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Recent advances in understanding and managing diverticulitis.

Carola Severi1, Marilia Carabotti2, Alessia Cicenia1

  • 1Department of Internal Medicine and Medical Specialties, University Sapienza of Rome, Viale del Policlinico 155, 00161 Rome, Italy.

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Summary

Acute diverticulitis (AD) poses a growing socioeconomic challenge. While outpatient management of uncomplicated AD is improving, preventing recurrences and understanding risk factors for this multifactorial disease require further research.

Keywords:
Colonic muscleDietDiverticulitisDrugsMicrobiotaPreventionRisk factorsTherapy

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Area of Science:

  • Gastroenterology
  • Epidemiology
  • Public Health

Background:

  • Acute diverticulitis (AD) presents a significant and increasing socioeconomic burden, with rising hospital admissions noted in women and younger populations.
  • The pathophysiology and natural history of AD remain incompletely understood, necessitating further investigation into risk factors and prevention strategies.
  • Current treatments targeting gut microbiota or mucosal inflammation show limited efficacy in preventing initial AD episodes or recurrences.

Purpose of the Study:

  • To review updated evidence on AD epidemiology and unresolved clinical questions.
  • To analyze predisposing and protective factors, integrating their potential mechanisms into AD pathogenesis.
  • To propose a unifying hypothesis for colonic microenvironments and summarize evidence-based therapeutic changes.

Main Methods:

  • Literature review of epidemiological data and clinical studies on acute diverticulitis.
  • Analysis of risk factors, including predisposing and protective elements.
  • Synthesis of pathogenic mechanisms and proposed therapeutic strategies.

Main Results:

  • Uncomplicated AD can increasingly be managed in outpatient settings, impacting healthcare costs.
  • The multifactorial nature of AD suggests no single cause, highlighting the need for patient stratification.
  • Recurrence of AD remains a significant clinical challenge and topic of debate.

Conclusions:

  • A better stratification of patients is crucial for developing tailored therapeutic strategies for AD.
  • Understanding the interplay of luminal and extra-luminal microenvironments may offer new insights.
  • Future research should focus on identifying specific risk factors and refining preventive and therapeutic approaches for AD.