Skip to main content

Advertisement

SpringerLink
Log in

Management of Diverticulosis

  • Colon (JC Anderson, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

The paradigm in the management of diverticular disease is continuously changing. This review serves as an overview of the management of diverticular disease including modifiable risk factors and medical and surgical therapies.

Recent findings

The treatment of acute uncomplicated diverticulitis has changed over time to a more conservative approach with the most recent trials showing that antibiotics neither accelerated recovery nor prevented complications of diverticulitis. Another paradigm shift has been in the surgical management of patients with acute diverticulitis with a more individualized approach favoring delay in surgery.

Summary

Diverticulosis is the most common finding on colonoscopy with a prevalence that increases with age. The management of diverticular disease and its complications are ever evolving with a focus on more conservative approach to the management of uncomplicated disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Simpson J, Scholefield JH, Spiller RC. Pathogenesis of colonic diverticula. Br J Surg. 2002;89:546–54.

    Article  CAS  PubMed  Google Scholar 

  2. Jun S, Stollman N. Epidemiology of diverticular disease. Best Pract Res Clin Anaesthesiol. 2002;16:529.

    Google Scholar 

  3. Strate LL, Modi R, Cohen E, et al. Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol. 2012;107:1486.

    Article  PubMed  Google Scholar 

  4. Peery AF, Crockett SD, Murphy CC, Lund JL, Dellon ES, Williams JL, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2019;156:254–72.

    Article  PubMed  Google Scholar 

  5. Peery AF, Barrett PR, Park D, Rogers AJ, Galanko JA, Martin CF, et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology. 2012;142:266–72.

    Article  PubMed  Google Scholar 

  6. Jarbrink-Sehgal ME, Andreasson A, Talley NJ, et al. Symptomatic diverticulosis is characterized by loose stools. Clin Gastroenterol Hepatol. 2016;14:1763–70.

    Article  PubMed  Google Scholar 

  7. Everhard JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology. 2009;136:741–54.

    Article  Google Scholar 

  8. Tanase I, Paun S, Stoica B, et al. Epidemiology of diverticular disease – systematic review of the literature. Chirurgia (Bucur). 2015;110(1):9–14.

    CAS  Google Scholar 

  9. Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. BMJ. 1971;2(5759):450–4.

    Article  CAS  PubMed  Google Scholar 

  10. Alatise OI, Arigbabu AO, Agbakwuru EA, Lawal OO, Ndububa DA, Ojo OS. Spectrum of colonoscopy findings in Ile-Ife Nigeria. Niger Postgrad Med J. 2012;19(4):219–24.

    CAS  PubMed  Google Scholar 

  11. Calder JF. Diverticular disease of the colon in Africans. Br Med J 1979;1(6176):1465–6.

  12. Maeda H, Hibi T. The burden of diverticular disease and its complications: west versus east. Inflamm Intest Dis. 2018;3(2):61–8.

    Article  Google Scholar 

  13. Warner E, Crighton EJ, Moineddin R, Mamdani M, Upshur R. Fourteen-year study of hospital admissions for diverticular disease in Ontario. Can J Gastroenterol. 2007;21(2):97–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Painter NS, Burkitt DP. Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol. 1975;4:3.

    Article  CAS  PubMed  Google Scholar 

  15. • Strate LL, Morris AM. Epidemiology, pathophysiology and treatment of diverticulitis. Gastroenterol. 2019;156:1282–98 A very thorough and current review of everything one needs to know about diverticulitis.

    Article  Google Scholar 

  16. Bharucha AE, Parthasarathy G, Ditah I, Fletcher JG, Ewelukwa O, Pendlimari R, et al. Temporal trends in the incidence and natural history of diverticulitis: a population-based study. Am J Gastroenterol. 2015;110:1589–96.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Liu PH, Cao Y, Keeley BR, Tam I, Wu K, Strate LL, et al. Adherence to a healthy lifestyle is associated with a lower risk of diverticulitis among men. Am J Gastroenterol. 2017;112(12):1868–76.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Strate LL, Keeley BR, Cao Y, Wu K, Giovannucci EL, Chan AT. Western dietary pattern increases, and prudent dietary pattern decreases, risk of incident diverticulitis in a prospective cohort study. Gastroenterology. 2017;152:1023–30.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Crowe FL, Appleby PN, Allen NE, Key TJ. Diet and risk of diverticular disease in the European Prospective Investigation into Cancer and Nutrition (EPIC) Oxford cohort: a prospective study of British vegetarians and non-vegetarians. BMJ. 2011;343:d4131.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC. A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr. 1994;60:757–64.

