Materiały źródłowe

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

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

  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. […] Diverticula of the colon are mucosal herniations in the colon wall muscle layer through (relatively weaker) points of entry of blood vessels through the colonic wall and are more commonly found in the sigmoid colon in the Western world. Although its pathogenesis remains poorly elucidated, it is likely to be multifactorial. […] 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.

• #1 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. 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.

• #1 Diverticulitis: Practice Essentials, Background, Pathophysiology

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

  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. Diverticulitis is frequently mild when pericolic fat and mesentery wall off a small perforation. However, larger perforations and more extensive disease lead to abscess formation and, rarely, intestinal rupture or peritonitis.

• #1 ClinMed International Library

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

  Diffuse ischemia of a colonic segment with diverticulosis has also been described as a contributing factor in the development of diverticular inflammation, especially in colonic segments with multiple diverticula that alter the intramural vascular distribution. 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.

• #1 Diverticulitis: Practice Essentials, Background, Pathophysiology

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

  It has been postulated that diverticulitis may also result from alterations in immune responses and in the intestinal bacteria, or gut microbiome. As small tears develop in the colon and become inflamed/infected, diverticulitis results. The microbiome is a prominent area of focus in current research. Investigators hope to isolate and grow bacteria from stool samples of individuals with asymptomatic diverticulosis and those with acute diverticulitis. Should these bacterial populations statistically differ, it may help clinicians to understand which patients are at a greater risk of developing diverticulitis. It may also allow the treatment of such changes in microbiota and the prevention of complicated disease.

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

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

  In addition to dietary fiber intake, genetics plays a role in the pathogenesis of diverticular disease. […] As previously mentioned, the prevailing paradigm in the development of diverticulosis focused on low dietary fiber intake resulting in higher intracolonic pressures. However, this notion has become more controversial. […] 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. […] Physical activity has been studied in many gastrointestinal disorders and proposed to reduce risk of colon cancer and other gastrointestinal disorder through decreased transit time, inflammation and/or colon pressure, which are similar mechanisms at play in diverticular disease.

• #1 Epidemiology, Pathophysiology, and Treatment of Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6716971/

  Several studies have associated diverticulitis with a chronic inflammatory state. […] Alterations in the gut microbiota are implicated in the pathogenesis of many intestinal disorders. […] Diet and lifestyle factors may induce alterations in the gut microbiome that lead to mucosal inflammation and diverticulitis. […] A genome-wide association study in Iceland and Denmark identified variants in genes that associated with diverticular disease. […] Localized high-pressure zones in the colon were originally believed to lead to formation of diverticula at weak spots in the colonic musculature.

• #1 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.

• #1 Tissue remodeling as a primary mechanism for diverticula formation

  https://medicalxpress.com/news/2024-03-tissue-remodeling-primary-mechanism-diverticula.html

  Tissue remodeling is a primary mechanism for diverticula formation. […] A new study, published in the journal Gut now suggests that tissue remodeling is a primary mechanism for diverticula formation. […] Researchers conducted DNA and RNA sequencing on colonic tissue from 404 patients. Results showed 38 genes with differential expression and 17 with varied transcript usage linked to diverticulosis. Additionally, diverticulosis severity was positively correlated with genetic predisposition to diverticulitis. […] Peery and colleagues linked the formation of diverticula to stromal and epithelial cells in the colon, particularly endothelial cells, myofibroblasts, fibroblasts, goblet, tuft, enterocytes, neurons, and glia. […] Interestingly, the researchers confirmed that the gene ENTPD7 was over-expressed in diverticulosis cases. […] In addition, the study showed that individuals with an increased genetic proclivity to diverticulitis show larger numbers of diverticula upon colonoscopy.

• #1 Management of Colonic Diverticulitis | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/diverticulitis/protocol

  Colonic diverticulitis is caused by inflammation of abnormal outpouchings (diverticula) in the wall of the large intestine. The precursor to diverticulitis is diverticulosis, in which the diverticula are not inflamed. […] Symptoms of diverticulitis typically involve acute or subacute lower abdominal pain, often associated with nausea, diarrhea, or constipation. While early studies suggested that diverticulitis is a recurrent disease of a progressive nature, more recent studies in the era of improved medical treatment and more reliable diagnostic imaging suggest the natural history is more benign. […] Acute episodes of diverticulitis may be complicated or uncomplicated. Complications are mostly caused by small or large perforations to the diverticula, which may introduce gut bacteria into the peritoneal space.

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

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16552

  As previously mentioned, the prevailing paradigm in the development of diverticulosis focused on low dietary fiber intake resulting in higher intracolonic pressures. However, this notion has become more controversial. […] 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. […] 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.

