Materiały źródłowe

• #1 Diverticular Disease: An Update on Pathogenesis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5832336/

  Diverticular disease is one of the most common conditions in the Western world and one of the most common findings identified at colonoscopy. The pathogenesis of diverticular disease is thought to be multifactorial and include both environmental and genetic factors in addition to the historically accepted etiology of dietary fiber deficiency. […] Our understanding of the pathogenesis of diverticular disease continues to evolve and is likely to be diverse and multifactorial. The pathogenesis of diverticular disease is multifactorial and not fully understood. However, several factors including colonic wall structure, colonic motility, genetics, fiber intake, vitamin D levels, obesity and physical activity have been studied and thought to influence the pathogenesis of the disease. […] While the pathogenesis of diverticular disease has largely been thought to be due to environmental risk factors such as diet, more recent epidemiologic data point to the additional contribution of genetic factors in the development of diverticular disease. […] In addition to dietary fiber intake, genetics plays a role in the pathogenesis of diverticular disease.

• #2 Diverticular Disease: An Update on Pathogenesis and Management

  https://www.gutnliver.org/journal/view.html?pn=search&uid=1280&vmd=Full

  Diverticular disease is one of the most common conditions in the Western world and one of the most common findings identified at colonoscopy. Recently, there has been a significant paradigm shift in our understanding of diverticular disease and its management. The pathogenesis of diverticular disease is thought to be multifactorial and include both environmental and genetic factors in addition to the historically accepted etiology of dietary fiber deficiency. […] Our understanding of the pathogenesis of diverticular disease continues to evolve and is likely to be diverse and multifactorial. […] The pathogenesis of diverticular disease is multifactorial and not fully understood. However, several factor including colonic wall structure, colonic motility, genetics, fiber intake, vitamin D levels, obesity and physical activity have been studied and thought to influence the pathogenesis of the disease.

• #3 Diverticular Disease: An Update on Pathogenesis and Management

  https://www.kci.go.kr/kciportal/landing/article.kci?arti_id=ART002324752

  Diverticular disease is one of the most common conditions in the Western world and one of the most common findings identified at colonoscopy. […] The pathogenesis of diverticular disease is thought to be multifactorial and include both environmental and genetic factors in addition to the historically accepted etiology of dietary fiber deficiency. […] Our understanding of the pathogenesis of diverticular disease continues to evolve and is likely to be diverse and multifactorial. […] Paradigm shifts in several areas of the pathogenesis and management of diverticular disease are explored in this review.

• #4 Diverticulosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Diverticulosis_pathophysiology

  The development of colonic diverticuli is the result of weakening in the muscular layer of the colonic wall. […] The most common colonic sites of diverticula development are regions of muscular weakness, which correspond to locations where the vasa recta penetrate the circular muscle layer of the colon. […] The development of diverticula in the sigmoid colon may be explained by Laplaces law: pressure (P) is proportional to wall tension (T) and is inversely proportional to bowel radius (R), where k is a conversion factor (P = kT R). Since the sigmoid colon is the segment of the colon with the smallest diameter, it is the site of the highest pressure during segmentation of the colon. […] A typical colonic diverticulum is a „false” or pulsion diverticulum, in which the mucosa and submucosa herniate through the muscle layer, covered only by serosa.

• #5 Colonic Diverticular Disease

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/colonic-diverticular-disease/

  Colonic diverticulae are acquired outpouchings of mucosa and muscularis mucosa that develop on the mesenteric side of the colonic wall. Diverticulae develop where the circular muscle layer is penetrated by vasa recta to supply the mucosa, a point of weakness in the colonic wall. This defect is enlarged by increased intraluminal pressure and is thought to be related to constipation and consequent straining to evacuate. The progression of diverticulosis to diverticulitis is poorly understood. The traditional belief is that fecal stasis and obstruction of a diverticulum leads to ischemia, ulceration, bacterial overgrowth and micro perforation. Diverticular bleeding is thought to be associated with baropressure causing the vasorecta to stretch and rupture. It is arterial bleeding from a branch at the dome or neck of the diverticulum.

• #6 Epidemiology and Pathophysiology of Diverticular Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2780269/

  Diverticular disease is common and thought to result from structural abnormalities of the colonic wall, disordered intestinal motility, or deficiencies of dietary fiber. […] The pathogenesis of the disorder involves three major areas: (1) structural abnormalities of the colonic wall, (2) disordered intestinal motility, and (3) deficiencies of dietary fiber. Additional factors have also been linked to diverticular disease. […] The colon, unlike the small intestine and rectum, contains only one complete muscular layer, the inner circular layer. […] The colonic wall is weakest at the points between the mesenteric and antimesenteric teniae where the vasa recta penetrate the muscle. […] Thickening of the circular muscle is not due to muscle hypertrophy or hyperplasia, but instead from abnormal elastin deposition.

• #7 Diverticulosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Diverticulosis_pathophysiology

  The development of colonic diverticuli is the result of weakening in the muscular layer of the colonic wall. […] The most common colonic sites of diverticula development are regions of muscular weakness, which correspond to locations where the vasa recta penetrate the circular muscle layer of the colon. […] The development of diverticula in the sigmoid colon may be explained by Laplaces law: pressure (P) is proportional to wall tension (T) and is inversely proportional to bowel radius (R), where k is a conversion factor (P = kT R). Since the sigmoid colon is the segment of the colon with the smallest diameter, it is the site of the highest pressure during segmentation of the colon. […] A typical colonic diverticulum is a „false” or pulsion diverticulum, in which the mucosa and submucosa herniate through the muscle layer, covered only by serosa.

• #8 Diverticulosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Diverticulosis_pathophysiology

  The development of colonic diverticuli is the result of weakening in the muscular layer of the colonic wall. […] The most common colonic sites of diverticula development are regions of muscular weakness, which correspond to locations where the vasa recta penetrate the circular muscle layer of the colon. […] The development of diverticula in the sigmoid colon may be explained by Laplaces law: pressure (P) is proportional to wall tension (T) and is inversely proportional to bowel radius (R), where k is a conversion factor (P = kT R). Since the sigmoid colon is the segment of the colon with the smallest diameter, it is the site of the highest pressure during segmentation of the colon. […] A typical colonic diverticulum is a „false” or pulsion diverticulum, in which the mucosa and submucosa herniate through the muscle layer, covered only by serosa.

• #9 Epidemiology and Pathophysiology of Diverticular Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2780269/

  Abnormal collagen cross-linking has been observed in the colonic walls of patients with diverticular disease. […] The association of increased collagen cross-linking and the development of colonic diverticula is supported by the observation that patients with connective tissue disease such as EhlersDanlos or Marfan syndrome who have similar abnormalities of collagen cross-linking also develop diverticulosis earlier in life. […] In the 1960s, Arfwidsson et al performed manometry on subjects with and without sigmoid diverticula, and showed higher luminal pressures in those with diverticular disease. […] Studies have shown that myoelectrical patterns differ in patients with diverticular disease compared with healthy subjects. […] A wide body of evidence has emerged that supports this theory. Fiber is thought to lower intracolonic pressures, speed transit times, increase stool weight and volume, and contribute to more frequent bowel movements.

• #10 Epidemiology and Pathophysiology of Diverticular Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2780269/

  Diverticular disease is common and thought to result from structural abnormalities of the colonic wall, disordered intestinal motility, or deficiencies of dietary fiber. […] The pathogenesis of the disorder involves three major areas: (1) structural abnormalities of the colonic wall, (2) disordered intestinal motility, and (3) deficiencies of dietary fiber. Additional factors have also been linked to diverticular disease. […] The colon, unlike the small intestine and rectum, contains only one complete muscular layer, the inner circular layer. […] The colonic wall is weakest at the points between the mesenteric and antimesenteric teniae where the vasa recta penetrate the muscle. […] Thickening of the circular muscle is not due to muscle hypertrophy or hyperplasia, but instead from abnormal elastin deposition.

• #11

  https://link.springer.com/article/10.1007/BF02617198

  The pathogenesis of colonic diverticulosis still is not well understood. It is believed that it is a combination of the degenerative process of aging, associated with spasm and increased intraluminal pressure. There is strong evidence to support the view that a muscle abnormality with shortening and hypertrophy precedes diverticulosis. An associated increase in the frequency and magnitude of spontaneous contractions causes an increase in internal pressure on the colon wall. Ultimately, this results in herniation and pouch formation. Once the diverticulum has herniated through the wall permanently, the continued increased pressure forces fecal contents into the pouch. This also causes vascular engorgement, necrosis of the mucosa, and bacterial penetration. […] The actual inflammation of diverticulitis results from perforation, rather than stagnation of fecal material. The shortening of the bowel, with spasm and thickening of the circular muscle, results in diverticular disease, and the common spastic colon may well be a precursor of diverticulosis coli.

