Materiały źródłowe

• #1 Diverticular disease: Epidemiology and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3174080/

  Diverticular disease of the colon is among the most prevalent conditions in western society and is among the leading reasons for outpatient visits and causes of hospitalization. While previously considered to be a disease primarily affecting the elderly, there is increasing incidence among individuals younger than 40 years of age. […] The incidence of diverticular disease has increased over the past century. Autopsy studies from the early part of the 20th century reported colonic diverticula rates of 2% to 10%. This has increased dramatically over the years. More recent data suggest that up to 50% of individuals older than 60 years of age have colonic diverticula, with 10% to 25% developing complications such as diverticulitis. Hospitalizations for diverticular disease have also been on the rise. According to an American study evaluating hospitalization rates between 1998 and 2005, rates of admission for diverticular disease increased by 26% during the eight-year study period. Similar trends have been observed in Canadian and European data over the same time period.

• #2 Inflammatory Bowel Disease Complicated by Diverticular Disease: The Data – Ulcerative Colitis Peer to Peer

  https://www.medpagetoday.com/resource-centers/ulcerative-colitis-crohns-disease/inflammatory-bowel-disease-complicated-diverticular-disease-data/3367

  Diverticular disease is the most common noncancerous medical condition affecting the colon. Colonic diverticula—regions of mucosal and submucosal tissue protruding through areas of the muscularis propria—are the most frequent finding during routine colonoscopy, and they increase in prevalence with age. Diverticulosis—the presence of diverticula—affects more than 70% of those older than 65 in Western countries and ranks fifth in health care costs among gastrointestinal diseases. Recent estimates using colonoscopy and computed tomography show that fewer than 5% of those with diverticulosis develop diverticulitis (inflammation of a diverticulum). However, the high prevalence of diverticulosis, especially among the elderly, leads to a high incidence of diverticulitis. […] In the United States, diverticulitis accounts for some 2.7 million outpatient visits annually and 200,000 to 300,000 hospital admissions, at a cost surpassing $2 billion. While the incidence of diverticulitis increases with age, occurrence among younger people has increased greatly in recent decades.

• #2 Diverticular disease: Epidemiology and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3174080/

  Diverticular disease has traditionally been believed to be a disease affecting the elderly. The prevalence of diverticular disease is as high as 65% by 85 years of age and estimated to be as low as 5% in those 40 years of age or younger. However, more recent literature has reported an increase in the incidence of diverticular disease among younger patients. […] Diverticular disease has long been regarded as a disease of western countries. The highest prevalence of this condition is in the United States, Europe and Australia, where approximately 50% of the population 60 years of age and older have diverticulosis. This common occurrence is in contrast to that in the developing world, where countries in Africa and Asia have prevalence rates of less than 0.5%. […] The rates of elective surgery following resolution of uncomplicated diverticulitis appear to be increasing. A 38% increase in elective operations was noted in a review of the NIS between 1998 and 2005, with the most significant increase reported in patients 44 years of age or younger. These trends have been accompanied by declines in the rates of surgical mortality and length of hospital stay. More than 90% of elective surgeries for diverticulitis resulted in primary anastomoses.

• #3 Diverticular Disease: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0800/diverticular-disease.html

  Incidence of diverticulitis is increasing. From 1980 to 2007, the incidence increased from 115 per 100,000 person-years to 188 per 100,000 person-years. […] Prevalence of diverticular disease is less than 10% in people 40 years vs. 80% in those older than 85 years. […] Only 1% to 4% of patients with diverticular disease will develop diverticulitis in their lifetime. […] Risk factors for diverticular disease include increasing age, constipation, low-fiber diet, smoking, red meat consumption, obesity, weight gain, lack of exercise, genetic susceptibility, and nonsteroidal anti-inflammatory drug and aspirin use. […] Consumption of popcorn, nuts, and seeds is not a risk factor for developing diverticulitis.