• #2 Epidemiology, Pathophysiology, and Treatment of Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6716971/

  Diverticulitis is a prevalent gastrointestinal disorder that is associated with significant morbidity and health care costs. […] Several risk factors, many of which are modifiable, have been identified including obesity, diet, and physical inactivity. Diet and lifestyle factors could affect risk of diverticulitis through their effects on the intestinal microbiome and inflammation. […] Genetic factors, as well as alterations in colonic neuromusculature, can also contribute to the development of diverticulitis. […] The pathophysiology of diverticulitis is incompletely understood. Long-standing but unproven theories suggest that diverticulitis results from obstruction and trauma to a diverticulum with subsequent ischemia, microperforation, and infection. […] More recent studies indicated that nut and seed consumption do not increase risk of diverticulitis, and that antibiotics may not hasten recovery or improve outcomes. These findings have led to models of diverticulitis pathogenesis that involve chronic inflammation and alterations in the gut microbiome.

• #2 Sigmoid diverticulitis: US findings | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/2036-7902-5-S1-S5

  Diverticulitis results from occlusion of a colonic diverticulum by stool, inflammation, or food particles, causing a microperforation and surrounding pericolic inflammation. A colonic diverticulum is a herniation of mucosa and submucosa, corresponding to a weak point where the vasa recti penetrate the tunica muscularis, so most colonic diverticula are false diverticula containing no muscularis propria. In 1965 Painter et al. presented the hypothesis that diverticular disease was caused by excess pressure in the colon due to segmentation based on insufficient intake of dietary fibre. In the Western world diverticulosis occurs primarily in the sigmoid colon, corresponding to the highest intraluminal pressure, where they are often associated with other typical findings of diverticular disease (i.e. muscularis propria thickening, shortening and narrowing of the lumen). The incidence for diverticulosis is 3366%, of these patients, 1025% will develop an acute episode of diverticulitis. Other risk factors are: obesity (BMI30), use of non-steroidal anti-inflammatory drugs or acetaminophen; smoking was not significantly associated with symptomatic diverticular disease, and a genetic predisposition was not proved yet. Retention of fecal matter within the diverticulum due to an occlusion may produce a mucosal abrasion resulting in infection or inflammation of the diverticulum wall (diverticulitis). The process may realise a focal intramural inflammatory mass or abscess, infiltrate along the bowel wall to produce an inflammatory bowel segment, and perforate into sigmoid mesentery where the process is usually contained. Therefore its presentation may vary greatly per individual patient, from symptomatic diverticulosis to perforated diverticulitis, even if the majority of individuals with diverticulosis are asymptomatic. However, perforation can cause intraperitoneal contamination that is associated with a much higher morbidity and mortality. From 1978 until today different classifications were proposed for the staging of acute complicated diverticolitis; first Hinchey that proposed a classification in 4 stages, developed to predict outcomes following the surgical management of complicated diverticular disease (perforated disease) (stage I: mesocolic/pericolic abscess; stage II: pelvic abscess; stage III generalized peritonitis; stage IV faecal peritonitis). Then the much more detailed information provided by CT scans led earlier to modifications of the original Hinchey classification. Subcategories could be defined considering the radiological findings. In 1997 Sher et al introduced the first modification for distinguishing between pericolic abscesses (stage I), distant abscesses amendable for percutaneous drainage (stage IIa), and complex abscesses associated with a possible fistula (stage IIb). This modification also implied the use of new treatment strategies such as CT-guided percutaneous drainage of abscesses. From these, several other classifications have been made (Wasvary et al. in 1999, Kohler et al in 1999, Siewert et al in 1995), among that deserve mention the Hansen/Stock classification and Kohler et al classification, both based on the clinical severity and presentation of disease. Finally in 2002 Ambrosetti et al. proposed a simplified staging of acute diverticulitis based on CT criteria and showed its prognostic significance in a prospective study: moderate diverticulitis defined by localized sigmoid wall thickening (5mm) with pericolic fat stranding, and severe diverticulitis defined by wall thickening accompanied by abscess, extraluminal air or extraluminal contrast. More recently Klarenbeek et al have proposed a new classification arranged in three stages of differentiating diverticula disease: a) uncomplicated, b) chronic complicated, and c) acute complicated, and according both clinical and radiological findings in addition to treatment modalities, in order to guide the clinical management and form the basis of a practice parameter for diverticular disease.

• #2 Diverticulitis: Practice Essentials, Background, Pathophysiology

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

  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. Diverticulitis is frequently mild when pericolic fat and mesentery wall off a small perforation. However, larger perforations and more extensive disease lead to abscess formation and, rarely, intestinal rupture or peritonitis.