• #12 Epidemiology and Pathophysiology of Diverticular Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2780269/

  Abnormal collagen cross-linking has been observed in the colonic walls of patients with diverticular disease. […] The association of increased collagen cross-linking and the development of colonic diverticula is supported by the observation that patients with connective tissue disease such as EhlersDanlos or Marfan syndrome who have similar abnormalities of collagen cross-linking also develop diverticulosis earlier in life. […] In the 1960s, Arfwidsson et al performed manometry on subjects with and without sigmoid diverticula, and showed higher luminal pressures in those with diverticular disease. […] Studies have shown that myoelectrical patterns differ in patients with diverticular disease compared with healthy subjects. […] A wide body of evidence has emerged that supports this theory. Fiber is thought to lower intracolonic pressures, speed transit times, increase stool weight and volume, and contribute to more frequent bowel movements.

• #13 Diverticulosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Diverticulosis_pathophysiology

  Abnormal colonic motility is an important predisposing factor in the development diverticula. […] Patients with diverticulosis have exaggerated segmentation contractions in which segmental muscular contractions separate the lumen into chambers. […] It is hypothesized that the increase in intraluminal pressure predisposes to herniation of mucosa and submucosa. […] Increased level of chemical mediators such as vasoactive intestinal peptide (VIP) is also thought to play a critical role in the development of colonic diverticula. […] The primary process is thought to be an erosion of the diverticular wall by increased intraluminal pressure or inspissated food particles. […] Inflammation and focal necrosis ensue, resulting in perforation and inflammation.

• #14 Epidemiology and Pathophysiology of Diverticular Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2780269/

  Abnormal collagen cross-linking has been observed in the colonic walls of patients with diverticular disease. […] The association of increased collagen cross-linking and the development of colonic diverticula is supported by the observation that patients with connective tissue disease such as EhlersDanlos or Marfan syndrome who have similar abnormalities of collagen cross-linking also develop diverticulosis earlier in life. […] In the 1960s, Arfwidsson et al performed manometry on subjects with and without sigmoid diverticula, and showed higher luminal pressures in those with diverticular disease. […] Studies have shown that myoelectrical patterns differ in patients with diverticular disease compared with healthy subjects. […] A wide body of evidence has emerged that supports this theory. Fiber is thought to lower intracolonic pressures, speed transit times, increase stool weight and volume, and contribute to more frequent bowel movements.

• #15 Diverticulosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Diverticulosis_pathophysiology

  Abnormal colonic motility is an important predisposing factor in the development diverticula. […] Patients with diverticulosis have exaggerated segmentation contractions in which segmental muscular contractions separate the lumen into chambers. […] It is hypothesized that the increase in intraluminal pressure predisposes to herniation of mucosa and submucosa. […] Increased level of chemical mediators such as vasoactive intestinal peptide (VIP) is also thought to play a critical role in the development of colonic diverticula. […] The primary process is thought to be an erosion of the diverticular wall by increased intraluminal pressure or inspissated food particles. […] Inflammation and focal necrosis ensue, resulting in perforation and inflammation.

• #16 Diverticulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/173388-overview

  Diverticular disease (diverticulosis, diverticulitis) is a general term that refers to the presence of diverticula, small pouches in the large intestinal (colonic) wall. These outpouchings arise when the inner layers of the colon push through weaknesses in the outer muscular layers. […] The cause of diverticulosis is unclear, but it has been associated with increased pressure from constipation or increasing abdominal girth in obesity. The classic high-fat and low-fiber diet of the Western culture may be a major contributor to the development of diverticulosis. The low-fiber diet is thought to predispose to diverticulosis owing to a slower fecal transit time and smaller stool weight. […] Diverticulitis is defined as an inflammation of one or more diverticula. Its pathogenesis remains unclear. Fecal material or undigested food particles may collect in a diverticulum, causing obstruction. This obstruction may result in distention of the diverticula secondary to mucous secretion and overgrowth of normal colonic bacteria. Vascular compromise and subsequent microperforation or macroperforation then ensue. Alternatively, some investigators believe that increased intraluminal pressure or inspissated food particles cause erosion of the diverticular wall, resulting in inflammation, focal necrosis, and perforation. […] It has been postulated that diverticulitis may also result from alterations in immune responses and in the intestinal bacteria, or gut microbiome.

• #17 Pathophysiology of Diverticular Disease: From Diverticula Formation to Symptom Generation

  https://www.mdpi.com/1422-0067/23/12/6698

  Diverticular disease is a common clinical problem, particularly in industrialized countries. The pathophysiology of diverticular disease as well as the mechanisms involved in the shift from an asymptomatic condition to a symptomatic one is still poorly understood. It is accepted that both genetic factors and environment, as well as intestinal microenvironment alterations, have a role in diverticula development and in the different phenotypic expressions of diverticular disease. […] The pathophysiology of diverticulitis appears to be related to obstruction of the diverticulum by fecal material, which causes inflammation of the mucosa resulting in congestion, mucosal trauma, and ischemia. […] New evidence demonstrated that genetic, environmental factors, and changes in the intestinal microenvironment, including microbiota imbalance, mucosal inflammation, enteric nervous system (ENS), and neuro-immune alterations, play a pivotal role in the pathophysiology of diverticulosis and SUDD.

• #18 Diverticulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/173388-overview

  Diverticular disease (diverticulosis, diverticulitis) is a general term that refers to the presence of diverticula, small pouches in the large intestinal (colonic) wall. These outpouchings arise when the inner layers of the colon push through weaknesses in the outer muscular layers. […] The cause of diverticulosis is unclear, but it has been associated with increased pressure from constipation or increasing abdominal girth in obesity. The classic high-fat and low-fiber diet of the Western culture may be a major contributor to the development of diverticulosis. The low-fiber diet is thought to predispose to diverticulosis owing to a slower fecal transit time and smaller stool weight. […] Diverticulitis is defined as an inflammation of one or more diverticula. Its pathogenesis remains unclear. Fecal material or undigested food particles may collect in a diverticulum, causing obstruction. This obstruction may result in distention of the diverticula secondary to mucous secretion and overgrowth of normal colonic bacteria. Vascular compromise and subsequent microperforation or macroperforation then ensue. Alternatively, some investigators believe that increased intraluminal pressure or inspissated food particles cause erosion of the diverticular wall, resulting in inflammation, focal necrosis, and perforation. […] It has been postulated that diverticulitis may also result from alterations in immune responses and in the intestinal bacteria, or gut microbiome.

• #19 English | World Gastroenterology Organisation

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

  Diverticular disease consists of: […] The present theory that fiber is a protective agent against the development of diverticula and subsequent diverticulitis holds that insoluble fiber causes the formation of more bulky stool, which leads to decreased effectiveness in colonic segmentation. […] The mechanism of developing diverticulitis centers around the perforation of a diverticulum, whether it be microscopic or macroscopic. […] Increased intraluminal pressure or inspissated food particles may erode the diverticular wall with resultant inflammation and focal necrosis, leading to perforation (micro/macro). […] The sigmoid is commonly affected, probably due to its small diameter. […] The vasa recta penetrating the bowel wall create areas of weakness through which a portion of the colonic mucosa and submucosa (covered by serosa) can herniate.

• #20 Diverticular disease – Wikipedia

  https://en.wikipedia.org/wiki/Diverticular_disease

  Diverticular disease is when problems occur due to diverticulosis, a benign condition defined by the formation of pouches (diverticula) from weak spots in the wall of the large intestine. […] Acute diverticulitis is thought to arise from either trauma or lack of blood flow to the existing diverticulum in the colon. […] The traumatic theory proposes that a fecalith, which is a hardened fecal matter, becomes trapped in a diverticulum, leading to colonic mucosa abrasion and local inflammation. Subsequent bacterial overgrowth and infection spreads from the mucosal wall to full bowel wall, eventually leading to bowel perforation. […] In the ischemic theory, it is thought that long standing colonic contraction causes blood vessel compression at the diverticular neck, leading to ischemia, inflammatory response, and perforation.