• #4 Update on the management of sigmoid diverticulitis

  https://www.wjgnet.com/1007-9327/full/v27/i9/760.htm

  On the other hand, the overall incidence of diverticulitis has been trending upwards in recent years. Furthermore, a substantial increase was observed in the prevalence of diverticulitis in younger patients. When confining analysis to patients in their 40s, there was an 11% risk of diverticulitis a 2.5 times higher risk than previously reported for the entire cohort of patients. This is in stark contrast to older reports of 1%-2% incidence of diverticulitis in young patients. In an analysis of the Nationwide Inpatient Sample of 267000 admissions for diverticulitis, the incidence of diverticulitis in patients between 18-44 years old nearly doubled over a 7 year period; of note, over the same time period, there was no change in patients older than 75 years of age and only a moderate increase in the age group in between. Similarly, smaller single institution cohorts have also reported higher incidence rates of diverticulitis in young patients ranging from 20% to 26% in some studies.

• #5 Update on the management of sigmoid diverticulitis

  https://www.wjgnet.com/1007-9327/full/v27/i9/760.htm

  Recent reports also suggest potential gender differences among patients with diverticulitis. Nationwide and single institution reviews have noted a male predominance in young patients as opposed to a female predominance in older patients with diverticulitis. Lahat et al demonstrated a male:female ratio of 3:1 in patients with diverticulitis under the age of 45, compared to a 1:2 ratio in patients over 45. Similarly in patients admitted for diverticulitis, Schauer et al noted a 2:1 male:female ratio in patients under 40 and a 1:1.5 ratio in older patients. In reviewing hospital discharge data for diverticulitis in England from 1989 to 2000, the likelihood to be hospitalized under 50 years of age was higher for males, and over the age of 50 higher for females. It should be noted that none of the authors offered a plausible explanation for these gender-related observations.

• #6 Diverticular Disease—An Updated Management Review

  https://www.mdpi.com/2036-7422/13/4/33

  Diverticular disease and its complications remain a significant global burden on healthcare systems. It is one of the most common gastrointestinal conditions among inpatients and outpatients in industrialized nations. In such nations, diverticulosis of the sigmoid colon has prevalence rates between 5–70%, based on age and diagnostic modality. Furthermore, colonic diverticulosis is the most common finding during routine colonoscopy, and in 2010, it was the eighth most common outpatient diagnosis in the United States, with 2,734,119 total outpatient visits. […] The lifetime risk of diverticulitis in a person with diverticulosis, diagnosed based on colonoscopy or computed tomography (CT), is about 5%. Even so, given that more than 50% of Americans over the age of 60 years have diverticulosis, diverticulitis is highly prevalent. In 2012, it was estimated that diverticulitis alone accounted for 216,650 hospital admissions. Furthermore, the incidence of diverticulitis is rising, with an increase of 26% in admissions for diverticulitis from 1998 to 2005; another study showed an increase of 26.8% for emergency room visits for diverticulitis from 2006 to 2013. In addition, the mean cost of these emergency room visits rose from $3061 to $4765 from 2006 to 2013, and this was adjusting for inflation. The financial impact of diverticulitis is considerable, with hospital admissions costing an aggregate of $2.2 billion.

• #7 Colonic diverticulosis and diverticular disease: Epidemiology, risk factors, and pathogenesis – UpToDate

  https://www.uptodate.com/contents/colonic-diverticulosis-and-diverticular-disease-epidemiology-risk-factors-and-pathogenesis

  Colonic diverticulosis and diverticular disease: Epidemiology, risk factors, and pathogenesis […] Diverticular disease of the colon is an important cause of hospital admissions and a significant contributor to health care costs in Western and industrialized societies. […] This topic will review the epidemiology, risk factors, and the pathogenesis of diverticulosis and diverticular disease. […] Epidemiology […] Prevalence — The prevalence of diverticulosis is age-dependent, and the prevalence and distribution within the colon varies by geography and race. In the United States, the prevalence of diverticulosis increases from fewer than 20 percent at age 40 to 60 percent by age 60. The number and size of diverticula also increase with age, suggesting that diverticulosis is a progressive process. The prevalence of diverticulosis appears to be higher in the left colon in countries in the West. In a study of 624 individuals undergoing first-time screening colonoscopy of whom 260 (42 percent) had diverticulosis, 72 percent had diverticula in the sigmoid colon, 10 percent in the descending, 6 percent in the transverse, 11 percent in the ascending, and 1 percent in the cecum. Black Americans were more likely to have diverticula in the proximal colon than White Americans. Data from more than 270,000 colonoscopy procedures indicate that females are less likely to have diverticulosis than males, particularly in younger age groups. Non-Hispanic White Americans were more likely to have diverticulosis than non-Hispanic Black Americans and Asian/Pacific Islanders. Non-Hispanic Black Americans were at increased odds of having any proximal diverticulosis and Asian/Pacific Islanders were at increased odds of having only proximal diverticulosis, which are often congenital in nature.