• #2 Patient education: Diverticular disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diverticular-disease-beyond-the-basics

  A diverticulum is a pouch-like structure that can form through points of weakness in the muscular wall of the colon (ie, at points where blood vessels pass through the wall). […] Inflammation of a diverticulum (diverticulitis) occurs when there is thinning and breakdown of the diverticular wall. This may be caused by increased pressure within the colon or by hardened particles of stool, which can become lodged within the diverticulum. […] Complications associated with diverticulitis can include the following: Abscess – a localized collection of pus, Fistula – an abnormal tract between two areas that are not normally connected (eg, bowel and bladder), Obstruction – a blockage of the colon, Peritonitis – infection involving the space around the abdominal organ, Sepsis – overwhelming body-wide infection that can lead to failure of multiple organs.

• #2 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. […] In light of these exciting results, we aimed to summarize current knowledge on the role of GM in the pathogenesis of DD. […] AD is the stage of the disease in which the GM is better profiled. This is probably because AD is the stage of DD with considerable morbidity and non-negligible mortality. 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.

• #2 Epidemiology, Pathophysiology, and Treatment of Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6716971/

  Several studies have associated diverticulitis with a chronic inflammatory state. […] Alterations in the gut microbiota are implicated in the pathogenesis of many intestinal disorders. […] Diet and lifestyle factors may induce alterations in the gut microbiome that lead to mucosal inflammation and diverticulitis. […] A genome-wide association study in Iceland and Denmark identified variants in genes that associated with diverticular disease. […] Localized high-pressure zones in the colon were originally believed to lead to formation of diverticula at weak spots in the colonic musculature.

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

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16552

  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. […] Diverticula of the colon are mucosal herniations in the colon wall muscle layer through (relatively weaker) points of entry of blood vessels through the colonic wall and are more commonly found in the sigmoid colon in the Western world. Although its pathogenesis remains poorly elucidated, it is likely to be multifactorial. […] 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.

• #2 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. […] 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.

• #2 MDCT of acute diverticulitis: protocols, common and uncommon CT findings, grading, differential diagnosis and management.

  https://epos.myesr.org/poster/esr/ecr2016/C-0816/background

  Colonic diverticula are false diverticula (pseudodiverticula). They are thought to be secondary to a localized weakness in the colonic wall where the vasa recta penetrate the circular muscular layer. […] Anomalies of colonic motility have also been identified. They consist of intense segmental contractions and might be related to up-regulation of M3 receptors. To note, Laplaces Law (P=kT/R; where P=pressure, T=tension and R=radius) would explain why the sigmoid colon is the most affected segment given that is the one with the smallest radius. […] Other factors such as mural thickening and changes in the collagen fibers can contribute to explain the pathogenesis of diverticulosis. […] Acute diverticulitis will develop when there is micro or macroperforation of colonic diverticula. […] Classically, it was proposed that the cascade of events begins when a fecalith obstructs the neck of the diverticula. This would facilitate bacterial overgrowth that eventually will produce local ischemia and perforation. More recent theories propose direct wall erosion produced by an increase in intraluminal pressure.

• #2 Peery Authors Genetic and Transcriptomic Landscape of Colonic Diverticulosis | Newsroom

  https://news.unchealthcare.org/2024/03/peery-authors-genetic-and-transcriptomic-landscape-of-colonic-diverticulosis/

  Researchers led by Anne Peery, MD, at the UNC School of Medicine, suggest that tissue remodeling is a primary mechanism for the development of colonic diverticulitis, a debilitating gastrointestinal condition. […] A study, published in the journal Gut in the BMJ family of journals now suggests that tissue remodeling is a primary mechanism for diverticula formation. […] Additionally, diverticulosis severity was positively correlated with genetic predisposition to diverticulitis. […] In addition, the study showed that individuals with an increased genetic proclivity to diverticulitis show larger numbers of diverticula upon colonoscopy.

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

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16552

  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. […] Diverticula of the colon are mucosal herniations in the colon wall muscle layer through (relatively weaker) points of entry of blood vessels through the colonic wall and are more commonly found in the sigmoid colon in the Western world. Although its pathogenesis remains poorly elucidated, it is likely to be multifactorial. […] 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.

