and re‐admissions for diverticulitis between patients who received antibiotics and those who did not.
Shabanzadeh DM, Wille-Jorgensen P. Antibiotics for uncomplicated diverticulitis. Cochrane Database Syst Rev. 2012;11:CD009092. doi:10.1002/14651858.CD009092.pub2.
de Korte N, Klarenbeek BR, Kuyvenhoven JP, Roumen RM, Cuesta MA, Stockmann HB. Management of diverticulitis: Results of a survey among gastroenterologists and surgeons. Colorectal Dis. 2011;13(12):e411–7. doi:10.1111/j.1463-1318.2011.02744.x.
Andersen JC, Bundgaard L, Elbrond H, et al. Danish national guidelines for treatment of diverticular disease. Dan Med J. 2012;59(5):C4453.
Unlu C, de Korte N, Daniels L, et al. A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial). BMC Surg. 2010;10:23–2482. doi:10.1186/1471-2482-10-23. 10-23.
Humes DJ, Simpson J, Smith J, et al. Visceral hypersensitivity in symptomatic diverticular disease and the role of neuropeptides and low grade inflammation. Neurogastroenterol Motil. 2012;24(4):318–e163. doi:10.1111/j.1365-2982.2011.01863.x.
Humes DJ, Simpson J, Neal KR, Scholefield JH, Spiller RC. Psychological and colonic factors in painful diverticulosis. Br J Surg. 2008;95(2):195–8. doi:10.1002/bjs.5962.
Jung HK, Choung RS, 3rd Locke GR, Schleck CD, Zinsmeister AR, Talley NJ. Diarrhea-predominant irritable bowel syndrome is associated with diverticular disease: A population-based study. Am J Gastroenterol. 2010;105(3):652–61. doi:10.1038/ajg.2009.621.
Simpson J, Neal KR, Scholefield JH, Spiller RC. Patterns of pain in diverticular disease and the influence of acute diverticulitis. Eur J Gastroenterol Hepatol. 2003;15(9):1005–10. doi:10.1097/01.meg.0000059193.12802.4b.
Cohen E, Fuller G, Bolus R, et al. Increased risk for irritable bowel syndrome following acute diverticulitis. Clin Gastroenterol Hepatol. 2013. doi:10.1016/j.cgh.2013.03.007.
Stefansson T, Ekbom A, Sparen P, Pahlman L. Association between sigmoid diverticulitis and left-sided colon cancer: A nested, population-based, case control study. Scand J Gastroenterol. 2004;39(8):743–7. doi:10.1080/00365520410003272.
Stefansson T, Ekbom A, Sparen P, Pahlman L. Increased risk of left sided colon cancer in patients with diverticular disease. Gut. 1993;34(4):499–502.
Granlund J, Svensson T, Granath F, et al. Diverticular disease and the risk of colon cancer - a population-based case–control study. Aliment Pharmacol Ther. 2011;34(6):675–81. doi:10.1111/j.1365-2036.2011.04782.x.
Schout PJ, Spillenaar Bilgen EJ, Groenen MJ. Routine screening for colon cancer after conservative treatment of diverticulitis. Dig Surg. 2012;29(5):408–11. doi:10.1159/000345332.
Schmilovitz-Weiss H, Yalunin E, Boaz M, et al. Does a colonoscopy after acute diverticulitis affect its management?: A single center experience. J Clin Gastroenterol. 2012;46(4):317–20. doi:10.1097/MCG.0b013e31823a43a1.
van de Wall BJ, Reuling EM, Consten EC, et al. Endoscopic evaluation of the colon after an episode of diverticulitis: A call for a more selective approach. Int J Colorectal Dis. 2012;27(9):1145–50. doi:10.1007/s00384-012-1448-0.
Westwood DA, Eglinton TW, Frizelle FA. Routine colonoscopy following acute uncomplicated diverticulitis. Br J Surg. 2011;98(11):1630–4. doi:10.1002/bjs.7602.
Compliance with Ethics Guidelines
Conflict of Interest
Lisa L. Strate and Adam Templeton declare that they have no conflict of interest
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Large Intestine
Rights and permissions
About this article
Cite this article
Templeton, A.W., Strate, L.L. Updates in Diverticular Disease. Curr Gastroenterol Rep 15, 339 (2013). https://doi.org/10.1007/s11894-013-0339-z
Published:
DOI: https://doi.org/10.1007/s11894-013-0339-z