• #8 English | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/guidelines/diverticular-disease/diverticular-disease-english

  Free perforation with generalized peritonitis […] Obstruction […] Abscess not amenable to percutaneous drainage […] Fistulas […] Clinical deterioration or failure to improve with conservative management […] Recurrent diverticulitis after resection is rare, ranging from 1% to 10%. In general, the progression of diverticular disease in the remaining colon is approximately 15%. […] Diverticulosis in Asia is predominantly a right-sided phenomenon, occurring in 3584% of cases. The early age of onset suggests a genetic basis, although this is still under investigation. […] In the developed world, the prevalence of diverticular disease ranges from 5% to 45%. The majority of this population (90%) is made up of patients with distal bowel disease. Only 1.5% of cases involve solely the right side of the large bowel.

• #9 English | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/guidelines/diverticular-disease/diverticular-disease-english

  In contrast, individuals in Africa and Asia who develop diverticular disease have predominantly right-colon involvement (7074%), especially in the ascending colon. […] Despite the increasing westernization of the diet, Japan still has a higher prevalence of right-sided diverticular disease (although cases involving the left colon are increasing). […] Hong Kong still has a 76% prevalence of right-sided diverticulosis.

• #10 Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States

  https://www.wjgnet.com/1007-9327/full/v17/i12/1600.htm

  Though diverticular disease is generally thought to be a disease of older adults, there are increasingly common reports of diverticulitis in individuals younger than 50 years. Based on single-centre reports, these cases were often male-predominant accompanied by a more aggressive disease course. […] The age-adjusted hospitalization rate for diverticulitis increased from 61.8 per 100000 to 75.5 per 100000 between 1998 and 2005, and increased similarly in both sexes. Diverticulitis-associated admissions were male-predominant in those younger than age 45 years but were female-predominant thereafter. Admission rates increased the most among those 45 years, while remaining unchanged for those 65 years. By 2005, the majority of hospitalized patients were 65 years. Age-adjusted rates of diverticulitis-associated hospitalizations were lower in the West (50.4/100000) compared to the Northeast (77.7/100000), South (73.9/100000), and Midwest (71.0/100000).

• #11 Diverticular Disease and Diverticulitis | Doctor

  https://patient.info/doctor/diverticular-disease

  Diverticulosis occurs in 5-10% of people aged 45 years and older. In people aged 85 years and older, it occurs in 80%. […] The incidence of perforated sigmoid diverticular disease is estimated to be 3.4 to 4.5 per 100,000 people per year. […] Approximately 75% of people with diverticula have asymptomatic diverticulosis; of the 25% of people with diverticula who develop symptomatic diverticular disease, approximately 75% will have at least one episode of diverticulitis. […] Disease is more virulent in young patients, with a high risk of recurrences or complications. […] The disorder is rare in rural Africa and Asia, with the highest prevalence seen in the USA, Europe, and Australia. […] The main risk factors are age over 50 years and low dietary fibre. […] Complicated diverticular disease has an increased frequency in patients who smoke, use non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol, and those who are obese and have low-fibre diets.

• #12 Diverticular Disease: A Crash Course for Clinicians

  https://www.gastroendonews.com/PRN/Article/02-23/Diverticular-Disease-A-Crash-Course-for-Clinicians/69341

  In fact, an 18-year follow-up of the HPFS published in 2008 found that consumption of nuts and popcorn was associated with a significantly reduced risk. […] We rarely talk about physical activity and diverticular disease, but there are some data, again from the HPFS, suggesting that patients with a high level of activity have a 34% lower risk of acute diverticulitis, Dr. Stollman explained. […] Nonsteroidal anti-inflammatory drugs (NSAIDs) are clearly the most significant risk factor for diverticular bleeding. […] Because of this evidence, Dr. Stollman suggested that elective use of NSAIDsnot including aspirin when it is indicatedbe avoided or minimized in all patients with a history of diverticulitis. […] Another development in the understanding of diverticular disease is the involvement of genetics.