    Article  CAS  PubMed  Google Scholar 

  21. Crowe FL, Balkwill A, Cairns BJ, Appleby PN, Green J, Reeves GK, et al. Source of dietary fibre and diverticular disease incidence: a prospective study of UK women. Gut. 2014;63:1450–6.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Aldoori WH, Giovannucci EL, Rochett HR, et al. A prospective study of dietary fiber types and symptomatic diverticular disease in men. J Nutr. 1998;128:714–9.

    Article  CAS  PubMed  Google Scholar 

  23. Aune D, Sen A, Norat T, Riboli E. Dietary fibre intake and the risk of diverticular disease: a systematic review 615 and meta-analysis of prospective studies. Eur J of Nutr 2020;59(2):421–432.

  24. Hjern F, Wolk A, Hakansson N. Obesity, physical inactivity and colonic diverticular disease requiring hospitalization in women: a prospective cohort study. Am J Gastroenterol 2012:107(2):296–302.

  25. Rosemar A, Angeras U, Rosengren A. Body mass index and diverticular disease: a 28-year follow-up study in men. Dis Colon Rectum 2007;51(4):450–5.

  26. Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology. 2009;136:115–22.

    Article  PubMed  Google Scholar 

  27. Ma W, Jovani M, Liu PH, Nguyen LH, Cao Y, Tam I, et al. Association between obesity and weight change and risk of diverticulitis in women. Gastroenterology. 2018;155(1):58–66.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Shoelson SE, Herrero L, Naaz A. Obesity, inflammation, and insulin resistance. Gastroenterology. 2007;132:2169–80.

    Article  CAS  PubMed  Google Scholar 

  29. Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: human gut microbes associated with obesity. Nature. 2006;444:1022–3.

    Article  CAS  PubMed  Google Scholar 

  30. Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC. A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men. Ann Epidemiol. 1995;5:221–8.

    Article  CAS  PubMed  Google Scholar 

  31. Hjern F, Wolk A, Hakansson N. Smoking and the risk of diverticular disease in women. Br J Surg. 2011;98:997–1002.

    Article  CAS  PubMed  Google Scholar 

  32. Humes DJ, Ludvigsson JF, Jarvholm B. Smoking and the risk of hospitalization for symptomatic diverticular disease: a population-based cohort study from Sweden. Dis Colon Rectum. 2016;59:110–4.

    Article  PubMed  Google Scholar 

  33. Aune D, Sen A, Leitzmann MF, Tonstad S, Norat T, Vatten LJ. Tobacco smoking and the risk of diverticular disease - a systematic review and meta-analysis of prospective studies. Color Dis. 2017;19:621–33.

    Article  CAS  Google Scholar 

  34. Hillemand B, Joly JP, Todoskoff J, Allard S, Martin C, Reumont G, et al. Alcoholism, colic diverticular disease and metabolic disorders. Sem Hop. 1979;55(43–44):2001–7.

    CAS  PubMed  Google Scholar 

  35. Tonnesen H, Engholm G, Moller H. Association between alcoholism and diverticulitis. Br J Surg. 1999;86(8):1067–8.

    Article  CAS  PubMed  Google Scholar 

  36. Williams PT. Incident diverticular disease is inversely related to vigorous physical activity. Med Sci Sports Exerc. 2009;41(5):1042–7.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Aldoori WH, Giovannucci EL, Rimm EB, Ascherio A, Stampfer MJ, Colditz GA, et al. Prospective study of physical activity and the risk of symptomatic diverticular disease in men. Gut. 1995;36:276–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. • Stollman N, Smalley W, Hirano I, et al. American Gastroenterological Association Institute guideline on the management of acute diverticulitis. Gastroenterology. 2015;149:1944–9 The most recent AGA guidelines that address several factors in the management of acute diverticulitis.

    Article  PubMed  Google Scholar 

  39. StrateLL LYL, HuangES, et al. Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology. 2011;140:1427–33.

    Article  Google Scholar 

  40. Reichert MC, Krawczyk M, Appenrodt B, Casper M, Friesenhahn-Ochs B, Grünhage F, et al. Selective association of nonaspirin NSAIDs with risk of diverticulitis. Int J Color Dis. 2018;33(4):423–30.

