Colonic diverticulosis and diverticular disease: Epidemiology, risk factors, and pathogenesis
- John H Pemberton, MD
John H Pemberton, MD
- Professor of Surgery
- Mayo Clinic and Mayo Medical School
Diverticular disease of the colon is an important cause of hospital admissions and a significant contributor to healthcare costs in Western and industrialized societies [1,2].
This topic will review the epidemiology, risk factors, and the pathogenesis of diverticulosis and diverticular disease. The clinical manifestations, diagnosis, and treatment of diverticulitis, diverticular bleeding, and segmental colitis associated with diverticula (diverticular colitis) are discussed in detail, separately. (See "Clinical manifestations and diagnosis of acute diverticulitis in adults" and "Acute colonic diverticulitis: Medical management" and "Colonic diverticular bleeding".)
●A diverticulum is a sac-like protrusion of the colonic wall.
●Diverticulosis is defined by the presence of diverticula. Diverticulosis may be asymptomatic or symptomatic.
●Diverticular disease is defined as clinically significant and symptomatic diverticulosis due to diverticular bleeding, diverticulitis, segmental colitis associated with diverticula, or symptomatic uncomplicated diverticular disease.
- Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology 2009; 136:741.
- Shaheen NJ, Hansen RA, Morgan DR, et al. The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol 2006; 101:2128.
- Painter NS, Burkitt DP. Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 1975; 4:3.
- Peery AF, Barrett PR, Park D, et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology 2012; 142:266.
- Hughes LE. Postmortem survey of diverticular disease of the colon. I. Diverticulosis and diverticulitis. Gut 1969; 10:336.
- Manousos ON, Truelove SC, Lumsden K. Prevalence of colonic diverticulosis in general population of Oxford area. Br Med J 1967; 3:762.
- Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol 1975; 4:53.
- Peery AF, Keku TO, Martin CF, et al. Distribution and Characteristics of Colonic Diverticula in a United States Screening Population. Clin Gastroenterol Hepatol 2016; 14:980.
- Delvaux M. Diverticular disease of the colon in Europe: epidemiology, impact on citizen health and prevention. Aliment Pharmacol Ther 2003; 18 Suppl 3:71.
- Chan CC, Lo KK, Chung EC, et al. Colonic diverticulosis in Hong Kong: distribution pattern and clinical significance. Clin Radiol 1998; 53:842.
- Ngoi SS, Chia J, Goh MY, et al. Surgical management of right colon diverticulitis. Dis Colon Rectum 1992; 35:799.
- Markham NI, Li AK. Diverticulitis of the right colon--experience from Hong Kong. Gut 1992; 33:547.
- Wang FW, Chuang HY, Tu MS, et al. Prevalence and risk factors of asymptomatic colorectal diverticulosis in Taiwan. BMC Gastroenterol 2015; 15:40.
- Sugihara K, Muto T, Morioka Y, et al. Diverticular disease of the colon in Japan. A review of 615 cases. Dis Colon Rectum 1984; 27:531.
- Miura S, Kodaira S, Shatari T, et al. Recent trends in diverticulosis of the right colon in Japan: retrospective review in a regional hospital. Dis Colon Rectum 2000; 43:1383.
- Imbembo AL, Bailey RW. Diverticular disease of the colon. In: Textbook of Surgery, 14th ed, Sabiston DC Jr (Ed), Churchill Livingstone, 1992. p.910.
- Gostout CJ, Wang KK, Ahlquist DA, et al. Acute gastrointestinal bleeding. Experience of a specialized management team. J Clin Gastroenterol 1992; 14:260.
- Meyers MA, Alonso DR, Gray GF, Baer JW. Pathogenesis of bleeding colonic diverticulosis. Gastroenterology 1976; 71:577.
- Casarella WJ, Kanter IE, Seaman WB. Right-sided colonic diverticula as a cause of acute rectal hemorrhage. N Engl J Med 1972; 286:450.
- Wong SK, Ho YH, Leong AP, Seow-Choen F. Clinical behavior of complicated right-sided and left-sided diverticulosis. Dis Colon Rectum 1997; 40:344.
- Strate LL, Modi R, Cohen E, Spiegel BM. Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol 2012; 107:1486.
- Stollman NH, Raskin JB. Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1999; 94:3110.
- Shahedi K, Fuller G, Bolus R, et al. Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol 2013; 11:1609.
- Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM. Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Ann Surg 2009; 249:210.
- Nguyen GC, Sam J, Anand N. Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States. World J Gastroenterol 2011; 17:1600.
- Fischer MG, Farkas AM. Diverticulitis of the cecum and ascending colon. Dis Colon Rectum 1984; 27:454.
- Rodkey GV, Welch CE. Changing patterns in the surgical treatment of diverticular disease. Ann Surg 1984; 200:466.
- Acosta JA, Grebenc ML, Doberneck RC, et al. Colonic diverticular disease in patients 40 years old or younger. Am Surg 1992; 58:605.
- Schauer PR, Ramos R, Ghiatas AA, Sirinek KR. Virulent diverticular disease in young obese men. Am J Surg 1992; 164:443.