• #13 Update on the management of sigmoid diverticulitis

  https://www.wjgnet.com/1007-9327/full/v27/i9/760.htm

  A diet low in fiber has long been regarded as the predominant exogenous or environmental factor leading to the development of diverticular disease. This hypothesis was initially put forth by Painter and Burkitt based on their observation of the extremely low rates of diverticular disease in rural Africa compared to developed Western countries. Colonic transit studies by Burkitt demonstrated increased colonic transit times (80 h vs 34 h) and lower stool weights (110 g/d vs 450 g/d) in English individuals consuming a low fiber diet compared to individuals living in rural Uganda respectively. It was speculated that the increased transit time would lead to elevated intraluminal pressure particularly on the left side of the colon, thereby promoting the development of diverticular disease. As countries become more developed and Westernized, an increase in the incidence of diverticulitis was commonly observed. Analyzing a prospective cohort of 47888 United States men over a 4 year period, an inverse association between fiber intake and the development of diverticular disease (relative risks risk ratio 0.58, CI: 0.41-0.83, P = 0.01) was found. This finding was corroborated in a study looking at 47033 men and women in the United Kingdom, 15459 (33%) of whom self-declared as vegetarians. This subgroup as a whole was noted to have a 30% risk reduction of developing diverticular disease (risk ratio 0.7, CI: 0.56-0.87, P = 0.001), while the highest quintile of fiber intake was associated with a 41% risk reduction (risk ratio 0.59, CI: 0.46-0.78, P 0.001) compared to non-vegetarians and individuals in the lowest quintile of fiber intake, respectively. Most recently, a study on 50019 healthy women in the Nurses’ Health Study showed that a higher intake of various sources of dietary fiber, except from vegetables, was associated with a lower risk of diverticulitis.

• #14 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 | The BMJ

  https://www.bmj.com/content/343/bmj.d4131

  After a mean follow-up time of 11.6 years, there were 812 cases of diverticular disease (806 admissions to hospital and six deaths). […] After adjustment for confounding variables, vegetarians had a 31% lower risk (relative risk 0.69, 95% confidence interval 0.55 to 0.86) of diverticular disease compared with meat eaters. […] Consuming a vegetarian diet and a high intake of dietary fibre were both associated with a lower risk of admission to hospital or death from diverticular disease. […] In this prospective cohort study of generally health conscious British adults, a vegetarian diet and a relatively high intake of dietary fibre (25 g/day) were both associated with a reduced risk of being admitted to hospital with or dying from diverticular disease. […] These results are consistent with the previous findings of a cross sectional study that showed a lower prevalence of asymptomatic diverticular disease among vegetarians than non-vegetarians.

• #15 Update on the management of sigmoid diverticulitis

  https://www.wjgnet.com/1007-9327/full/v27/i9/760.htm

  Additional environmental factors implicated in diverticulitis include smoking, use of steroids and non-steroidal anti-inflammatory medications, and obesity. A traditionally held belief was that patients with diverticulosis should avoid particulate foods such as nuts, popcorn, corn, or sunflower seeds for fear of particulate material obstructing diverticula and triggering diverticulitis. This myth has since been solidly debunked via the benchmark study that analyzed 47288 men over a follow-up period of 18 years: The authors did not observe a negative effect, but surprisingly there was even a potential protective impact of nut, corn or popcorn consumption with regards to the development of diverticulitis. […] In contrast to associating extrinsic and environmental factors as the leading cause for the development of diverticular disease, the contribution of potential endogenous, i.e. genetic factors, has largely been underreported – until recently. A Swedish national database analysis of over 104000 twins reported nearly 2300 hospitalizations for diverticular disease. An odds ratio of 7.15 (CI: 4.82-10.61) was noted for monozygotic twins, compared to 3.2 (CI: 2.21-4.63) for dizygotic twins; the overall contribution of genetics to diverticular disease was calculated to be 40%. A review of the Danish national registry data from 1977-2011 found 10400 index siblings and 920 twins with diverticular disease. The authors calculated the risk ratio for siblings to be 2.92 (CI: 2.5-3.39) compared to the general population. Similar to the Swedish study, the risk ratio for diverticular disease was substantially higher in twins with 14.5 (CI: 8.9-23) and 5.5 (CI: 3.3-8.6) for monozygotic and dizygotic twins, respectively. The calculated heritable contribution in this study was 53% (CI: 0.45-0.61). Last but not least, yet unpublished data from our own institution showed an incidental prevalence of diverticula in young patients undergoing abdominal CT scans for unrelated suspected appendicitis; 14% of patients less than 20 years of age and 40% of patients between 20-39 years of age had evidence of diverticulosis, suggesting that there could not yet have been sufficient lifetime to allow for extrinsic factors alone, such as fiber-deficiency related constipation, to take effect.