    Article  Google Scholar 

  41. Kvasnovsky CL, Papagrigoriadis S, Bjarnason I. Increased diverticular complications with nonsteroidal anti-inflammatory drugs and other medications: a systematic review and meta-analysis. Color Dis. 2014;16:189–96.

    Article  Google Scholar 

  42. Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Willett WC. Use of acetaminophen and nonsteroidal anti-inflammatory drugs: a prospective study and the risk of symptomatic diverticular disease in men. Arch Fam Med. 1998;7:255–60.

    Article  CAS  PubMed  Google Scholar 

  43. Humes DJ, Fleming KM, Spiller RC, West J. Concurrent drug use and the risk of perforated colonic diverticular disease: a population-based case-control study. Gut. 2011;60:219–24.

    Article  PubMed  Google Scholar 

  44. Morris CR, Harvey IM, Stebbings WSL, Speakman CTM, Kennedy HJ, Hart AR. Anti-inflammatory drugs, analgesics and the risk of perforated colonic diverticular disease. Br J Surg. 2003;90:1267–72.

    Article  CAS  PubMed  Google Scholar 

  45. Ananthakrishnan AN, Khalili H, Higuchi LM, Bao Y, Korzenik JR, Giovannucci EL, et al. Higher predicted vitamin D status is associated with reduced risk of Crohn’s disease. Gastroenterology. 2012;142(3):482–9.

    Article  CAS  PubMed  Google Scholar 

  46. Carlberg C. Nutrigenomics of vitamin D. Nutrients. 2019;11(3):676.

    Article  CAS  PubMed Central  Google Scholar 

  47. Maguire LH, Song M, Strate LE, Giovannucci EL, Chan AT. Higher serum levels of vitamin D are associated with reduced risk of diverticulitis. Clin Gastroenterol Hepatol. 2013;11:1631–5.

    Article  CAS  PubMed  Google Scholar 

  48. Maguire LH, Song M, Strate LL, Giovannucci EL, Chan AT. Geographic and seasonal variation is associated with diverticulitis admissions. JAMA Surg. 2015;150(1):74–7.

    Article  PubMed  PubMed Central  Google Scholar 

  49. O’grady M, Fracs M, Clarke L, et al. Statin use and risk of acute diverticulitis: a population-based case-control study. Medicine. 2020;99:20.

    Article  Google Scholar 

  50. Kwak B, Mulhaupt F, Myit S, Mach F. Statins as a newly recognized type of immunomodulator. Nat Med. 2000;6:1399–402.

    Article  CAS  PubMed  Google Scholar 

  51. Bereswill S, Munoz M, Fischer A, et al. Anti-inflammatory effects of resveratrol, curcumin and simvastatin in acute small intestinal inflammation. PLoS One. 2010;5:e15099.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Sasaki M, Bharwani S, Jordan P, Joh T, Manas K, Warren A, et al. The 3-hydroxy-3-methylglutaryl-CoA reductase inhibitor pravastatin reduces disease activity and inflammation in dextran-sulfate induced colitis. J Pharmacol Exp Ther. 2003;305:78–85.

    Article  CAS  PubMed  Google Scholar 

  53. Freckelton J, Evans JA, Croagh D, Moore GT. Metformin use in diabetics with diverticular disease is associated with reduced incidence of diverticulitis. Scand J Gastroenterol. 2017;52:969–72.

    CAS  PubMed  Google Scholar 

  54. Koh SJ, Kim JM, Kim IK, Ko SH, Kim JS. Anti-inflammatory mechanism of metformin and its effects in intestinal inflammation and colitis associated colon cancer. J Gastroenterol Hepatol. 2014;29:502–10.

    Article  CAS  PubMed  Google Scholar 

  55. Shin NR, Lee JC, Lee HY, et al. An increase in the Akkermansia spp. population induced by metformin treatment improves glucose homeostasis in diet-induced obese mice. Gut. 2014;63:727–35.

    Article  CAS  PubMed  Google Scholar 

  56. Morris CR, Harvey IM, Stebbings WS, Speakman CT, Kennedy HJ, Hart AR. Do calcium channel blockers and antimuscarinics protect against perforated colonic diverticular disease? A case control study. Gut. 2003;52:1734–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Bassotti G, Calcara C, Annese V, Fiorella S, Roselli P, Morelli A. Nifedipine and verapamil inhibit the sigmoid colon myoelectric response to eating in healthy volunteers. Dis Colon Rectum. 1998;41:377–80.

