Review article: the current and evolving treatment of colonic diverticular disease

Abstract

SUMMARY BackgroundFormation of colonic diverticula, via herniation of the colonic wall, is responsible for the development of diverticulosis and consequently diverticular disease. Diverticular disease can be associated with numerous debilitating abdominal and gastrointestinal symptoms (including pain, bloating, nausea, constipation and diarrhoea).

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

“…This approach may be particularly useful in patients with persistent complaints. We know that diverticulitis generally resolves in a few days, especially when uncomplicated [1]. If 7-10 days have passed without resolution (or without a significant clinical improvement), colonoscopy should be mandatory in order to exclude other diseases explaining the symptoms' persistence.…”

“…It is highly prevalent in western countries, where diverticula are mainly located in the sigmoiddescending colon [1], while Asian people generally have right diverticulosis (represented by real diverticula) [1]. This different location of colonic diverticulosis leads to different complications: left diverticulosis shows higher risk of inflammatory complications (mainly diverticulitis), that occur in about 5% of those patients [2]; right diverticulosis shows higher risk of bleeding, that occurs in >50% of those patients [3].…”

“…Colonic diverticulosis is characterized by the presence of sac-like protrusions called "diverticula", which occur when colonic mucosa and submucosa herniate through defects in the muscle layer of the colon wall (pseudo-diverticula) [1]. It is highly prevalent in western countries, where diverticula are mainly located in the sigmoiddescending colon [1], while Asian people generally have right diverticulosis (represented by real diverticula) [1].…”

“…This anatomic alteration generally affects the elderly. However, the large majority of those people will remain entirely asymptomatic, and only one fifth of them may manifest clinical illness [1].…”

“…Despite these general contraindications, colonoscopy has today several indications in managing diverticular disease of the colon, ranging from treatment of diverticular bleeding to diagnosis of Segmental Colitis Associated with Diverticulosis (SCAD) [1] (Table I).…”