• #21 ClinMed International Library

  https://clinmedjournals.org/articles/ijsrp/ijsrp-2-017.php?jid=ijsrp

  Diverticular disease is a common entity in the western world with an increasing incidence globally. This probably reflects both an increase in detection and an ageing population. The pathophysiology of diverticular disease is likely multifactorial involving dietary habits, changes in colonic pressures and motility, and colon wall structural changes. […] The pathogenesis of diverticulitis is not entirely understood. It is presumed that factors responsible for diverticula formation, including insufficient dietary fiber intake, colonic pressure and motility changes, and colonic wall structural alterations, may also contribute to subsequent inflammatory episodes. […] Formerly, the pathophysiology of diverticulitis was thought to be similar to that of appendicitis in which a fecolith either lodges within the neck of the diverticulum or abrades the mucosal surface of the sac leading to inflammation, proliferation of bacteria, diverticulum distension, and localized ischemia. However, this concept has been questioned based on anatomic studies that have shown inflammation with micro perforation in the absence of a fecolith.

• #22 Diverticulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/173388-overview

  Diverticular disease (diverticulosis, diverticulitis) is a general term that refers to the presence of diverticula, small pouches in the large intestinal (colonic) wall. These outpouchings arise when the inner layers of the colon push through weaknesses in the outer muscular layers. […] The cause of diverticulosis is unclear, but it has been associated with increased pressure from constipation or increasing abdominal girth in obesity. The classic high-fat and low-fiber diet of the Western culture may be a major contributor to the development of diverticulosis. The low-fiber diet is thought to predispose to diverticulosis owing to a slower fecal transit time and smaller stool weight. […] Diverticulitis is defined as an inflammation of one or more diverticula. Its pathogenesis remains unclear. Fecal material or undigested food particles may collect in a diverticulum, causing obstruction. This obstruction may result in distention of the diverticula secondary to mucous secretion and overgrowth of normal colonic bacteria. Vascular compromise and subsequent microperforation or macroperforation then ensue. Alternatively, some investigators believe that increased intraluminal pressure or inspissated food particles cause erosion of the diverticular wall, resulting in inflammation, focal necrosis, and perforation. […] It has been postulated that diverticulitis may also result from alterations in immune responses and in the intestinal bacteria, or gut microbiome.

• #23 Diverticulosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Diverticulosis_pathophysiology

  Abnormal colonic motility is an important predisposing factor in the development diverticula. […] Patients with diverticulosis have exaggerated segmentation contractions in which segmental muscular contractions separate the lumen into chambers. […] It is hypothesized that the increase in intraluminal pressure predisposes to herniation of mucosa and submucosa. […] Increased level of chemical mediators such as vasoactive intestinal peptide (VIP) is also thought to play a critical role in the development of colonic diverticula. […] The primary process is thought to be an erosion of the diverticular wall by increased intraluminal pressure or inspissated food particles. […] Inflammation and focal necrosis ensue, resulting in perforation and inflammation.

• #24 Diverticular disease – Wikipedia

  https://en.wikipedia.org/wiki/Diverticular_disease

  Diverticular disease is when problems occur due to diverticulosis, a benign condition defined by the formation of pouches (diverticula) from weak spots in the wall of the large intestine. […] Acute diverticulitis is thought to arise from either trauma or lack of blood flow to the existing diverticulum in the colon. […] The traumatic theory proposes that a fecalith, which is a hardened fecal matter, becomes trapped in a diverticulum, leading to colonic mucosa abrasion and local inflammation. Subsequent bacterial overgrowth and infection spreads from the mucosal wall to full bowel wall, eventually leading to bowel perforation. […] In the ischemic theory, it is thought that long standing colonic contraction causes blood vessel compression at the diverticular neck, leading to ischemia, inflammatory response, and perforation.

• #25 Diverticular disease – Wikipedia

  https://en.wikipedia.org/wiki/Diverticular_disease

  Similar to the diverticulitis ischemia theory above, SUDD is thought to be caused by sustained colonic contraction leading to mucosal ischemia within the diverticulum. […] Low grade inflammation of the colonic mucosa within the diverticulum and visceral hypersensitivity are also thought to cause SUDD. […] SCAD, also known as diverticular colitis, is when there is mucosal inflammation in a colonic segment with diverticulosis that may or may not have evidence of diverticulitis, or inflammation within or around a diverticulum itself. The cause is currently unknown. It is thought to be multi-factorial, including colonic ischemia secondary to old age and other cardiovascular risk factors, diverticulosis causing mucosal prolapse, fecal stasis and subsequent microbiome disturbance, eventually leading to inflammation of the colon segment.

• #26

  https://link.springer.com/article/10.1007/BF02617198

  The pathogenesis of colonic diverticulosis still is not well understood. It is believed that it is a combination of the degenerative process of aging, associated with spasm and increased intraluminal pressure. There is strong evidence to support the view that a muscle abnormality with shortening and hypertrophy precedes diverticulosis. An associated increase in the frequency and magnitude of spontaneous contractions causes an increase in internal pressure on the colon wall. Ultimately, this results in herniation and pouch formation. Once the diverticulum has herniated through the wall permanently, the continued increased pressure forces fecal contents into the pouch. This also causes vascular engorgement, necrosis of the mucosa, and bacterial penetration. […] The actual inflammation of diverticulitis results from perforation, rather than stagnation of fecal material. The shortening of the bowel, with spasm and thickening of the circular muscle, results in diverticular disease, and the common spastic colon may well be a precursor of diverticulosis coli.

• #27

  https://link.springer.com/article/10.1007/BF02617198

  The pathogenesis of colonic diverticulosis still is not well understood. It is believed that it is a combination of the degenerative process of aging, associated with spasm and increased intraluminal pressure. There is strong evidence to support the view that a muscle abnormality with shortening and hypertrophy precedes diverticulosis. An associated increase in the frequency and magnitude of spontaneous contractions causes an increase in internal pressure on the colon wall. Ultimately, this results in herniation and pouch formation. Once the diverticulum has herniated through the wall permanently, the continued increased pressure forces fecal contents into the pouch. This also causes vascular engorgement, necrosis of the mucosa, and bacterial penetration. […] The actual inflammation of diverticulitis results from perforation, rather than stagnation of fecal material. The shortening of the bowel, with spasm and thickening of the circular muscle, results in diverticular disease, and the common spastic colon may well be a precursor of diverticulosis coli.

• #28 Diverticular Disease | The Washington Manual of Medical Therapeutics

  https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602863/all/Diverticular_Disease?q=Disease+Diverticular

  Diverticulitis results from microperforation of a diverticulum and resultant extracolonic or intramural inflammation. […] Although microperforation is part of the pathogenesis of diverticulitis, frank perforation with peritonitis requires surgical consultation.

• #29 Diverticular Disease | The Washington Manual of Medical Therapeutics

  https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602863/all/Diverticular_Disease?q=Disease+Diverticular

  Diverticulitis results from microperforation of a diverticulum and resultant extracolonic or intramural inflammation. […] Although microperforation is part of the pathogenesis of diverticulitis, frank perforation with peritonitis requires surgical consultation.

• #30

  https://step1.medbullets.com/gastrointestinal/110047/diverticular-disease

  diverticulosis to condition of having multiple sac-like protrusions (diverticula) of the colonic wall that are not inflamed […] the diverticula are outpouchings of the colonic mucosa and submucosa through areas of weakness within the muscle layers of the colon wall […] diverticulitis is defined as inflammation of a diverticulum […] results from a microscopic or macroscopic perforation of a diverticulum due to diverticular inflammation and focal necrosis […] primary process is thought to be due to erosion of the diverticular wall by increased intraluminal pressure or inspissated food particles […] erosions of the wall then lead to inflammation and focal necrosis that may lead to micro- or macroscopic perforation […] the inflammation is frequently mild and often walled off by pericolic fat and mesentery […] this may lead to the formation of a localized abscess or a fistula (if adjacent organs are involved) […] poor containment of the inflamed diverticulum or abscess can result in free perforation and peritonitis.

• #31

  https://step1.medbullets.com/gastrointestinal/110047/diverticular-disease

  diverticulosis to condition of having multiple sac-like protrusions (diverticula) of the colonic wall that are not inflamed […] the diverticula are outpouchings of the colonic mucosa and submucosa through areas of weakness within the muscle layers of the colon wall […] diverticulitis is defined as inflammation of a diverticulum […] results from a microscopic or macroscopic perforation of a diverticulum due to diverticular inflammation and focal necrosis […] primary process is thought to be due to erosion of the diverticular wall by increased intraluminal pressure or inspissated food particles […] erosions of the wall then lead to inflammation and focal necrosis that may lead to micro- or macroscopic perforation […] the inflammation is frequently mild and often walled off by pericolic fat and mesentery […] this may lead to the formation of a localized abscess or a fistula (if adjacent organs are involved) […] poor containment of the inflamed diverticulum or abscess can result in free perforation and peritonitis.

