Diverticular disease

Colonic diverticula are formed by mucosal outpouching from the colonic wall. Their presence increases with increasing age, with most, white patients, being situated in the left colon. The aetiology of these outpouchings is not fully understood but dietary, lifestyle and genetic factors have all been implicated. Most patients with diverticula are asymptomatic (diverticulosis); however, approximately 20% develop symptoms such as intermittent abdominal pain and change in bowel habit and are said to have symptomatic diverticular disease. Acute diverticulitis is characterized by acute inflammation within these pockets, with associated constitutional symptoms. Other complications include perforation, abscess, fistulae, strictures and bleeding, albeit in relatively few people. Stratifying patients using high-quality computed tomography is important as it allows a more tailored approach to treatment. Managing chronic symptoms in symptomatic diverticulosis requires identifying those with irritable bowel syndrome, who might respond differently, from those with symptoms after acute diverticulitis. A high-fibre diet, cyclical antibiotics and anti-inflammatory treatments have been proposed, but no treatments have yet been shown to benefit unselected patients with symptomatic diverticular disease. Planned surgical resection in symptomatic patients must be undertaken on a case-by-case basis. In those with complicated disease tailored treatment based on age, co-morbidity and functional status is the main stay of management.