• #3 Sigmoid diverticulitis: US findings | springermedizin.de

  https://www.springermedizin.de/sigmoid-diverticulitis-us-findings/9675674

  Diverticulitis results from occlusion of a colonic diverticulum by stool, inflammation, or food particles, causing a microperforation and surrounding pericolic inflammation. […] A colonic diverticulum is a herniation of mucosa and submucosa, corresponding to a weak point where the vasa recti penetrate the tunica muscularis, so most colonic diverticula are false diverticula containing no muscularis propria. […] In 1965 Painter et al. presented the hypothesis that diverticular disease was caused by excess pressure in the colon due to segmentation based on insufficient intake of dietary fibre. […] In the Western world diverticulosis occurs primarily in the sigmoid colon, corresponding to the highest intraluminal pressure, where they are often associated with other typical findings of diverticular disease (i.e. muscularis propria thickening, shortening and narrowing of the lumen).

• #3 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.

• #3 Diverticulitis: Practice Essentials, Background, Pathophysiology

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

  It has been postulated that diverticulitis may also result from alterations in immune responses and in the intestinal bacteria, or gut microbiome. As small tears develop in the colon and become inflamed/infected, diverticulitis results. The microbiome is a prominent area of focus in current research. Investigators hope to isolate and grow bacteria from stool samples of individuals with asymptomatic diverticulosis and those with acute diverticulitis. Should these bacterial populations statistically differ, it may help clinicians to understand which patients are at a greater risk of developing diverticulitis. It may also allow the treatment of such changes in microbiota and the prevention of complicated disease.

• #3 Epidemiology, Pathophysiology, and Treatment of Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6716971/

  Several studies have associated diverticulitis with a chronic inflammatory state. […] Alterations in the gut microbiota are implicated in the pathogenesis of many intestinal disorders. […] Diet and lifestyle factors may induce alterations in the gut microbiome that lead to mucosal inflammation and diverticulitis. […] A genome-wide association study in Iceland and Denmark identified variants in genes that associated with diverticular disease. […] Localized high-pressure zones in the colon were originally believed to lead to formation of diverticula at weak spots in the colonic musculature.

• #3 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

  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. Hall demonstrated that a family history of diverticular disease is associated with a higher risk of recurrence in patients with an incident case of diverticulitis. […] Although these clinical observations have been important in establishing a hereditary predisposition to the disease, localization of a specific gene is still in flux. A recent genome-wide association study identified several gene variants (COLQ, ARHGAP15, and FAM155A) that may contribute to diverticular disease.

• #3 Epidemiology, Pathophysiology, and Treatment of Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6716971/

  Diverticulitis is a prevalent gastrointestinal disorder that is associated with significant morbidity and health care costs. […] Several risk factors, many of which are modifiable, have been identified including obesity, diet, and physical inactivity. Diet and lifestyle factors could affect risk of diverticulitis through their effects on the intestinal microbiome and inflammation. […] Genetic factors, as well as alterations in colonic neuromusculature, can also contribute to the development of diverticulitis. […] The pathophysiology of diverticulitis is incompletely understood. Long-standing but unproven theories suggest that diverticulitis results from obstruction and trauma to a diverticulum with subsequent ischemia, microperforation, and infection. […] More recent studies indicated that nut and seed consumption do not increase risk of diverticulitis, and that antibiotics may not hasten recovery or improve outcomes. These findings have led to models of diverticulitis pathogenesis that involve chronic inflammation and alterations in the gut microbiome.

• #3 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. […] 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.

• #3 MDCT of acute diverticulitis: protocols, common and uncommon CT findings, grading, differential diagnosis and management.

  https://epos.myesr.org/poster/esr/ecr2016/C-0816/background

  Colonic diverticula are false diverticula (pseudodiverticula). They are thought to be secondary to a localized weakness in the colonic wall where the vasa recta penetrate the circular muscular layer. […] Anomalies of colonic motility have also been identified. They consist of intense segmental contractions and might be related to up-regulation of M3 receptors. To note, Laplaces Law (P=kT/R; where P=pressure, T=tension and R=radius) would explain why the sigmoid colon is the most affected segment given that is the one with the smallest radius. […] Other factors such as mural thickening and changes in the collagen fibers can contribute to explain the pathogenesis of diverticulosis. […] Acute diverticulitis will develop when there is micro or macroperforation of colonic diverticula. […] Classically, it was proposed that the cascade of events begins when a fecalith obstructs the neck of the diverticula. This would facilitate bacterial overgrowth that eventually will produce local ischemia and perforation. More recent theories propose direct wall erosion produced by an increase in intraluminal pressure.