• #32 Epidemiology and Pathophysiology of Diverticular Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2780269/

  Although inflammation is certainly the major component of complicated diverticular disease, including diverticulitis, new evidence suggests that inflammation may also play a role in the early pathogenesis of the disease. […] Nonsteroidal antiinflammatory drugs (NSAIDs) are associated with gastrointestinal complications, especially bleeding in the upper gastrointestinal tract. […] A lack of physical activity and the presence of obesity have been shown to increase the risk of diverticular disease. […] It has been postulated that fiber influences colonic microflora. Recently, the role microflora plays in the development and progression of diverticular disease has been the topic of debate.

• #33 The Role of Inflammation in Bowel Disease and Diverticular Disease – Southern Medical Association

  https://sma.org/inflammation-in-bowel-disease/

  Chronic or long-term inflammation appears to be linked to an ever-increasing number of medical conditions. […] A further condition affecting the gastrointestinal tract is diverticular disease, which can develop into diverticulitis. This involves small bulges or pockets that develop in the lining of the large intestine. […] The role of inflammation in the development of diverticulosis remains to be understood. It is mainly thought to be a neuromuscular abnormality, with little or no role for inflammation. […] For diverticulitis, mucosal inflammation due to activation of the immune system is acknowledged as the underlying cause. Furthermore, this inflammation is thought to be caused by bacterial overgrowth. […] The important anti-inflammatory mediator interleukin-10 is seen at raised levels in symptomatic uncomplicated diverticular disease, a probable attempt by the immune system to control a low-grade inflammation. […] The 2019 review authors conclude that, although most of the mechanisms leading to the occurrence of diverticular disease remain to be elucidated, „the role of low-grade inflammation seems to be a proven fact”.

• #34 Recent updates on classification and unsolved issues of diverticular disease: a narrative review

  https://www.e-jyms.org/journal/view.php?number=2856

  Recently, a paradigm shift has occurred in the classification of diverticular disease and the understanding of its pathogenesis. […] Low-grade inflammation, visceral hypersensitivity, abnormal intestinal motility, and genetic factors have emerged as the key contributors to the pathogenesis of diverticular disease. […] Traditionally, diverticulitis has been considered to develop due to obstruction of the diverticulum opening, fecal stasis, and bacterial overgrowth. However, the concept of diverticular disease as a chronic inflammatory disease has recently emerged. […] In addition to traditional concepts, chronic low-grade inflammation, alterations in the gut microbiota, visceral hypersensitivity, and abnormal intestinal motility have recently emerged as important factors in the pathogenesis of diverticular disease.

• #35 Cited

  https://www.koreamed.org/SearchBasic.php?RID=2560485

  Recently, a paradigm shift has occurred in the classification of diverticular disease and the understanding of its pathogenesis. […] Low-grade inflammation, visceral hypersensitivity, abnormal intestinal motility, and genetic factors have emerged as the key contributors to the pathogenesis of diverticular disease. […] The roles of dietary fiber, nonabsorbable antibiotics, 5-aminosalicylates, and probiotics in the prevention of diverticular disease are controversial and require further investigation. […] Visceral hypersensitivity in symptomatic diverticular disease and the role of neuropeptides and low grade inflammation. […] Treatment of diverticular disease with aminosalicylates: the evidence. […] Probiotics for the treatment of symptomatic uncomplicated diverticular disease: rationale and current evidence. […] Evidence for dietary fibre modification in the recovery and prevention of reoccurrence of acute, uncomplicated diverticulitis: a systematic literature review.

• #36 Recent updates on classification and unsolved issues of diverticular disease: a narrative review

  https://www.e-jyms.org/journal/view.php?number=2856

  Recently, a paradigm shift has occurred in the classification of diverticular disease and the understanding of its pathogenesis. […] Low-grade inflammation, visceral hypersensitivity, abnormal intestinal motility, and genetic factors have emerged as the key contributors to the pathogenesis of diverticular disease. […] Traditionally, diverticulitis has been considered to develop due to obstruction of the diverticulum opening, fecal stasis, and bacterial overgrowth. However, the concept of diverticular disease as a chronic inflammatory disease has recently emerged. […] In addition to traditional concepts, chronic low-grade inflammation, alterations in the gut microbiota, visceral hypersensitivity, and abnormal intestinal motility have recently emerged as important factors in the pathogenesis of diverticular disease.

• #37 Recent updates on classification and unsolved issues of diverticular disease: a narrative review

  https://www.e-jyms.org/journal/view.php?number=2856

  Recently, a paradigm shift has occurred in the classification of diverticular disease and the understanding of its pathogenesis. […] Low-grade inflammation, visceral hypersensitivity, abnormal intestinal motility, and genetic factors have emerged as the key contributors to the pathogenesis of diverticular disease. […] Traditionally, diverticulitis has been considered to develop due to obstruction of the diverticulum opening, fecal stasis, and bacterial overgrowth. However, the concept of diverticular disease as a chronic inflammatory disease has recently emerged. […] In addition to traditional concepts, chronic low-grade inflammation, alterations in the gut microbiota, visceral hypersensitivity, and abnormal intestinal motility have recently emerged as important factors in the pathogenesis of diverticular disease.

• #38 Pathogenesis of diverticulosis and diverticular disease – Minerva Gastroenterologica e Dietologica 2017 June;63(2):99-109 – Minerva Medica – Journals

  https://www.minervamedica.it/en/journals/gastroenterology/article.php?cod=R08Y2017N02A0099

  The role of the microbiome has been explored and microbial and metabolomic signatures are also important in predicting disease severity. […] That diverticulosis is a chronic disease is shown by mucosal pathology with subtle chronic inflammation present in those with asymptomatic diverticulosis and inflammation may lead to muscular hypertrophy, enteric nerve remodeling with disordered motility. […] The diverticulitis quality of life instrument shows that this condition impacts markedly on patients well-being and prevention and amelioration of complications should be the aim of treatment and further research to attain this goal is needed.

• #39 Pathogenesis of diverticulosis and diverticular disease – Minerva Gastroenterologica e Dietologica 2017 June;63(2):99-109 – Minerva Medica – Journals

  https://www.minervamedica.it/en/journals/gastroenterology/article.php?cod=R08Y2017N02A0099

  The role of the microbiome has been explored and microbial and metabolomic signatures are also important in predicting disease severity. […] That diverticulosis is a chronic disease is shown by mucosal pathology with subtle chronic inflammation present in those with asymptomatic diverticulosis and inflammation may lead to muscular hypertrophy, enteric nerve remodeling with disordered motility. […] The diverticulitis quality of life instrument shows that this condition impacts markedly on patients well-being and prevention and amelioration of complications should be the aim of treatment and further research to attain this goal is needed.

• #40 Diverticular disease – Wikipedia

  https://en.wikipedia.org/wiki/Diverticular_disease

  Similar to the diverticulitis ischemia theory above, SUDD is thought to be caused by sustained colonic contraction leading to mucosal ischemia within the diverticulum. […] Low grade inflammation of the colonic mucosa within the diverticulum and visceral hypersensitivity are also thought to cause SUDD. […] SCAD, also known as diverticular colitis, is when there is mucosal inflammation in a colonic segment with diverticulosis that may or may not have evidence of diverticulitis, or inflammation within or around a diverticulum itself. The cause is currently unknown. It is thought to be multi-factorial, including colonic ischemia secondary to old age and other cardiovascular risk factors, diverticulosis causing mucosal prolapse, fecal stasis and subsequent microbiome disturbance, eventually leading to inflammation of the colon segment.

• #41 Colonic diverticular disease. Treatment and prevention | Gastroenterología y Hepatología

  https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-14-articulo-colonic-diverticular-disease-treatment-prevention-S021057051500103X

  Symptoms development in diverticular disease is probably related to complex interactions among genetic features, colon structure, intestinal motility low grade inflammation and postinflammatory hypersensitivity. […] The presence of a chronic, low-grade intestinal inflammation would induce a sensory-motor dysfunction, leading to symptom development and/or persistence. […] Changes in intestinal micro flora could be one of the putative mechanisms responsible for low-grade inflammation. […] Bacterial overgrowth aided by the faecal stasis inside the diverticula could contribute to chronic low-grade inflammation that sensitizes both intrinsic primary efferent and extrinsic primary afferent neurons.