    Article  CAS  PubMed  Google Scholar 

  58. Cirocchi R, Randolph JJ, Binda GA, Gioia S, Henry BM, Tomaszewski KA, et al. Is the outpatient management of acute diverticulitis safe and effective? A systematic review and meta-analysis. Techniques in Coloproctology. 2019;23:87–100.

    Article  CAS  PubMed  Google Scholar 

  59. Reddy VB, Longo WE. The burden of diverticular disease on patients and healthcare systems. Gastroenterol Hepatol. 2013;9:21–7.

    Google Scholar 

  60. • Feingold D, Steele SR, Lee S, et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014;57:284–94 The surgical guidelines on the surgical management of diverticulitis including timing and necessity of colonoscopy.

    Article  PubMed  Google Scholar 

  61. Sartelli M, Catena F, Ansaloni L, Coccolini F, et al. WSES guidelines for the management of acute left sided colonic diverticulitis in the emergency setting. World J Emerg Surg. 2016;29:11–37.

    Google Scholar 

  62. Binda GA, Cuomo R, Laghi A, Nascimbeni R, Serventi A, Bellini D, et al. Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines. Tech Coloproctol. 2015;19:615–26.

    Article  CAS  PubMed  Google Scholar 

  63. Andeweg CS, Wegdam JA, Groenewoud J, van der Wilt GJ, van Goor H, Bleichrodt RP. Toward an evidence-based step-up approach in diagnosing diverticulitis. Scand J Gastroenterol. 2014;49:775–84.

    Article  PubMed  Google Scholar 

  64. Hjern F, Josephson T, Altman D, Holmström B, Mellgren A, Pollack J, et al. Conservative treatment of acute colonic diverticulitis: are antibiotics always mandatory? Scand J Gastroenterol. 2007;42(1):41–7.

    Article  PubMed  Google Scholar 

  65. Unlu C, de Korte N, Daniels L, et al. A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial). BMC Surg. 2010;10:23.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Chabok A, Pahlman L, Hjern F, et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012;99:532–9.

    Article  CAS  PubMed  Google Scholar 

  67. • Desai M, Fathallah J, Nutalapati V, Saligram S. Antibiotics versus no antibiotics for acute uncomplicated diverticulitis: a systematic review and meta-analysis. Dis Colon Rectum. 2019;62(8):1005–12 Recent review of the role of antibiotics in the treatment of acute uncomplicated diverticulitis.

    Article  PubMed  Google Scholar 

  68. Unlu C, de Korte N, Daniels L, et al. A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial). BMC Surg 2010;10:23.

  69. Daniels L, Unlu C, de Korte N, et al. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. 2017;104:52–61.

    Article  CAS  PubMed  Google Scholar 

  70. Nader FK, Sylla P, Abou-khalil M, et al. EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice. Surg Endosc. 2019;33(9):2726–41.

    Article  Google Scholar 

  71. Stollman N, Magowan S, Shanahan F, et al. A randomized controlled study of mesalamine after acute diverticulitis: results of the DIVA trial. J Clin Gastroenterol. 2013;47:621.

    Article  CAS  PubMed  Google Scholar 

  72. Raskin JB, Kamm MA, Jamal MM, Márquez J, Melzer E, Schoen RE, et al. Mesalamine did not prevent recurrent diverticulitis in phase 3 controlled trials. Gastroenterology. 2014;147:793–802.

    Article  CAS  PubMed  Google Scholar 

  73. Kruis W, Kardalinos V, Eisenbach T, Lukas M, Vich T, Bunganic I, et al. Randomised clinical trial: mesalazine versus placebo in the prevention of diverticulitis recurrence. Aliment Pharmacol Ther. 2017;46:282–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Khan MA, Ali B, Lee WM, Howden CW. Mesalamine does not prevent recurrent acute colonic diverticulitis: meta-analysis of randomized, placebo-controlled trials. Am J Gastroenterol. 2016;111:579–81.

    Article  PubMed  Google Scholar 

  75. Bianchi M, Festa V, Moretti A, Ciaco A, Mangone M, Tornatore V, et al. Meta-analysis: long-term therapy with rifaximin in the management of uncomplicated diverticular disease. AlimentaryPharmacology and Therapeutics. 2011;33:902–10.