• #16 Diverticulosis and diverticulitis | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diverticulosis-and-diverticulitis

  Diverticulosis is extremely common. Old age and diet may be the most important risk factors. More than half of all adults over the age of 70 have the condition. […] Studies appear to show that diverticulosis became more common in the 20th century. It is also more common in Western nations including North America, Europe and Australia. It is less common in Asia and very uncommon in Africa. […] Analysis of large-scale epidemiological studies has found that people with higher overall fibre intake have lower incidence of diverticulitis, the main complication of diverticular disease. […] Analysis of familial cases of diverticulitis has identified at least 2 genes associated with this condition, and one of these (TNFSF15) has been shown to be associated with diverticulitis in multiple studies.

• #17 Update on the management of sigmoid diverticulitis

  https://www.wjgnet.com/1007-9327/full/v27/i9/760.htm

  It has been historically reported that 10%-25% of patients with diverticulosis will eventually develop diverticulitis. This claim largely stems from a benchmark review of the natural history of diverticular disease by Parks. In a 1947 review of 47000 radiological images of the colon, the prevalence of diverticulosis was 8.5% amongst the entire cohort, 15% of which were diagnosed with diverticulitis. In 1958, a double-contrast barium enema study in 300 patients with diverticulosis estimated the risk of developing diverticulitis at 10% over a 1-5 year period and up to 25% after a 6-10 years follow up period. […] More recent data suggest that the traditionally quoted lifetime risk of developing diverticulitis from diverticulosis is exaggerated. In a study on veterans with diverticulosis with an 11 year follow up, there was a 1% risk of diverticulitis as confirmed by computed tomography (CT) or at time of surgery. In a cohort of 2100 patients, there was a 4.3% risk of diverticulitis over a median follow up period of 7 years.

• #18 Diverticular Disease—An Updated Management Review

  https://www.mdpi.com/2036-7422/13/4/33

  Admission to a hospital is recommended for all patients with complicated diverticulitis for bowel rest, IV antibiotics, IV fluid resuscitation, and possible intervention. Abscesses can be treated with CT-guided percutaneous drainage if the abscess is large enough and localized, assuming the patient is stable. There is a large range in the rate of recurrence after conservatively managed acute diverticulitis: from 13–60.5% with most studies in the range of 25% of patients having a recurrent episode within 1–10 years. […] It is critical to understand the etiology, classification, and management of diverticular disease due to the tremendous burden these subtypes place on healthcare systems. Categories of diverticular disease include uncomplicated and complicated diverticulitis, segmental colitis associated with diverticulosis, and symptomatic uncomplicated diverticular disease. Though subject to debate, it is thought that low fiber, high red meat, and high-fat diets, NSAIDs, low ultraviolet light exposure, smoking, and obesity are risk factors for diverticular disease. Treatment varies from conservative to surgical management, depending on the severity and presentation of the illness.

• #19 Complicated diverticular disease of the colon, do we need to change the classical approach, a retrospective study of 110 patients in southeast England | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/1749-7922-3-5

  The aim of this study is to evaluate the outcomes of management of complicated diverticular disease of the colon in a district NHS hospital and to explore the current strategies of its treatment. […] The overall complication rate following surgical and conservative management in our series was 49.09%. […] The rate of progression of diverticular disease to complicated diverticulitis is varied. After one episode of diverticulitis, one-third of patients have recurrent symptoms; after a second episode, a further third have a subsequent episode while perforation is commonest during the first episode of acute diverticulitis. […] Variable mortality rate was reported in literature and ranged from 4% to 16% while high mortality figure of 50% was confirmed in cases of perforation with generalized fecal peritonitis.