• #42 Colonic diverticular disease. Treatment and prevention | Gastroenterología y Hepatología

  https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-14-articulo-colonic-diverticular-disease-treatment-prevention-S021057051500103X

  Symptoms development in diverticular disease is probably related to complex interactions among genetic features, colon structure, intestinal motility low grade inflammation and postinflammatory hypersensitivity. […] The presence of a chronic, low-grade intestinal inflammation would induce a sensory-motor dysfunction, leading to symptom development and/or persistence. […] Changes in intestinal micro flora could be one of the putative mechanisms responsible for low-grade inflammation. […] Bacterial overgrowth aided by the faecal stasis inside the diverticula could contribute to chronic low-grade inflammation that sensitizes both intrinsic primary efferent and extrinsic primary afferent neurons.

• #43 The Role of Inflammation in Bowel Disease and Diverticular Disease – Southern Medical Association

  https://sma.org/inflammation-in-bowel-disease/

  Chronic or long-term inflammation appears to be linked to an ever-increasing number of medical conditions. […] A further condition affecting the gastrointestinal tract is diverticular disease, which can develop into diverticulitis. This involves small bulges or pockets that develop in the lining of the large intestine. […] The role of inflammation in the development of diverticulosis remains to be understood. It is mainly thought to be a neuromuscular abnormality, with little or no role for inflammation. […] For diverticulitis, mucosal inflammation due to activation of the immune system is acknowledged as the underlying cause. Furthermore, this inflammation is thought to be caused by bacterial overgrowth. […] The important anti-inflammatory mediator interleukin-10 is seen at raised levels in symptomatic uncomplicated diverticular disease, a probable attempt by the immune system to control a low-grade inflammation. […] The 2019 review authors conclude that, although most of the mechanisms leading to the occurrence of diverticular disease remain to be elucidated, „the role of low-grade inflammation seems to be a proven fact”.

• #44 Colonic diverticular disease. Treatment and prevention | Gastroenterología y Hepatología

  https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-14-articulo-colonic-diverticular-disease-treatment-prevention-S021057051500103X

  Symptoms development in diverticular disease is probably related to complex interactions among genetic features, colon structure, intestinal motility low grade inflammation and postinflammatory hypersensitivity. […] The presence of a chronic, low-grade intestinal inflammation would induce a sensory-motor dysfunction, leading to symptom development and/or persistence. […] Changes in intestinal micro flora could be one of the putative mechanisms responsible for low-grade inflammation. […] Bacterial overgrowth aided by the faecal stasis inside the diverticula could contribute to chronic low-grade inflammation that sensitizes both intrinsic primary efferent and extrinsic primary afferent neurons.

• #45 Colonic diverticular disease. Treatment and prevention | Gastroenterología y Hepatología

  https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-14-articulo-colonic-diverticular-disease-treatment-prevention-S021057051500103X

  Symptoms development in diverticular disease is probably related to complex interactions among genetic features, colon structure, intestinal motility low grade inflammation and postinflammatory hypersensitivity. […] The presence of a chronic, low-grade intestinal inflammation would induce a sensory-motor dysfunction, leading to symptom development and/or persistence. […] Changes in intestinal micro flora could be one of the putative mechanisms responsible for low-grade inflammation. […] Bacterial overgrowth aided by the faecal stasis inside the diverticula could contribute to chronic low-grade inflammation that sensitizes both intrinsic primary efferent and extrinsic primary afferent neurons.

• #46 Diverticular Disease—An Updated Management Review

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

  The „traumatic” theory suggests that the onset of diverticulitis is the result of an acute inflammation due to traumatic damage to a diverticulum. […] The „ischemic” theory suggests that colonic motility, rather than fecal entrapment, causes diverticulitis. […] Studies have identified that the composition of colonic microbiota differs in patients with diverticular disease in comparison to those without. […] Given the variation in theories of pathogenesis and onset, it seems critical to understand a genetic basis for the development of diverticular disease.

• #47 Colonic Diverticular Disease | ASCRS Textbook of Colon and Rectal Surgery

  https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285032/all/Colonic_Diverticular_Disease

  There is some evidence that patients with diverticular disease have lower levels of bacteria that metabolize fiber into short-chain fatty acids (SCFA). […] The fecal microbiome appears to be important to normal gut function. Its role in the pathogenesis of diverticular disease is still to be determined. It is not clear whether the aforementioned changes are causal or simply associated with the development of the disease. […] Although the association between smoking and diverticular disease was once considered controversial, more recent data suggests a strong association. […] The use of non-steroidal anti-inflammatory (NSAID) agents has been associated with the development of multiple gastrointestinal complications. […] A number of retrospective case series have noted increased rates of obesity in patients with diverticulitis, particularly patients under the age of 40.

• #48 Colonic Diverticular Disease | ASCRS Textbook of Colon and Rectal Surgery

  https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285032/all/Colonic_Diverticular_Disease

  There is some evidence that patients with diverticular disease have lower levels of bacteria that metabolize fiber into short-chain fatty acids (SCFA). […] The fecal microbiome appears to be important to normal gut function. Its role in the pathogenesis of diverticular disease is still to be determined. It is not clear whether the aforementioned changes are causal or simply associated with the development of the disease. […] Although the association between smoking and diverticular disease was once considered controversial, more recent data suggests a strong association. […] The use of non-steroidal anti-inflammatory (NSAID) agents has been associated with the development of multiple gastrointestinal complications. […] A number of retrospective case series have noted increased rates of obesity in patients with diverticulitis, particularly patients under the age of 40.

• #49 ClinMed International Library

  https://clinmedjournals.org/articles/ijsrp/ijsrp-2-017.php?jid=ijsrp

  Additionally, an imbalance of the colonic microflora has been suggested as a pathogenic factor in both diverticulosis and diverticulitis. […] The exact cause of colonic wall perforation in the setting of diverticulitis remains largely unknown but four hypotheses have been postulated: Mechanical hypothesis, Enzymatic matrix metalloproteinase (MMP) hypothesis, Immunosuppression hypothesis, Ischemia hypothesis. […] Although not one single hypothesis is widely accepted, many investigators favor a combination of the above. It is my personal opinion that diverticulosis originates from a weakened colonic wall caused by increased luminal pressures, altered motility and structural changes of the colon wall, mainly defective collagen remodeling. I also believe that it is this „defective or altered structure” of the colon wall that serves as a chemotactic stimulus, and therefore, leads to recurrent or persistent inflammation and perforation.

• #50 Epidemiology and Pathophysiology of Diverticular Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2780269/

  Although inflammation is certainly the major component of complicated diverticular disease, including diverticulitis, new evidence suggests that inflammation may also play a role in the early pathogenesis of the disease. […] Nonsteroidal antiinflammatory drugs (NSAIDs) are associated with gastrointestinal complications, especially bleeding in the upper gastrointestinal tract. […] A lack of physical activity and the presence of obesity have been shown to increase the risk of diverticular disease. […] It has been postulated that fiber influences colonic microflora. Recently, the role microflora plays in the development and progression of diverticular disease has been the topic of debate.

• #51 Gut microbiome composition and metabolic activity in women with diverticulitis | Nature Communications

  https://www.nature.com/articles/s41467-024-47859-4

  The etiopathogenesis of diverticulitis, among the most common gastrointestinal diagnoses, remains largely unknown. […] Despite the recent statistics showing that diverticulitis is among the top common gastrointestinal disorders responsible for millions of healthcare encounters, the pathogenesis of diverticulitis remains largely unclear. […] The recent theory of diverticulitis pathogenesis supports a role of gut microbiota in the pathogenesis of this disease as well. […] Acute diverticulitis involves micro- or macro-perforations with translocation of bacteria across the colon mucosal barrier, which sometimes results in systemic inflammation and complications. […] Lifestyle and dietary factors that have been consistently linked to diverticulitis, such as obesity and a Western diet including low fiber intake, have an impact on the composition and function of the gut microbiome, including altered metabolism of short-chain fatty acids and bile acids with attendant intestinal barrier dysfunction, leading to mucosal inflammation and subsequent development of diverticulitis.

• #52 The role of gut microbiota in the pathogenesis of diverticular disease: where are we now? | Genome Medicine | Full Text

  https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-024-01426-0

  Diverticular disease (DD) is widespread worldwide. The role of gut microbiota (GM) in DD is not entirely understood. […] Pathogenesis of DD is still not fully understood. Researchers have also focused on the gut microbiota (GM) in DD. […] This means GM also plays a crucial role in the hosts metabolic functions. […] Although the significance of these changes must be investigated more in-depth, these data suggest that some bacterial species may interact with lifestyle factors in the pathogenesis of diverticulosis. […] Therefore, it is crucial to better understand the role of GM in its pathogenesis and the possible therapeutic implications. […] All of these changes showed the crucial role of GM in the pathogenesis of AD and its severity, which may influence the hosts metabolic activity.