• #3 Tissue remodeling as a primary mechanism for diverticula formation

  https://medicalxpress.com/news/2024-03-tissue-remodeling-primary-mechanism-diverticula.html

  Tissue remodeling is a primary mechanism for diverticula formation. […] A new study, published in the journal Gut now suggests that tissue remodeling is a primary mechanism for diverticula formation. […] Researchers conducted DNA and RNA sequencing on colonic tissue from 404 patients. Results showed 38 genes with differential expression and 17 with varied transcript usage linked to diverticulosis. Additionally, diverticulosis severity was positively correlated with genetic predisposition to diverticulitis. […] Peery and colleagues linked the formation of diverticula to stromal and epithelial cells in the colon, particularly endothelial cells, myofibroblasts, fibroblasts, goblet, tuft, enterocytes, neurons, and glia. […] Interestingly, the researchers confirmed that the gene ENTPD7 was over-expressed in diverticulosis cases. […] In addition, the study showed that individuals with an increased genetic proclivity to diverticulitis show larger numbers of diverticula upon colonoscopy.

• #3 Sigmoid diverticulitis: US findings | springermedizin.de

  https://www.springermedizin.de/sigmoid-diverticulitis-us-findings/9675674

  However, perforation can cause intraperitoneal contamination that is associated with a much higher morbidity and mortality. […] From 1978 until today different classifications were proposed for the staging of acute complicated diverticolitis; first Hinchey that proposed a classification in 4 stages, developed to predict outcomes following the surgical management of complicated diverticular disease (perforated disease) (stage I: mesocolic/pericolic abscess; stage II: pelvic abscess; stage III generalized peritonitis; stage IV faecal peritonitis). […] Then the much more detailed information provided by CT scans led earlier to modifications of the original Hinchey classification. […] Subcategories could be defined considering the radiological findings. […] In 1997 Sher et al introduced the first modification for distinguishing between pericolic abscesses (stage I), distant abscesses amendable for percutaneous drainage (stage IIa), and complex abscesses associated with a possible fistula (stage IIb).

• #3

  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, and family history and genetics.

• #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 MDCT of acute diverticulitis: protocols, common and uncommon CT findings, grading, differential diagnosis and management.

  https://epos.myesr.org/poster/esr/ecr2016/C-0816/background

  Colonic diverticula are false diverticula (pseudodiverticula). They are thought to be secondary to a localized weakness in the colonic wall where the vasa recta penetrate the circular muscular layer. […] Anomalies of colonic motility have also been identified. They consist of intense segmental contractions and might be related to up-regulation of M3 receptors. To note, Laplaces Law (P=kT/R; where P=pressure, T=tension and R=radius) would explain why the sigmoid colon is the most affected segment given that is the one with the smallest radius. […] Other factors such as mural thickening and changes in the collagen fibers can contribute to explain the pathogenesis of diverticulosis. […] Acute diverticulitis will develop when there is micro or macroperforation of colonic diverticula. […] Classically, it was proposed that the cascade of events begins when a fecalith obstructs the neck of the diverticula. This would facilitate bacterial overgrowth that eventually will produce local ischemia and perforation. More recent theories propose direct wall erosion produced by an increase in intraluminal pressure.

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

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16552

  As previously mentioned, the prevailing paradigm in the development of diverticulosis focused on low dietary fiber intake resulting in higher intracolonic pressures. However, this notion has become more controversial. […] 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. […] 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.

• #4 Epidemiology, Pathophysiology, and Treatment of Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6716971/

  Several studies have associated diverticulitis with a chronic inflammatory state. […] Alterations in the gut microbiota are implicated in the pathogenesis of many intestinal disorders. […] Diet and lifestyle factors may induce alterations in the gut microbiome that lead to mucosal inflammation and diverticulitis. […] A genome-wide association study in Iceland and Denmark identified variants in genes that associated with diverticular disease. […] Localized high-pressure zones in the colon were originally believed to lead to formation of diverticula at weak spots in the colonic musculature.

• #4 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

  Several authors have postulated that an altered microbiome could influence the pathogenesis of diverticulitis. […] There is some evidence that patients with diverticular disease have lower levels of bacteria that metabolize fiber into short-chain fatty acids (SCFA). SCFA are thought to increase the production of antimicrobial and mucus peptides in the gut. […] Although there were numerous contributors to the lower risk of disease, it appears that fiber has an important role to play in the pathogenesis of this disease.

• #4 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. […] 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. […] Genetic studies have shown a familial association and a specific gene, TNFSF 15 may predict severity of disease. […] 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.

• #4

  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, and family history and genetics.

• #4

  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.