    Article  CAS  Google Scholar 

  76. Lanas A, Ponce J, Bignamini A, Mearin F. One year intermittent rifaximin plus fibre supplementation vs. fibre supplementation alone to prevent diverticulitis recurrence: a proof-of-concept study. Dig Liver Dis. 2013;45:104–9.

    Article  CAS  PubMed  Google Scholar 

  77. Sanders ME. Probiotics: definition, sources, selection, and uses. Clin Infec Dis. 2008;46(2):S58–61.

    Article  Google Scholar 

  78. Sullivan A, Nord CE. Probiotics and gastrointestinal disease. J Intern Med. 2005;257:78–92.

    Article  CAS  PubMed  Google Scholar 

  79. Lahner E, Bellisario C, Hassan C, Zullo A, Esposito G, Annibale B. Probiotics in the treatment of diverticular disease: a systematic review. J Gastrointestin Liver Dis. 2016;25:79–86.

    Article  PubMed  Google Scholar 

  80. Ford AC, Quigley EMM, LAci BE, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014;109:1547–61.

    Article  PubMed  Google Scholar 

  81. Tursi A, Brandimarte G, Giorgetti GM, Elisei W. Mesalazine and/or Lactobacillus casei in maintaining long-term remission of symptomatic uncomplicated diverticular disease of the colon. Hepato gastroenterol. 2008;55:916–20.

    Google Scholar 

  82. Annibale B, Maconi G, Lahner E, de Giorgi F, Cuomo R. Efficacy of Lactobacillus paracasei sub. Paracasei F19 on abdominal symptoms in patients with symptomatic uncomplicated diverticular disease: a pilot study. Minerva Gastroenterol Dietol. 2011;57:13–22.

    CAS  PubMed  Google Scholar 

  83. Su GL, Ko CW, Bercik P, Falck-Ytter Y, Sultan S, Weizman AV, et al. AGA clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders. Gastroenterol. 2020;159:697–705.

    Article  CAS  Google Scholar 

  84. Yamada A, Sugimoto T, Kondo S, Ohta M, Watabe H, Maeda S, et al. Assessment of the risk factors for colonic diverticular hemorrhage. Dis Colon Rectum. 2008;51:116–20.

    Article  PubMed  Google Scholar 

  85. Goh H, Bourne R. Non-steroidal anti-inflammatory drugs and perforated diverticular disease: a case-control study. Ann R Coll Surg Engl. 2002;84:93–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  86. Ponziani FR, Scaldaferri F, Petito V, Paroni Sterbini F, Pecere S, Lopetuso LR, et al. The role of antibiotics in gut microbiota modulation: the eubiotic effects of rifaximin. Dig Dis. 2016;34:269–78.

    Article  PubMed  Google Scholar 

  87. Colecchia A, Vestito A, Pasqui F, Mazzella G, Roda E, Pistoia F, et al. Efficacy of long term cyclic administration of the poorly absorbed antibiotic rifaximin in symptomatic, uncomplicated colonic diverticular disease. World J Gastroenterol. 2007;13:264–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. D’Incà R, Pomerri F, Vettorato MG, et al. Interaction between rifaximin and dietary fibre in patients with diverticular disease. Aliment Pharmacol Ther. 2007;25:771–9.

    Article  PubMed  Google Scholar 

  89. Latella G, Pimpo MT, Sottili S, Zippi M, Viscido A, Chiaramonte M, et al. Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon. Int J Color Dis. 2003;18:55–62.

    Article  Google Scholar 

  90. Barbara G, Cremon C, Barbaro MR, Bellacosa L, Stanghellini V. Treatment of diverticular disease with aminosalicylates: the evidence. J Clin Gastroenterol. 2016;50(Suppl 1):S60–3.

    Article  CAS  PubMed  Google Scholar 

  91. Kruis W, Meier E, Schumacher M, et al. Randomised clinical trial: mesalazine for uncomplicated diverticular disease of the colon - placebo-controlled study. Aliment Pharmacol Ther. 2014;37:680–90.

    Article  Google Scholar 

  92. Tursi A, Brandimarte G, Elisei W, Picchio M, Forti G, Pianese G, et al. Randomised clinical trial: mesalazine and/or probiotics in maintaining remission of symptomatic uncomplicated diverticular disease - a double-blind, randomised, placebo-controlled study. Aliment Pharmacol Ther. 2013;38:741–51.

    Article  CAS  PubMed  Google Scholar 

  93. Schembri J, Bonello J, Dimitrios K, et al. Segmental colitis associated with diverticulosis: is it the coexistence of colonic diverticulosis and inflammatory bowel disease? Annals of Gastroenterol. 2017;30:257–61.