• #53 The role of gut microbiota in the pathogenesis of diverticular disease: where are we now? | Genome Medicine | Full Text

  https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-024-01426-0

  Diverticular disease (DD) is widespread worldwide. The role of gut microbiota (GM) in DD is not entirely understood. […] Pathogenesis of DD is still not fully understood. Researchers have also focused on the gut microbiota (GM) in DD. […] This means GM also plays a crucial role in the hosts metabolic functions. […] Although the significance of these changes must be investigated more in-depth, these data suggest that some bacterial species may interact with lifestyle factors in the pathogenesis of diverticulosis. […] Therefore, it is crucial to better understand the role of GM in its pathogenesis and the possible therapeutic implications. […] All of these changes showed the crucial role of GM in the pathogenesis of AD and its severity, which may influence the hosts metabolic activity.

• #54 Diverticular Disease: An Update on Pathogenesis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5832336/

  Diverticular disease is one of the most common conditions in the Western world and one of the most common findings identified at colonoscopy. The pathogenesis of diverticular disease is thought to be multifactorial and include both environmental and genetic factors in addition to the historically accepted etiology of dietary fiber deficiency. […] Our understanding of the pathogenesis of diverticular disease continues to evolve and is likely to be diverse and multifactorial. The pathogenesis of diverticular disease is multifactorial and not fully understood. However, several factors including colonic wall structure, colonic motility, genetics, fiber intake, vitamin D levels, obesity and physical activity have been studied and thought to influence the pathogenesis of the disease. […] While the pathogenesis of diverticular disease has largely been thought to be due to environmental risk factors such as diet, more recent epidemiologic data point to the additional contribution of genetic factors in the development of diverticular disease. […] In addition to dietary fiber intake, genetics plays a role in the pathogenesis of diverticular disease.

• #55 Diverticular Disease: An Update on Pathogenesis and Management

  https://www.gutnliver.org/journal/view.html?pn=search&uid=1280&vmd=Full

  While the pathogenesis of diverticular disease has largely been thought to be due to environmental risk factors such as diet, more recent epidemiologic data point to the additional contribution of genetic factors in the development of diverticular disease. […] The role of vitamin D has recently been explored in diverticular disease. […] The rate of diverticular disease has increased over the past few decades in conjunction with increasing rates of obesity. Obesity has been often cited as a risk factor for numerous gastrointestinal diseases including diverticulitis. […] Cyclooxygenase inhibitors have a well-known association with increased risk of gastrointestinal bleeding (i.e., ulcers and diverticular) but are also being increasingly recognized as risk factors for diverticulitis and its complications.

• #56 Pathogenesis of Diverticulosis and Diverticular Disease

  https://vitalprd-lb.newcastle.edu.au/vital/access/manager/Repository?view=list&f0=sm_creator%3A%22Torti%2C+Gabriele%22&sort=null

  In this session different problems regarding the pathogenesis of diverticular disease were considered, including Genetics, Neuromuscular function abnormalities, Patterns of mucosa inflammation, and Impact of lifestyle. […] The patients affected by diverticular disease have clear genetic pattern, that might predispose to the occurrence of the disease as well as to its complications. […] Neuromuscular abnormalities may be recognized already at the stage of diverticulosis, and inflammation may explain symptoms occurrence in symptomatic uncomplicated diverticular disease (SUDD) or symptoms persistence after an episode of acute diverticulitis. […] Finally, lifestyle might also have an impact on symptoms occurrence. Specifically smoking, but also obesity seem to play an important role, while the role of low-fiber diet and constipation is now under debate.

• #57 Diverticular disease and diverticulitis: causes, symptoms and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/diverticular-disease-and-diverticulitis-causes-symptoms-and-treatment

  Diverticulosis develops when a section of the mucosa pushes out or herniates through a weak area of muscle in the wall of the colon. The exact mechanism causing this is not known, but is thought to be related to raised intra-colonic pressure in segmented portions of the colon as a result of the contraction of the muscular wall. […] The genetic element in the pathogenesis of diverticular disease has also been substantiated in sibling and twin studies. […] Tursi hypothesised in 2014 about the role of inflammation in the pathogenesis of diverticular disease, ranging from increased inflammatory infiltrate to enhanced expression of the pro-inflammatory cytokine TNF-α. As such, diverticular disease may be considered as a chronic inflammatory process and, therefore, mesalazine may be potential therapeutic tool.

• #58 Colonic Diverticular Disease | ASCRS Textbook of Colon and Rectal Surgery

  https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285032/all/Colonic_Diverticular_Disease

  Our understanding of the pathophysiology of diverticular disease is evolving. […] Many behavioral and environmental factors may influence the development of diverticular disease. […] The progression of normal colonic architecture to diverticulosis and subsequent diverticulitis is not well understood. Multiple lines of evidence suggest that this progression is multifactorial and may involve diet, the microbiome, lifestyle, and genetics. […] A hereditary basis for diverticular disease was suggested by a number of sources. […] Although these clinical observations have been important in establishing a hereditary predisposition to the disease, localization of a specific gene is still in flux. […] Several authors have postulated that an altered microbiome could influence the pathogenesis of diverticulitis.

• #59 Colonic Diverticular Disease | ASCRS Textbook of Colon and Rectal Surgery

  https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285032/all/Colonic_Diverticular_Disease

  Our understanding of the pathophysiology of diverticular disease is evolving. […] Many behavioral and environmental factors may influence the development of diverticular disease. […] The progression of normal colonic architecture to diverticulosis and subsequent diverticulitis is not well understood. Multiple lines of evidence suggest that this progression is multifactorial and may involve diet, the microbiome, lifestyle, and genetics. […] A hereditary basis for diverticular disease was suggested by a number of sources. […] Although these clinical observations have been important in establishing a hereditary predisposition to the disease, localization of a specific gene is still in flux. […] Several authors have postulated that an altered microbiome could influence the pathogenesis of diverticulitis.

• #60 Pathogenesis of diverticulosis and diverticular disease – Minerva Gastroenterologica e Dietologica 2017 June;63(2):99-109 – Minerva Medica – Journals

  https://www.minervamedica.it/en/journals/gastroenterology/article.php?cod=R08Y2017N02A0099

  Diverticulosis is defined by the presence of diverticula due to herniation of mucosa and muscularis mucosa through the muscularis propria at sites of vascular penetration in the colon and is asymptomatic in the vast majority affected. […] Diverticular disease is defined as clinically significant and symptomatic diverticulosis, which may have an absence of macroscopically overt colitis and in true diverticulitis there is macroscopic inflammation of diverticula with related acute or chronic complications. […] Diverticulosis is one of the most common chronic diseases, yet research in this field on pathogenesis has lagged behind other common conditions such as diabetes mellitus. […] It has been shown there is an association with age, diet, drugs and smoking. […] Genetic studies have shown a familial association and a specific gene, TNFSF 15 may predict severity of disease.

• #61 Diverticulitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/173388-overview

  Diverticular disease (diverticulosis, diverticulitis) is a general term that refers to the presence of diverticula, small pouches in the large intestinal (colonic) wall. These outpouchings arise when the inner layers of the colon push through weaknesses in the outer muscular layers. […] The cause of diverticulosis is unclear, but it has been associated with increased pressure from constipation or increasing abdominal girth in obesity. The classic high-fat and low-fiber diet of the Western culture may be a major contributor to the development of diverticulosis. The low-fiber diet is thought to predispose to diverticulosis owing to a slower fecal transit time and smaller stool weight. […] Diverticulitis is defined as an inflammation of one or more diverticula. Its pathogenesis remains unclear. Fecal material or undigested food particles may collect in a diverticulum, causing obstruction. This obstruction may result in distention of the diverticula secondary to mucous secretion and overgrowth of normal colonic bacteria. Vascular compromise and subsequent microperforation or macroperforation then ensue. Alternatively, some investigators believe that increased intraluminal pressure or inspissated food particles cause erosion of the diverticular wall, resulting in inflammation, focal necrosis, and perforation. […] It has been postulated that diverticulitis may also result from alterations in immune responses and in the intestinal bacteria, or gut microbiome.