• #4 Sigmoid diverticulitis: US findings | springermedizin.de

  https://www.springermedizin.de/sigmoid-diverticulitis-us-findings/9675674

  This modification also implied the use of new treatment strategies such as CT-guided percutaneous drainage of abscesses. […] From these, several other classifications have been made (Wasvary et al. in 1999, Kohler et al in 1999, Siewert et al in 1995), among that deserve mention the Hansen/Stock classification and Kohler et al classification, both based on the clinical severity and presentation of disease. […] Finally in 2002 Ambrosetti et al. proposed a simplified staging of acute diverticulitis based on CT criteria and showed its prognostic significance in a prospective study: moderate diverticulitis defined by localized sigmoid wall thickening (5mm) with pericolic fat stranding, and severe diverticulitis defined by wall thickening accompanied by abscess, extraluminal air or extraluminal contrast.

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

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16552

  Since it is believed that low-grade chronic inflammation may play a role in the pathogenesis of SUDD, mesalamine has been investigated in this patient population. […] Inflammation secondary to fecal stasis in diverticular disease has been suspected to cause changes in the colonic microbiome. […] Physical activity has been studied in many gastrointestinal disorders and proposed to reduce risk of colon cancer and other gastrointestinal disorder through decreased transit time, inflammation and/or colon pressure, which are similar mechanisms at play in diverticular disease. […] 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.

• #4 The pathogenesis of acute diverticulitis and the role of the intestinal microbiome – University of Otago

  https://ourarchive.otago.ac.nz/esploro/outputs/graduate/The-pathogenesis-of-acute-diverticulitis-and/9926479293401891

  Aim This thesis has four aims: 1. To provide a contemporary overview of the pathogenesis of acute diverticulitis. […] The understanding of its pathophysiology has evolved, and is now considered to arise through a process of dysregulated immune response to intestinal microbiota in a genetically susceptible individual. […] This thesis provides a contemporary overview of the pathogenesis of acute diverticulitis, outlining a multifactorial process. Environmental risk factors are hypothesised to influence the colonic microbiome, which in turn interacts with the host immune system, thereby influencing local and systemic inflammation. New evidence from this thesis supports this hypothesis with distinct microbiome compositional changes demonstrated in patients with acute diverticulitis.

• #5 Epidemiology, Pathophysiology, and Treatment of Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6716971/

  Several studies have associated diverticulitis with a chronic inflammatory state. […] Alterations in the gut microbiota are implicated in the pathogenesis of many intestinal disorders. […] Diet and lifestyle factors may induce alterations in the gut microbiome that lead to mucosal inflammation and diverticulitis. […] A genome-wide association study in Iceland and Denmark identified variants in genes that associated with diverticular disease. […] Localized high-pressure zones in the colon were originally believed to lead to formation of diverticula at weak spots in the colonic musculature.

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

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

  The presence of diverticula can predispose to the weakness of the epithelial barrier that can likely become a point of entrance for the bacteria and other luminal antigens into the lamina propria. This may induce hyperactivation of immune cells with subsequent effects on the ENS and muscular cells which could explain symptom generation in SUDD.

• #5 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

  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. Hall demonstrated that a family history of diverticular disease is associated with a higher risk of recurrence in patients with an incident case of diverticulitis. […] Although these clinical observations have been important in establishing a hereditary predisposition to the disease, localization of a specific gene is still in flux. A recent genome-wide association study identified several gene variants (COLQ, ARHGAP15, and FAM155A) that may contribute to diverticular disease.

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

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

  In addition to dietary fiber intake, genetics plays a role in the pathogenesis of diverticular disease. […] As previously mentioned, the prevailing paradigm in the development of diverticulosis focused on low dietary fiber intake resulting in higher intracolonic pressures. However, this notion has become more controversial. […] 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. […] Physical activity has been studied in many gastrointestinal disorders and proposed to reduce risk of colon cancer and other gastrointestinal disorder through decreased transit time, inflammation and/or colon pressure, which are similar mechanisms at play in diverticular disease.

• #5 Diverticular Disease | Division of Gastroenterology

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

  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.

• #5 Sigmoid diverticulitis: US findings | springermedizin.de

  https://www.springermedizin.de/sigmoid-diverticulitis-us-findings/9675674

  More recently Klarenbeek et al have proposed a new classification arranged in three stages of differentiating diverticula disease: a) uncomplicated, b) chronic complicated, and c) acute complicated, and according both clinical and radiological findings in addition to treatment modalities, in order to guide the clinical management and form the basis of a practice parameter for diverticular disease.

• #5 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.

• #5 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. […] 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. […] Genetic studies have shown a familial association and a specific gene, TNFSF 15 may predict severity of disease. […] 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.

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

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16552

  Since it is believed that low-grade chronic inflammation may play a role in the pathogenesis of SUDD, mesalamine has been investigated in this patient population. […] Inflammation secondary to fecal stasis in diverticular disease has been suspected to cause changes in the colonic microbiome. […] Physical activity has been studied in many gastrointestinal disorders and proposed to reduce risk of colon cancer and other gastrointestinal disorder through decreased transit time, inflammation and/or colon pressure, which are similar mechanisms at play in diverticular disease. […] 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.

