Diverticulitis is a common disease. Recent changes in understanding its natural history have substantially modified treatment paradigms.
It has been reviewed the etiology and natural history of diverticulitis and recent changes in treatment guidelines.
Eighty articles met criteria for analysis.
The pathophysiology of diverticulitis is associated with altered gut motility, increased luminal pressure, and a disordered colonic microenvironment.
Several studies have examined histologic commonalities with inflammatory bowel disease and irritable bowel syndrome but were focused on associative rather than causal pathways.
The natural history of uncomplicated diverticulitis is often benign. For example, in a cohort study of 2366 of 3165 patients hospitalized for acute diverticulitis and followed up for 8.9 years, only 13.3% of patients had a recurrence and 3.9%, a second recurrence.
In contrast to what was previously thought, the risk of septic peritonitis is reduced and not increased with each recurrence. Patient-reported outcomes studies show 20% to 35% of patients managed nonoperatively progress to chronic abdominal pain compared with 5% to 25% of patients treated operatively.
Randomized trials and cohort studies have shown that antibiotics and fiber were not as beneficial as previously thought and that Mesalamine ( 5-Aminosalicylic acid; 5-ASA ) might be useful.
Surgical therapy for chronic disease is not always warranted.
Recent studies have demonstrated a lesser role for aggressive antibiotic or surgical intervention for chronic or recurrent diverticulitis than was previously thought necessary. ( Xagena )
Morris AE et al, JAMA 2014;311:287-297