• #62 Epidemiology and Pathophysiology of Diverticular Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2780269/

  Although inflammation is certainly the major component of complicated diverticular disease, including diverticulitis, new evidence suggests that inflammation may also play a role in the early pathogenesis of the disease. […] Nonsteroidal antiinflammatory drugs (NSAIDs) are associated with gastrointestinal complications, especially bleeding in the upper gastrointestinal tract. […] A lack of physical activity and the presence of obesity have been shown to increase the risk of diverticular disease. […] It has been postulated that fiber influences colonic microflora. Recently, the role microflora plays in the development and progression of diverticular disease has been the topic of debate.

• #63 Diverticular Disease: An Update on Pathogenesis and Management

  https://www.gutnliver.org/journal/view.html?pn=search&uid=1280&vmd=Full

  While the pathogenesis of diverticular disease has largely been thought to be due to environmental risk factors such as diet, more recent epidemiologic data point to the additional contribution of genetic factors in the development of diverticular disease. […] The role of vitamin D has recently been explored in diverticular disease. […] The rate of diverticular disease has increased over the past few decades in conjunction with increasing rates of obesity. Obesity has been often cited as a risk factor for numerous gastrointestinal diseases including diverticulitis. […] Cyclooxygenase inhibitors have a well-known association with increased risk of gastrointestinal bleeding (i.e., ulcers and diverticular) but are also being increasingly recognized as risk factors for diverticulitis and its complications.

• #64 Colonic Diverticular Disease | ASCRS Textbook of Colon and Rectal Surgery

  https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285032/all/Colonic_Diverticular_Disease

  There is some evidence that patients with diverticular disease have lower levels of bacteria that metabolize fiber into short-chain fatty acids (SCFA). […] The fecal microbiome appears to be important to normal gut function. Its role in the pathogenesis of diverticular disease is still to be determined. It is not clear whether the aforementioned changes are causal or simply associated with the development of the disease. […] Although the association between smoking and diverticular disease was once considered controversial, more recent data suggests a strong association. […] The use of non-steroidal anti-inflammatory (NSAID) agents has been associated with the development of multiple gastrointestinal complications. […] A number of retrospective case series have noted increased rates of obesity in patients with diverticulitis, particularly patients under the age of 40.

• #65 Pathogenesis of Diverticulosis and Diverticular Disease

  https://vitalprd-lb.newcastle.edu.au/vital/access/manager/Repository?view=list&f0=sm_creator%3A%22Torti%2C+Gabriele%22&sort=null

  In this session different problems regarding the pathogenesis of diverticular disease were considered, including Genetics, Neuromuscular function abnormalities, Patterns of mucosa inflammation, and Impact of lifestyle. […] The patients affected by diverticular disease have clear genetic pattern, that might predispose to the occurrence of the disease as well as to its complications. […] Neuromuscular abnormalities may be recognized already at the stage of diverticulosis, and inflammation may explain symptoms occurrence in symptomatic uncomplicated diverticular disease (SUDD) or symptoms persistence after an episode of acute diverticulitis. […] Finally, lifestyle might also have an impact on symptoms occurrence. Specifically smoking, but also obesity seem to play an important role, while the role of low-fiber diet and constipation is now under debate.

• #66 Epidemiology and Pathophysiology of Diverticular Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2780269/

  Although inflammation is certainly the major component of complicated diverticular disease, including diverticulitis, new evidence suggests that inflammation may also play a role in the early pathogenesis of the disease. […] Nonsteroidal antiinflammatory drugs (NSAIDs) are associated with gastrointestinal complications, especially bleeding in the upper gastrointestinal tract. […] A lack of physical activity and the presence of obesity have been shown to increase the risk of diverticular disease. […] It has been postulated that fiber influences colonic microflora. Recently, the role microflora plays in the development and progression of diverticular disease has been the topic of debate.

• #67 Diverticular Disease: An Update on Pathogenesis and Management

  https://www.gutnliver.org/journal/view.html?pn=search&uid=1280&vmd=Full

  While the pathogenesis of diverticular disease has largely been thought to be due to environmental risk factors such as diet, more recent epidemiologic data point to the additional contribution of genetic factors in the development of diverticular disease. […] The role of vitamin D has recently been explored in diverticular disease. […] The rate of diverticular disease has increased over the past few decades in conjunction with increasing rates of obesity. Obesity has been often cited as a risk factor for numerous gastrointestinal diseases including diverticulitis. […] Cyclooxygenase inhibitors have a well-known association with increased risk of gastrointestinal bleeding (i.e., ulcers and diverticular) but are also being increasingly recognized as risk factors for diverticulitis and its complications.

• #68 Colonic Diverticular Disease | ASCRS Textbook of Colon and Rectal Surgery

  https://www.ascrsu.com/ascrs/view/ASCRS-Textbook-of-Colon-and-Rectal-Surgery/2285032/all/Colonic_Diverticular_Disease

  There is some evidence that patients with diverticular disease have lower levels of bacteria that metabolize fiber into short-chain fatty acids (SCFA). […] The fecal microbiome appears to be important to normal gut function. Its role in the pathogenesis of diverticular disease is still to be determined. It is not clear whether the aforementioned changes are causal or simply associated with the development of the disease. […] Although the association between smoking and diverticular disease was once considered controversial, more recent data suggests a strong association. […] The use of non-steroidal anti-inflammatory (NSAID) agents has been associated with the development of multiple gastrointestinal complications. […] A number of retrospective case series have noted increased rates of obesity in patients with diverticulitis, particularly patients under the age of 40.

• #69 Diverticular Disease and Diverticulitis | Doctor

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

  Diverticula can occur throughout the gastrointestinal tract, but are seen most commonly in the sigmoid and descending colon. A diverticulum consists of a herniation of mucosa through the thickened colonic muscle. Diverticulitis is defined as evidence of diverticular inflammation (fever, tachycardia) with or without localised symptoms and signs. […] 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. […] The risk of perforation may be increased by the use of NSAIDs and long-term use of opioids. […] Most patients admitted with acute diverticulitis will respond to conservative treatment, but 15-30% will need surgery. The indications for surgery are: purulent or faecal peritonitis, uncontrolled sepsis, fistula, obstruction, inability to exclude carcinoma.

• #70

  https://bpac.org.nz/2023/diverticulitis.aspx

  The place of bacterial infection in the pathogenesis of diverticulitis is also being questioned as most cases of mild, uncomplicated diverticulitis resolve spontaneously, and antibiotics do not speed up recovery or reduce the risk of complications. […] For people who already have diverticulosis, risk factors that influence the development of acute diverticulitis include: Increasing age, Western diets, high in red meat and refined grains and low in fibre, Obesity, specifically central obesity, Smoking, Medicines including NSAIDs, opioids and corticosteroids, Family history and genetics. […] Insufficient clinical evidence for the use of antibiotics in patients with mild symptoms, combined with wider acceptance of an inflammatory aetiology of acute diverticulitis, drives this change in clinical practice.

• #71 Diverticular Disease: An Update on Pathogenesis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5832336/

  Diverticular disease is one of the most common conditions in the Western world and one of the most common findings identified at colonoscopy. The pathogenesis of diverticular disease is thought to be multifactorial and include both environmental and genetic factors in addition to the historically accepted etiology of dietary fiber deficiency. […] Our understanding of the pathogenesis of diverticular disease continues to evolve and is likely to be diverse and multifactorial. The pathogenesis of diverticular disease is multifactorial and not fully understood. However, several factors including colonic wall structure, colonic motility, genetics, fiber intake, vitamin D levels, obesity and physical activity have been studied and thought to influence the pathogenesis of the disease. […] While the pathogenesis of diverticular disease has largely been thought to be due to environmental risk factors such as diet, more recent epidemiologic data point to the additional contribution of genetic factors in the development of diverticular disease. […] In addition to dietary fiber intake, genetics plays a role in the pathogenesis of diverticular disease.

• #72 Diverticular Disease: An Update on Pathogenesis and Management

  https://www.gutnliver.org/journal/view.html?pn=search&uid=1280&vmd=Full

  Diverticular disease is one of the most common conditions in the Western world and one of the most common findings identified at colonoscopy. Recently, there has been a significant paradigm shift in our understanding of diverticular disease and its management. The pathogenesis of diverticular disease is thought to be multifactorial and include both environmental and genetic factors in addition to the historically accepted etiology of dietary fiber deficiency. […] Our understanding of the pathogenesis of diverticular disease continues to evolve and is likely to be diverse and multifactorial. […] The pathogenesis of diverticular disease is multifactorial and not fully understood. However, several factor including colonic wall structure, colonic motility, genetics, fiber intake, vitamin D levels, obesity and physical activity have been studied and thought to influence the pathogenesis of the disease.

