[Diverticular disease: myths and realities]

Area of Science:

• Gastroenterology
• Colorectal Diseases
• Microbiome Research

Background:

• Diverticulosis and diverticular disease are prevalent in Western nations, with rising incidence and healthcare impact.
• Pathogenesis understanding is evolving, identifying low-grade inflammation, microbiota alterations, visceral hypersensitivity, and motility dysfunction as key factors.
• The risk of developing diverticulitis from diverticulosis is estimated between 10-25%.

Purpose of the Study:

• To review current knowledge on the pathogenesis and treatment of diverticular disease.
• To evaluate the evidence supporting dietary, antibiotic, and surgical interventions.
• To explore emerging therapeutic strategies based on new pathophysiological insights.

Main Methods:

• Literature review of recent studies on diverticular disease pathogenesis and management.
• Analysis of evidence regarding diet, antibiotics, surgery, and novel treatments.
• Synthesis of findings to inform clinical practice and future research directions.

Main Results:

• High-fiber diet's protective role against diverticulosis lacks strong evidence, contrary to existing guidelines.
• Evidence for antibiotics in uncomplicated diverticulitis is sparse and of low quality.
• A conservative surgical approach is favored for recurrent or chronic symptomatic disease.
• Emerging treatments like mesalamine, rifaximin, and probiotics show potential but require further validation.

Conclusions:

• Diverticular disease understanding is shifting towards a chronic disorder model.
• Current evidence challenges traditional dietary recommendations and supports conservative management strategies.
• Further research is crucial to validate novel treatments for diverticular disease efficacy and cost-effectiveness.