    Google Scholar 

  94. Tursi A. Segmental colitis associated with diverticulosis: complication of diverticular disease or autonomous entity? Dig Dis Sci. 2011;56:27–34.

    Article  PubMed  Google Scholar 

  95. Ludeman L, Shepherd NA. What is diverticular colitis? Pathology. 2002;34:568–72.

    Article  CAS  PubMed  Google Scholar 

  96. Tursi A, Brandimarte G, Giorgetti GM, Elisei W. Beclomethasone dipropionate plus VSL#3 for the treatment of mild to moderate diverticular colitis: an open, pilot study. J Clin Gastroenterol. 2005;39:644–5.

    Article  PubMed  Google Scholar 

  97. Strate L, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111(4):459–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Nigam N, Ham SA, Sengupta N. Early colonoscopy for diverticular bleeding does not reduce risk of postdischarge recurrent bleeding: a propensity score matching analysis. Clin Gastroenterol Hepatol. 2019;17:1105–11.

    Article  PubMed  Google Scholar 

  99. Kaltenbach T, Watson R, Shah J, Friedland S, Sato T, Shergill A, et al. Colonoscopy with clipping is useful in the diagnosis and treatment of diverticular bleeding. Clin Gastroenterol Hepatol. 2012;10:131–7.

    Article  PubMed  Google Scholar 

  100. Strate LL, Naumann CR. The role of colonoscopy and radiological procedures in the management of acute lower intestinal bleeding. Clin Gastroenterol Hepatol. 2010;8:333–43.

    Article  PubMed  Google Scholar 

  101. Barker KB, Arnold HL, Fillman EP, Palekar NA, Gering SA, Parker AL. Safety of band ligator use in the small bowel and the colon. Gastrointest Endosc. 2005;62:224–7.

    Article  PubMed  Google Scholar 

  102. Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975;4:53.

    Article  CAS  PubMed  Google Scholar 

  103. Rezapour M, Stollman N. Diverticular disease in the elderly. Current Gastroenterol Reports. 2019;21(9):46.

    Article  Google Scholar 

  104. Horgan AF, McConnell EJ, Wolff BG, et al. Atypical diverticular disease: surgical results. Dis Colon Rectum. 2001;44:1315–8.

    Article  CAS  PubMed  Google Scholar 

  105. Wolff BG, Boostrom SY. Prophylactic resection, uncomplicated diverticulitis, and recurrent diverticulitis. Dig Dis. 2012;30:108–13.

    Article  PubMed  Google Scholar 

  106. Chodak GW, Rangel DM, Passaro E Jr. Colonic diverticulitis in patients under age 40: need for earlier diagnosis. Am J Surg. 1981;141:699–702.

    Article  CAS  PubMed  Google Scholar 

  107. Eusebio EB, Eisenberg MM. Natural history of diverticular disease of the colon in young patients. Am J Surg. 1973;125:308–11.

    Article  CAS  PubMed  Google Scholar 

  108. Schauer PR, Ramos R, Chiatas AA, SIrinek KR. Virulent diverticular disease in young obese men. Am J Surg. 1992;164(5):443–6.

    Article  CAS  PubMed  Google Scholar 

  109. Lidor AO, Schneider E, Segal J, Yu Q, Feinberg R, Wu AW. Elective surgery for diverticulitis is associated with high risk of intestinal diversion and hospital readmission in older adults. J Gastrointest Surg. 2010;14:1867–73.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of California Los Angeles, Los Angeles, CA, USA

    Mona Rezapour MD MHS

  2. UCLA Digestive Diseases, 7345 Medical Center Drive, Suite 420, West Hills, CA, 91307, USA

    Mona Rezapour MD MHS

  3. Alta Bates Summit Medical Center, East Bay Center for Digestive Health, Oakland, CA, USA

    Neil Stollman MD

Authors
  1. Mona Rezapour MD MHS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Neil Stollman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mona Rezapour MD MHS.

Ethics declarations

Conflict of Interest

Mona Rezapour declares that she has no conflict of interest

Neil Stollman declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Colon

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rezapour, M., Stollman, N. Management of Diverticulosis. Curr Treat Options Gastro 19, 14–29 (2021). https://doi.org/10.1007/s11938-020-00329-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11938-020-00329-4

Keywords

Search

Navigation