Emerging evidence and recent controversies in diverticulitis: a 5-year review

Abstract

Diverticulitis is a common gastrointestinal disease that still garners significant attention and study because of its heterogeneity in presentation and outcome. We provide a review of the newest and most controversial topics in diverticulitis. Recent discoveries on the influence of diet and other environmental risk factors are discussed, showing how the epidemiology of the disease process is shifting away from what was previously felt to be a disorder primarily limited to older western populations. Interestingly, as has long been suspected, genetic mutations and variations associated with the development of diverticulitis are being discovered and are summarized here. The data for non-operative and outpatient management of diverticulitis are reviewed, as are pharmacologic agents studied for use in the secondary prevention of diverticulitis. Lastly, we present controversies in the surgical treatment of diverticulitis. This review will provide a synopsis of the last 5 years of literature relating to diverticulitis.

The Association between Anthropometric Indicators and Colorectal Polyps and Diverticulosis

“…This phenomenon might be explained by the fact that some genes, such as LAMB4, TNFSF15, ARHGAP15, ANO1, ELN, and SPINT2, play known roles in processes logically related to diverticulitis, including inflammation, intestinal transport, intestinal motility, and extracellular matrix formation. 59 60 Our study failed to show the effect of other risk factors of colorectal lesions that need further investigation.…”

Current diagnosis and management of acute colonic diverticulitis: What you need to know

“…29,30 Genetic basis for the disease may also be supported by association between diverticulitis and connective tissue disorders, neuromuscular disorders, and epithelial disorders such as Ehlers-Danlos syndrome, Marfan syndrome, and conditions such as incisional hernias and aortic aneurysms. 31 Laminin protein mutations have been implicated in diverticulitis. Laminins are part of the extracellular matrix and are involved in development of the enteric nervous system.…”

“…Laminins are part of the extracellular matrix and are involved in development of the enteric nervous system. 15,31 Diet and lifestyle factors may affect risk of diverticulitis through effects on the intestinal microbiome and chronic inflammation. 15 Finally, environmental effects are thought to contribute to the pathophysiology of diverticulitis.…”

“…41,46,[50][51][52][53] The practice, however, has not been adopted widely in the United States. 31 The AVOD trial, conducted in Sweden and Iceland and first published in 2012, demonstrated no difference in outcomes between those patients treated with or without antibiotics for acute uncomplicated diverticulitis after 12 months of follow-up. 41 The authors concluded antibiotics neither accelerate recovery not prevent complications or recurrence and should be reserved for complicated cases of diverticulitis only.…”

Diverticulosis and Diverticulitis: Epidemiology, Pathophysiology, and Current Treatment Trends

“…The use of a low-fiber diet in managing diverticulitis remains controversial. Some studies have suggested that it helps in relieving symptoms; however, there is not much evidence to support it [ 39 ]. Studies have advocated using medicines like mesalamine, probiotics, and rifaximin in treating diverticulitis.…”