Diverticular Disease: The Old, the New, and the Ever-Changing View

Michael S. DiSiena, MD; John W. Birk, MD


South Med J. 2018;111(3):144-150. 

In This Article

Abstract and Introduction


Our understanding of diverticular disease has evolved significantly during the last 25 years, and as such, a reexamination is in order. We performed a literature search for the years 1960–2017 of PubMed, Medline, and Google Scholar for updates regarding the epidemiology, risk factors, and therapies for traditional diverticulitis as well as the recently described subtypes of diverticular disease, segmental colitis associated with diverticulosis, and symptomatic uncomplicated diverticular disease. Although the prevalence of diverticulosis is still extremely common in the general population, the literature suggests that the incidence of diverticulitis is much less than previously believed and occurrences do not necessarily increase with age. In addition, the commonly held beliefs that low-fiber diets alone contribute to the development of diverticulosis and diverticulitis have not been verified; however, the combination of a low-fiber diet and a high red meat/high-fat diet is a risk factor for diverticulitis. Surgery continues to be the treatment for severe complications of diverticulitis, but new literature suggests that it has a poor utility in preventing a recurrence of diverticulitis in the long term; therefore, elective surgery after two episodes of diverticulitis is no longer the standard.


In this reexamination of diverticular disease, we aim to address epidemiology, diagnosis, and therapy. Specifics include new knowledge on incidence, reoccurrence, the atypical forms of diverticular disease (segmental colitis associated with diverticulosis [SCAD] and symptomatic uncomplicated diverticular disease [SUDD]), as well as prophylactic therapies such as specialized fibers, prebiotics, and probiotics (Figure). We also revisit when antibiotics and a postattack colonoscopy are necessary. Finally, we review the changing views on indications for surgery.


Various forms of diverticulitis and treatments. CT, computed tomography; SCAD, segmental colitis associated with diverticulosis; SUDD, symptomatic uncomplicated diverticular disease.