Course of the Diverticular Disease: What is changing?

Area of Science:

• Gastroenterology
• Digestive Diseases
• Clinical Medicine

Background:

• Diverticular disease presents diagnostic challenges, often overlapping with Irritable Bowel Syndrome (IBS).
• Understanding risk factors for acute diverticulitis and effective prevention strategies remains crucial.

Purpose of the Study:

• To differentiate Symptomatic Uncomplicated Diverticular Disease (SUDD) from IBS.
• To identify key factors influencing the evolution to acute diverticulitis.
• To evaluate current strategies for the prevention of acute diverticulitis.

Main Methods:

• Comparative analysis of symptoms and laboratory findings between SUDD and IBS.
• Review of risk factors, including bowel habits and inflammation, for diverticulitis progression.
• Assessment of evidence for primary and secondary prevention of acute diverticulitis.

Main Results:

• SUDD and IBS can be differentiated using a combination of clinical symptoms and laboratory data.
• Inflammation appears to be a more significant factor in the evolution and recurrence of acute diverticulitis than altered bowel habits.
• Mesalazine shows potential for primary prevention of acute diverticulitis, while fiber and rifaximin lack definitive evidence. Secondary prevention lacks drug recommendations, and surgery is individualized.

Conclusions:

• Distinct clinical and laboratory profiles aid in differentiating SUDD from IBS.
• Inflammation is a critical driver of acute diverticulitis, particularly recurrence.
• Current primary prevention options are limited, and secondary prevention lacks robust evidence, necessitating case-by-case surgical consideration.