• #20

  https://fascrs.org/patients/diseases-and-conditions/a-z/diverticular-disease-expanded-version

  Diverticular disease most commonly affects adults and may be managed medically or surgically, depending on patient circumstances. […] Diverticulosis is very common, and the proportion of the population with diverticulosis increases with age. […] The most common complication of diverticulosis is diverticulitis. […] It is estimated that 10-20% of people with diverticulosis will develop diverticulitis. […] Once a person has an attack of diverticulitis, he or she is at risk for further episodes and for the development of complications. […] The most feared complication of diverticulitis is perforation and peritonitis, which often requires emergency surgery and the creation of a colostomy. […] Other complications of diverticulosis include bleeding, formation of a narrowing in the colon that does not easily let stool pass (called a stricture), or formation of a tract to another organ or the skin (called a fistula).

• #21 Diverticular disease and diverticulitis

  https://www.nhs.uk/conditions/diverticular-disease-and-diverticulitis/

  Rarely, diverticulitis can lead to serious complications such as a build-up of pus (abscess) in your bowel, a blockage in your bowel, an opening from your bowel to another organ, such as your bladder, called a fistula, and a hole (perforation) in your bowel, which can cause a severe infection called peritonitis.

• #22 Diverticulitis: Symptoms, Causes, Diagnosis, Treatment, Surgery

  https://www.healthline.com/health/diverticulitis

  Nearly 200,000 people in the United States are hospitalized each year for diverticulitis. […] Several risk factors for diverticulitis have been identified. […] For instance, diverticulosis affects nearly 6 in 10 people older than 60 years old, and up to 25% of these people will develop diverticulitis. […] Diverticulitis commonly occurs in males under 50 years old and females ages 50 to 70 years. […] Its estimated that 1 in 4 people with diverticulitis will develop complications. […] Up to 1 in 2 people may also experience recurring diverticulitis flare-ups. […] Diverticulitis occurs when diverticula in the large intestine become infected. The exact cause of why this happens is unknown. However, some factors associated with diverticulitis include smoking, having obesity, and eating a diet low in fiber or high in fat and red meat. […] Diverticulitis is relatively common in the Western world. […] In most cases, it can be treated through short-term dietary changes and medication. […] However, if you develop complications, you may require hospital treatment like surgery to repair damage to your colon.

• #23 English | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/guidelines/diverticular-disease/diverticular-disease-english

  Complicated diverticular disease has been noted with increased frequency in patients who smoke, use non-steroidal anti-inflammatory drugs and acetaminophen (especially paracetamol) and those who are obese and have low-fiber diets. […] Diverticulosis is symptomatic in 70% of cases; leads to diverticulitis in 1525%; and is associated with bleeding in 515%. […] Diverticular disease remains the most common cause of massive lower gastrointestinal bleeding, accounting for 3050% of cases. It is estimated that 15% of patients with diverticulosis will bleed at some time in their lives. […] Despite this, bleeding stops spontaneously in 7080% of cases. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to increase the risk of bleeding from diverticular disease, with over 50% of patients with bleeding diverticula receiving NSAID treatment at the time of presentation.

• #24 Diverticular disease practice points

  https://www.racgp.org.au/afp/2017/november/diverticular-disease-practice-points

  Diverticular disease and its spectrum of complications are increasingly encountered in the Australian population. […] Diverticulosis, the presence of small outpouchings of the intestinal wall (diverticula), occurs in 10% of people over the age of 45 years and 65% of those aged over 70 years. […] Diverticular disease encompasses the spectrum of presentations and complications of diverticulosis. […] Following an acute presentation of diverticulitis, colonoscopy is generally undertaken to exclude neoplasia. […] Most gastroenterology and colorectal surgical publications recommend that patients presenting with CT-diagnosed diverticulitis should undergo colonoscopy to exclude malignancy. […] Overall, the available evidence suggests that while malignancy cannot be entirely excluded in all cases of uncomplicated CT-diagnosed diverticulitis, the risk of malignancy is low and routine interval colonoscopy in all patients is potentially not justified.

