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Updates in Diverticular Disease

  • Large Intestine (B Cash, Section Editor)
  • Published:
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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.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 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.

    Article  PubMed  Google Scholar 

  2. Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975;4(1):53–69.

    PubMed  CAS  Google Scholar 

  3. 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.

    Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  CAS  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. Painter NS, Burkitt DP. Diverticular disease of the colon: A deficiency disease of western civilization. Br Med J. 1971;2(5759):450–4.

    Article  PubMed  CAS  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Jacobs DO. Clinical practice. diverticulitis. N Engl J Med. 2007;357(20):2057–66.

    Article  PubMed  CAS  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. •• 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.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  CAS  Google Scholar 

  18. 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.

    Article  PubMed  CAS  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. Parks TG. Post-mortem studies on the colon with special reference to diverticular disease. Proc R Soc Med. 1968;61(9):932–4.

    PubMed  CAS  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. Floch MH. A hypothesis: Is diverticulitis a type of inflammatory bowel disease? J Clin Gastroenterol. 2006;40 Suppl 3:S121–5.

    Article  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Google Scholar 

  27. • 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.

  28. Shabanzadeh DM, Wille-Jorgensen P. Antibiotics for uncomplicated diverticulitis. Cochrane Database Syst Rev. 2012;11:CD009092. doi:10.1002/14651858.CD009092.pub2.

    PubMed  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. Andersen JC, Bundgaard L, Elbrond H, et al. Danish national guidelines for treatment of diverticular disease. Dan Med J. 2012;59(5):C4453.

    PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  CAS  Google Scholar 

  33. 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.

    Article  PubMed  CAS  Google Scholar 

  34. 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.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  PubMed  Google Scholar 

  36. 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.

    Google Scholar 

  37. 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.

    Article  PubMed  CAS  Google Scholar 

  38. 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.

    Article  PubMed  CAS  Google Scholar 

  39. 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.

    Article  PubMed  CAS  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. 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.

    Article  PubMed  Google Scholar 

  43. 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.

    Article  PubMed  CAS  Google Scholar 

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Lisa L. Strate and Adam Templeton declare that they have no conflict of interest

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Lisa L. Strate.

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This article is part of the Topical Collection on Large Intestine

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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

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