- Painter NS. The cause of diverticular disease of the colon, its symptoms and its complications. Review and hypothesis. J R Coll Surg Edinb 1985; 30:118.
- Aldoori WH, Giovannucci EL, Rimm EB, et al. A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr 1994; 60:757.
- Nair P, Mayberry JF. Vegetarianism, dietary fibre and gastro-intestinal disease. Dig Dis 1994; 12:177.
- Rege RV, Nahrwold DL. Diverticular disease. Curr Probl Surg 1989; 26:133.
- Talbot JM. Role of dietary fiber in diverticular disease and colon cancer. Fed Proc 1981; 40:2337.
- Mendeloff AI. A critique of "fiber deficiency". Dig Dis 1976; 21:109.
- Ornstein MH, Littlewood ER, Baird IM, et al. Are fibre supplements really necessary in diverticular disease of the colon? A controlled clinical trial. Br Med J (Clin Res Ed) 1981; 282:1353.
- Brodribb AJ. Treatment of symptomatic diverticular disease with a high-fibre diet. Lancet 1977; 1:664.
- Hodgson WJ. The placebo effect. Is it important in diverticular disease? Am J Gastroenterol 1977; 67:157.
- Peery AF, Sandler RS, Ahnen DJ, et al. Constipation and a low-fiber diet are not associated with diverticulosis. Clin Gastroenterol Hepatol 2013; 11:1622.
- Ornstein MH, Littlewood ER, Baird IM, et al. Are fibre supplements really necessary in diverticular disease of the colon? Br Med J (Clin Res Ed) 1981; 282:1629.
- Taylor I, Duthie HL. Bran tablets and diverticular disease. Br Med J 1976; 1:988.
- Crowe FL, Appleby PN, Allen NE, Key TJ. Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians. BMJ 2011; 343:d4131.
- Strate LL, Liu YL, Syngal S, et al. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA 2008; 300:907.
- Aldoori WH, Giovannucci EL, Rimm EB, et al. Prospective study of physical activity and the risk of symptomatic diverticular disease in men. Gut 1995; 36:276.
- Strate LL, Liu YL, Aldoori WH, et al. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology 2009; 136:115.
- Hjern F, Wolk A, Håkansson N. Smoking and the risk of diverticular disease in women. Br J Surg 2011; 98:997.
- Aldoori WH, Giovannucci EL, Rimm EB, et al. A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men. Ann Epidemiol 1995; 5:221.
- 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.
- Strate LL, Liu YL, Huang ES, et al. Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology 2011; 140:1427.
- Aldoori WH, Giovannucci EL, Rimm EB, et al. 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.
- Morris CR, Harvey IM, Stebbings WS, et al. Do calcium channel blockers and antimuscarinics protect against perforated colonic diverticular disease? A case control study. Gut 2003; 52:1734.
- Maguire LH, Song M, Strate LE, et al. Higher serum levels of vitamin D are associated with a reduced risk of diverticulitis. Clin Gastroenterol Hepatol 2013; 11:1631.
- Golder M, Burleigh DE, Belai A, et al. Smooth muscle cholinergic denervation hypersensitivity in diverticular disease. Lancet 2003; 361:1945.
- Böttner M, Barrenschee M, Hellwig I, et al. The enteric serotonergic system is altered in patients with diverticular disease. Gut 2013; 62:1753.
- PAINTER NS, TRUELOVE SC, ARDRAN GM, TUCKEY M. SEGMENTATION AND THE LOCALIZATION OF INTRALUMINAL PRESSURES IN THE HUMAN COLON, WITH SPECIAL REFERENCE TO THE PATHOGENESIS OF COLONIC DIVERTICULA. Gastroenterology 1965; 49:169.
- Whiteway J, Morson BC. Elastosis in diverticular disease of the sigmoid colon. Gut 1985; 26:258.
- Wess L, Eastwood MA, Wess TJ, et al. Cross linking of collagen is increased in colonic diverticulosis. Gut 1995; 37:91.
- Scheff RT, Zuckerman G, Harter H, et al. Diverticular disease in patients with chronic renal failure due to polycystic kidney disease. Ann Intern Med 1980; 92:202.
- Ludeman L, Shepherd NA. What is diverticular colitis? Pathology 2002; 34:568.
- Bassotti G, Sietchiping-Nzepa F, De Roberto G, et al. Colonic regular contractile frequency patterns in irritable bowel syndrome: the 'spastic colon' revisited. Eur J Gastroenterol Hepatol 2004; 16:613.
- Bassotti G, Battaglia E, Bellone G, et al. Interstitial cells of Cajal, enteric nerves, and glial cells in colonic diverticular disease. J Clin Pathol 2005; 58:973.
- Simpson J, Sundler F, Humes DJ, et al. Post inflammatory damage to the enteric nervous system in diverticular disease and its relationship to symptoms. Neurogastroenterol Motil 2009; 21:847.
- RISK FACTORS
- - Fiber
- - Fat and red meat
- - Seeds and nuts
- Physical activity
- Diverticular bleeding
- Segmental colitis associated with diverticula
- Symptomatic uncomplicated diverticular disease
- INFORMATION FOR PATIENTS