• #25 A/Prof James Toh | Specialist Colorectal & General Surgeon – Diverticular Disease and Diverticulitis

  https://sydneycolorectalsurgeons.com.au/diverticular-disease-and-diverticulitis

  Diverticular disease is common in the ageing population. As a broad generalisation, there is a 65% risk of diverticular disease at the age of 65, and a 75% lifetime risk of diverticular disease by the age of 80. In patients with diverticulosis, the risk of diverticulitis has been cited from around 1% to 25%. Complicated diverticulitis refers to macroscopic diverticular perforation which may be localised or may lead to faeculent peritonitis if not contained. Over 30% of lower gastrointestinal bleeding is associated with diverticular disease. Smoking cessation, combating obesity as well as avoiding the use of NSAIDS and corticosteroids may reduce the risk of complicated diverticulitis. Complicated diverticulitis and diverticular bleeding usually require hospitalization, antibiotics and intravenous fluids with cessation of oral intake. Approximately 20-30% of patients will get further episodes of diverticulitis. Majority of patients with diverticular disease and diverticulitis do not need surgery. However, patients with severe diverticular disease and recurrent diverticulitis may benefit from surgery. […] The risk of a diagnosis of cancer after an emergency presentation with diverticulitis is 1-10%, as the symptoms and CT findings of diverticulitis may mimick colorectal cancer.

• #26 Diverticular disease practice points

  https://www.racgp.org.au/afp/2017/november/diverticular-disease-practice-points

  A more selective approach based on higher risk features should be used. […] It should be noted, however, that age-appropriate colonoscopic screening should occur in patients with risk factors who present after uncomplicated diverticulitis. […] The most recent point of contention concerns the utility of antibiotics in treating diverticulitis. […] Early trials suggested that acute uncomplicated diverticulitis can be safely treated without antibiotics and that this management does not increase further events of diverticulitis. […] While the available data suggest that observational management may be safe and effective, they are insufficient to change current practice, as the specific population groups to which this approach should be applied have not been identified. […] Although data suggest that patients with acute uncomplicated diverticulitis may be able to be safely treated without antibiotics, this assumes appropriate selection of patients and an uncomplicated clinical course.

• #27 Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States

  https://www.wjgnet.com/1007-9327/full/v17/i12/1600.htm

  Diverticulitis-associated hospitalizations have steeply risen, especially in young adults. These epidemiological trends vary by geographic region and warrant further investigation into potential dietary and environmental etiologies. […] Our nationwide analysis has demonstrated geographic variations in the burden of diverticulitis and underscores rapidly increasing rates of diverticulitis-associated hospitalizations among individuals younger than age 45 years. These findings have implications for understanding the underlying etiology of diverticulitis as well as for the timely diagnosis of this condition in younger individuals. The rising epidemiological trends and geographic variations in diverticulitis-associated admissions, particularly among younger individuals, may correlate with observed temporal changes and regional differences in diet and obesity in America.

• #28 Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States

  https://www.wjgnet.com/1007-9327/full/v17/i12/1600.htm

  The overall rates of acute diverticulitis hospitalizations increased in the US in the last decade, which has been previously reported in the US as well as in the UK and Finland. An epidemiological study of adults aged 40-74 years has also shown a rise in obesity, decreased physical activity, and decreased fibre intake which may all contribute to the increasing incidence of diverticular disease. Similarly, a decline in fibre intake among children and 3-fold rise in childhood obesity in the US over the last 3 decades may also partially explain the sharp rise in admissions for diverticulitis among younger age groups. […] The higher prevalence of obesity in the South and Midwest may correlate with our findings of higher rates of diverticulitis admissions in those regions compared to the West. Regional variation in diet may also contribute to geographic differences in diverticulitis admissions.

• #29 Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States

  https://www.wjgnet.com/1007-9327/full/v17/i12/1600.htm

  Despite these limitations, this nationally representative analysis has demonstrated geographic variations in epidemiological trends in the burden of diverticulitis that will hopefully stimulate hypotheses into the aetiology of diverticular disease. Prospective studies are needed to determine if there is an association between diverticulitis and obesity, dietary intake, and other environmental factors, particularly among younger adults. From a clinical perspective, these findings drive the need for increased vigilance for diverticular disease among younger adults presenting with abdominal pain.