• #73 Diverticular Disease: An Update on Pathogenesis and Management

  https://www.gutnliver.org/journal/view.html?pn=search&uid=1280&vmd=Full

  For decades, antibiotics have been the cornerstone of acute diverticulitis treatment. This was mainly due to the prevailing belief that diverticulitis was due to obstruction of a diverticulum leading to mucosal abrasions, micro-perforation and translocation of bacteria. […] Diverticular disease is a complex disease process with a number of paradigm shifts in recent years in regards to its pathogenesis and management. Much of our accepted understanding of diverticular disease has been challenged, including the role of fiber in etiology, as well as risk factors beyond fiber deficiency, such as genetics, exercise, and perhaps even low vitamin D levels.

• #74 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. […] 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.

• #75 Diverticular Disease—An Updated Management Review

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

  Diverticular disease is highly prevalent in the Western world, placing an increased burden on healthcare systems. […] Multiple theories contribute to our understanding of the etiology of the disease, with pathogenesis affected by age, diet, environmental conditions, lifestyle, the microbiome, genetics, and motility. […] Though still widely debated, the underlying pathological mechanisms that result in the formation of colonic diverticula and the subsets of diverticular disease are likely due to complex interactions among age, colonic motility, diet, colonic microbiota, genetic factors, and changes in colonic structure. […] Diverticulitis is likely due to chronic inflammation, especially considering that many of its risk factors, such as obesity, lack of exercise, and consuming a processed-grain, high red meat diet are associated with systemic inflammation.

• #76 Management of Diverticular Disease

  https://www.uspharmacist.com/article/management-of-diverticular-disease

  A high-fiber diet can alleviate symptoms of diverticular disease (diverticulosis and diverticulitis) and prevent recurrence of acute diverticulitis. […] There is now thought to be an overlap between chronic diverticular inflammation and the inflammation of IBD. […] Segmental colitis associated with diverticula (SCAD) is a chronic condition occurring in the areas of the colon with diverticular formation. […] The inflammation associated with SCAD typically affects the mucosa between the diverticula and not the diverticula themselves.

• #77

  https://journals.lww.com/jcge/fulltext/2011/04001/Antibiotics_and_Probiotics_in_the_Treatment_of.11.aspx?generateEpub=Article%7Cjcge:2011:04001:00011%7C10.1097/mcg.0b013e318210c784%7C

  Diverticular disease is one of the most common diseases of Western industrialized countries, and it may be associated with numerous abdominal symptoms (including pain, bloating, nausea, diarrhea, and constipation). […] Changing concepts on pathophysiology of the disease suggest that diverticular disease may share many of the hallmarks of the inflammatory bowel diseases. […] On this basis, a new therapeutic approach based on mesalazine and probiotics may enhance treatment efficacy in shortening the course of the disease and in preventing recurrences.

• #78 Diverticular disease – Wikipedia

  https://en.wikipedia.org/wiki/Diverticular_disease

  Similar to the diverticulitis ischemia theory above, SUDD is thought to be caused by sustained colonic contraction leading to mucosal ischemia within the diverticulum. […] Low grade inflammation of the colonic mucosa within the diverticulum and visceral hypersensitivity are also thought to cause SUDD. […] SCAD, also known as diverticular colitis, is when there is mucosal inflammation in a colonic segment with diverticulosis that may or may not have evidence of diverticulitis, or inflammation within or around a diverticulum itself. The cause is currently unknown. It is thought to be multi-factorial, including colonic ischemia secondary to old age and other cardiovascular risk factors, diverticulosis causing mucosal prolapse, fecal stasis and subsequent microbiome disturbance, eventually leading to inflammation of the colon segment.

• #79 Diverticular Disease | Division of Gastroenterology

  https://gastro.uw.edu/research/Diverticular

  In diverticular disease, small bulges or pockets (diverticula) develop in the lining of the intestine. Diverticulitis is when these pockets become inflamed or infected. […] Research in diverticular disease by our faculty has led to a better understanding of the natural history of diverticular disease and the phenotyping of patients who have diverticular disease. […] Studies of diet and plasma inflammatory markers suggest that chronic, systemic inflammation is a potential mechanism that underlies the dietary effects on diverticulitis development. […] Her work has informed guidelines, changed dietary recommendations, and formed the basis of current medical measures for prevention of diverticulitis. She has also established seminal data regarding the role of chronic inflammation and the gut microbiome in diverticulitis.

• #80 Diverticular Disease | Division of Gastroenterology

  https://gastro.uw.edu/research/Diverticular

  In diverticular disease, small bulges or pockets (diverticula) develop in the lining of the intestine. Diverticulitis is when these pockets become inflamed or infected. […] Research in diverticular disease by our faculty has led to a better understanding of the natural history of diverticular disease and the phenotyping of patients who have diverticular disease. […] Studies of diet and plasma inflammatory markers suggest that chronic, systemic inflammation is a potential mechanism that underlies the dietary effects on diverticulitis development. […] Her work has informed guidelines, changed dietary recommendations, and formed the basis of current medical measures for prevention of diverticulitis. She has also established seminal data regarding the role of chronic inflammation and the gut microbiome in diverticulitis.

• #81 Diverticular Disease: An Update on Pathogenesis and Management

  https://www.gutnliver.org/journal/view.html?pn=search&uid=1280&vmd=Full

  While the pathogenesis of diverticular disease has largely been thought to be due to environmental risk factors such as diet, more recent epidemiologic data point to the additional contribution of genetic factors in the development of diverticular disease. […] The role of vitamin D has recently been explored in diverticular disease. […] The rate of diverticular disease has increased over the past few decades in conjunction with increasing rates of obesity. Obesity has been often cited as a risk factor for numerous gastrointestinal diseases including diverticulitis. […] Cyclooxygenase inhibitors have a well-known association with increased risk of gastrointestinal bleeding (i.e., ulcers and diverticular) but are also being increasingly recognized as risk factors for diverticulitis and its complications.

• #82 The role of gut microbiota in the pathogenesis of diverticular disease: where are we now? | Genome Medicine | Full Text

  https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-024-01426-0

  However, several points must be addressed. […] We think comprehending the metabolic activity arising from the relationship between host characteristics and GM will be necessary to define who is at risk of AD and, therefore, must be treated (and, of course, how it must be treated). […] Therefore, microbiomics and metabolomic studies could be the future in this setting, which may aid physicians in selecting patients at risk (such as those obesity or specific endoscopic damage) who need to be treated and followed up.

• #83 Diverticulitis

  https://www.uspharmacist.com/article/diverticulitis

  New therapies are continuously being investigated to treat diverticulitis. As we learn more about this common disease, our ability to maintain the health of our geriatric population improves. The concept that this disease is primarily inflammatory has sparked interest in the use of mesalamine and probiotics.

• #84

  https://journals.lww.com/jcge/fulltext/2011/04001/Antibiotics_and_Probiotics_in_the_Treatment_of.11.aspx?generateEpub=Article%7Cjcge:2011:04001:00011%7C10.1097/mcg.0b013e318210c784%7C

  Diverticular disease is one of the most common diseases of Western industrialized countries, and it may be associated with numerous abdominal symptoms (including pain, bloating, nausea, diarrhea, and constipation). […] Changing concepts on pathophysiology of the disease suggest that diverticular disease may share many of the hallmarks of the inflammatory bowel diseases. […] On this basis, a new therapeutic approach based on mesalazine and probiotics may enhance treatment efficacy in shortening the course of the disease and in preventing recurrences.

• #85 Diverticular disease and diverticulitis: causes, symptoms and treatment – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/diverticular-disease-and-diverticulitis-causes-symptoms-and-treatment

  Diverticulosis develops when a section of the mucosa pushes out or herniates through a weak area of muscle in the wall of the colon. The exact mechanism causing this is not known, but is thought to be related to raised intra-colonic pressure in segmented portions of the colon as a result of the contraction of the muscular wall. […] The genetic element in the pathogenesis of diverticular disease has also been substantiated in sibling and twin studies. […] Tursi hypothesised in 2014 about the role of inflammation in the pathogenesis of diverticular disease, ranging from increased inflammatory infiltrate to enhanced expression of the pro-inflammatory cytokine TNF-α. As such, diverticular disease may be considered as a chronic inflammatory process and, therefore, mesalazine may be potential therapeutic tool.

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