• #6 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. First, are the GM changes a continuum from diverticulosis to AD? […] 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.

• #6 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. […] 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. […] Genetic studies have shown a familial association and a specific gene, TNFSF 15 may predict severity of disease. […] 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.

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

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16552

  As previously mentioned, the prevailing paradigm in the development of diverticulosis focused on low dietary fiber intake resulting in higher intracolonic pressures. However, this notion has become more controversial. […] 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. […] 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.

• #6 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. […] 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.

• #6

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

  Diverticulitis occurs when small pockets in the wall of the large bowel become inflamed, usually without a specific identifiable cause. […] However, there has been a global shift to less intensive management based on evidence that inflammation has a more significant role than previously thought. This means that many patients can be treated in the community with analgesia and selective use of oral antibiotics. […] The exact causes of diverticulitis are also unclear. Current theories include chronic inflammation, alterations in gut microbiome, defects in gastrointestinal smooth muscle and genetic causes. […] It is now accepted that obstruction is rare and diets high in nuts, seeds and corn do not increase this risk of developing diverticulitis, suggesting there are other mechanisms involved.

• #7 ClinMed International Library

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

  Diffuse ischemia of a colonic segment with diverticulosis has also been described as a contributing factor in the development of diverticular inflammation, especially in colonic segments with multiple diverticula that alter the intramural vascular distribution. 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.

• #7 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

  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. Hall demonstrated that a family history of diverticular disease is associated with a higher risk of recurrence in patients with an incident case of diverticulitis. […] Although these clinical observations have been important in establishing a hereditary predisposition to the disease, localization of a specific gene is still in flux. A recent genome-wide association study identified several gene variants (COLQ, ARHGAP15, and FAM155A) that may contribute to diverticular disease.

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

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

  In addition to dietary fiber intake, genetics plays a role in the pathogenesis of diverticular disease. […] As previously mentioned, the prevailing paradigm in the development of diverticulosis focused on low dietary fiber intake resulting in higher intracolonic pressures. However, this notion has become more controversial. […] 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. […] Physical activity has been studied in many gastrointestinal disorders and proposed to reduce risk of colon cancer and other gastrointestinal disorder through decreased transit time, inflammation and/or colon pressure, which are similar mechanisms at play in diverticular disease.

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

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16552

  Since it is believed that low-grade chronic inflammation may play a role in the pathogenesis of SUDD, mesalamine has been investigated in this patient population. […] Inflammation secondary to fecal stasis in diverticular disease has been suspected to cause changes in the colonic microbiome. […] Physical activity has been studied in many gastrointestinal disorders and proposed to reduce risk of colon cancer and other gastrointestinal disorder through decreased transit time, inflammation and/or colon pressure, which are similar mechanisms at play in diverticular disease. […] 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.

• #8 Common variation in FAM155A is associated with diverticulitis but not diverticulosis | Scientific Reports

  https://www.nature.com/articles/s41598-020-58437-1

  Colonic diverticulosis is a widespread gastrointestinal condition described as formation of diverticula, which are sac-like protrusions of mucosa and submucosa through muscularis externa. […] It is hypothesized that environmental factors together with structural alteration of the colonic wall and remodeling of the enteric nervous system are all predisposing components in the development of colonic diverticula. […] In recent years, epidemiological twin data have suggested that genetic factors are another major cofactor in the pathogenesis of DD. […] Our major finding is that the rs67153654 risk allele in FAM155 is significantly associated with diverticulitis after adjusting for cofactors, but not with diverticulosis. […] All of the analyzed SNPs are located in introns, supporting a molecular mechanism at the level of RNA-expression in the surrounding gene or LD to another, yet unidentified causal variant.

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

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16552

  Since it is believed that low-grade chronic inflammation may play a role in the pathogenesis of SUDD, mesalamine has been investigated in this patient population. […] Inflammation secondary to fecal stasis in diverticular disease has been suspected to cause changes in the colonic microbiome. […] Physical activity has been studied in many gastrointestinal disorders and proposed to reduce risk of colon cancer and other gastrointestinal disorder through decreased transit time, inflammation and/or colon pressure, which are similar mechanisms at play in diverticular disease. […] 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.