• #30 Update on the management of sigmoid diverticulitis

  https://www.wjgnet.com/1007-9327/full/v27/i9/760.htm

  In summary, the development of diverticula may have both constitutional/genetic as well as extrinsic environmental and nutritional factors. The risk of developing diverticulitis in individuals with diverticulosis is lower than previously estimated. However, the overall incidence of diverticulitis is on the rise with an increasing proportion of cases seen in younger patients. Lifestyle factors may not be solely responsible for diverticulosis but play a more crucial role in initiating an inflammatory cascade once diverticula are present. […] The prevalence of diverticulitis is expected to increase substantially in the future as the population ages and the disease becomes more prevalent in younger patient populations. The development of diverticula/diverticulosis may have both intrinsic and extrinsic factors. The pathogenesis from diverticulosis to diverticulitis has several components, many of which are extrinsic and related to lifestyle. Different sub-entities of diverticular disease have been recognized but are yet poorly understood; they may cause blurring and overlap of symptoms. CT imaging is essential in the diagnosis of diverticulitis and classification of diverticular disease severity as it carries prognostic and potentially therapeutic significance. Interval colonoscopy remains advisable after an acute attack, particularly after complicated diverticulitis to rule out malignancy or advanced adenomata at the target site and the rest of the colon. Non-operative management of diverticulitis remains primarily based on antibiotics, but those may be omitted in mild cases. Supportive measures may include probiotics or anti-inflammatories, as dietary changes. Secondary prophylaxis focuses broad health improvement goals whereas the evidence for targeted interventions remains weak. Failure of non-operative management is typically defined as persistent or worsening symptoms and objective findings (SIRS, leukocytosis) after 72 h of best treatment. This should prompt further intervention, either in the form of imaging-guided drainage of an abscess or surgery. Resection offers the best source control in the acute, chronic, or elective setting. Laparoscopic lavage is currently not considered non-inferior to a surgical resection and should not be used outside of specific circumstances or protocols. A primary colorectal anastomosis should be considered at time of a resection unless the patient is unstable or there is poor tissue quality on each bowel end. A protective diverting ostomy can allow for an anastomosis when not all parameters are optimal. The indication for an elective surgical resection should be individualized and not be based on rigid criteria such as young age or a specific number of attacks. Instead, high-risk constellations such as complicated diverticulitis or immunosuppression should lead the considerations for elective colectomy when there is no obvious objective disease pathology (stricture, fistula, inflammation) after resolution of acute symptoms. Minimally invasive surgery (robotic, laparoscopic) is the primary approach for all elective cases and may be used in select emergency cases.

• #31 Update on the management of sigmoid diverticulitis

  https://www.wjgnet.com/1007-9327/full/v27/i9/760.htm

  Diverticular disease and diverticulitis are the most common non-cancerous pathology of the colon. It has traditionally been considered a disease of the elderly and associated with cultural and dietary habits. There has been a growing evolution in our understanding and the treatment guidelines for this disease. To provide an updated review of the epidemiology, pathogenesis, classification and highlight changes in the medical and surgical management of diverticulitis. Diverticulitis is increasingly being seen in young patients ( 50 years). Genetic contributions to diverticulitis may be larger than previously thought. Potential similarities and overlap with inflammatory bowel disease and irritable bowel syndrome exist. Computed tomography imaging represents the standard to classify the severity of diverticulitis. Modifications to the traditional Hinchey classification might serve to better delineate mild and intermediate forms as well as better classify chronic presentations of diverticulitis. Non-operative management is primarily based on antibiotics and supportive measures, but antibiotics may be omitted in mild cases. Interval colonoscopy remains advisable after an acute attack, particularly after a complicated form. Acute surgery is needed for the most severe as well as refractory cases, whereas elective resections are individualized and should be considered for chronic, smoldering, or recurrent forms and respective complications (stricture, fistula, etc.) and for patients with factors highly predictive of recurrent attacks. Diverticulitis is no longer a disease of the elderly. Our evolving understanding of diverticulitis as a clinical entity has led into a more nuanced approach in both the medical and surgical management of this common disease. Non-surgical management remains the appropriate treatment for greater than 70% of patients. In individuals with non-relenting, persistent, or recurrent symptoms and those with complicated disease and sequelae, a segmental colectomy remains the most effective surgical treatment in the acute, chronic, or elective-prophylactic setting.

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