• #9 Diagnosis and Management of Acute Diverticulitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0501/p612.html

  Uncomplicated diverticulitis is localized diverticular inflammation, whereas complicated diverticulitis is diverticular inflammation associated with an abscess, phlegmon, fistula, obstruction, bleeding, or perforation. […] Acute diverticulitis is inflammation of the colonic diverticulum, which may involve perforation or microperforation. […] Factors associated with diverticulosis include alterations in colonic wall resistance, colonic motility, and dietary issues, such as lack of fiber, that contribute to increased intraluminal pressure and weakness of the bowel wall. […] Genetic susceptibility is an important component for the development of diverticular disease because monozygotic twins are twice as likely as dizygotic twins to develop diverticulosis. […] Aspirin and nonsteroidal anti-inflammatory drugs increase the risk of diverticulitis (hazard ratio = 1.2 to 1.7).

• #9

  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, and family history and genetics.

• #10 Tissue remodeling as a primary mechanism for diverticula formation

  https://medicalxpress.com/news/2024-03-tissue-remodeling-primary-mechanism-diverticula.html

  Tissue remodeling is a primary mechanism for diverticula formation. […] A new study, published in the journal Gut now suggests that tissue remodeling is a primary mechanism for diverticula formation. […] Researchers conducted DNA and RNA sequencing on colonic tissue from 404 patients. Results showed 38 genes with differential expression and 17 with varied transcript usage linked to diverticulosis. Additionally, diverticulosis severity was positively correlated with genetic predisposition to diverticulitis. […] Peery and colleagues linked the formation of diverticula to stromal and epithelial cells in the colon, particularly endothelial cells, myofibroblasts, fibroblasts, goblet, tuft, enterocytes, neurons, and glia. […] Interestingly, the researchers confirmed that the gene ENTPD7 was over-expressed in diverticulosis cases. […] In addition, the study showed that individuals with an increased genetic proclivity to diverticulitis show larger numbers of diverticula upon colonoscopy.

• #10

  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, and family history and genetics.

• #11 Peery Authors Genetic and Transcriptomic Landscape of Colonic Diverticulosis | Newsroom

  https://news.unchealthcare.org/2024/03/peery-authors-genetic-and-transcriptomic-landscape-of-colonic-diverticulosis/

  Researchers led by Anne Peery, MD, at the UNC School of Medicine, suggest that tissue remodeling is a primary mechanism for the development of colonic diverticulitis, a debilitating gastrointestinal condition. […] A study, published in the journal Gut in the BMJ family of journals now suggests that tissue remodeling is a primary mechanism for diverticula formation. […] Additionally, diverticulosis severity was positively correlated with genetic predisposition to diverticulitis. […] In addition, the study showed that individuals with an increased genetic proclivity to diverticulitis show larger numbers of diverticula upon colonoscopy.

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

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16552

  As previously mentioned, the prevailing paradigm in the development of diverticulosis focused on low dietary fiber intake resulting in higher intracolonic pressures. However, this notion has become more controversial. […] 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. […] 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.

• #12

  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, and family history and genetics.

• #13 Epidemiology, Pathophysiology, and Treatment of Diverticulitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6716971/

  Diverticulitis is a prevalent gastrointestinal disorder that is associated with significant morbidity and health care costs. […] Several risk factors, many of which are modifiable, have been identified including obesity, diet, and physical inactivity. Diet and lifestyle factors could affect risk of diverticulitis through their effects on the intestinal microbiome and inflammation. […] Genetic factors, as well as alterations in colonic neuromusculature, can also contribute to the development of diverticulitis. […] The pathophysiology of diverticulitis is incompletely understood. Long-standing but unproven theories suggest that diverticulitis results from obstruction and trauma to a diverticulum with subsequent ischemia, microperforation, and infection. […] More recent studies indicated that nut and seed consumption do not increase risk of diverticulitis, and that antibiotics may not hasten recovery or improve outcomes. These findings have led to models of diverticulitis pathogenesis that involve chronic inflammation and alterations in the gut microbiome.

• #14 Colonic Diverticular Disease

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

  The belief that ingestion of undigested foods such as nuts, seeds and popcorn can precipitate complications of diverticular disease by lodging in colonic diverticula is inaccurate. […] The notion that an elective sigmoid resection should be performed after a second or third attack of uncomplicated diverticulitis are no longer supported by international guidelines. The rate or recurrence of diverticulitis following a sigmoid colectomy is between 1% and 10%. It is thought the reduced bowel luminal diameter of the sigmoid results in a relative high pressure zone, precipitating proximal inflation. Recurrence is reduced by ensuring that all of the sigmoid is resected and the proximal colon is anastomosed to the rectum. […] The exact pathophysiology of SCAD is unknown, though it has been postulated that fecal stasis and microbial dysbiosis associated with diverticulosis can act as an environmental trigger to precipitate segmental colitis.

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