Changing views on diverticular disease as a cause of gastro-intestinal bleeding

Over the past 60 years there has been continuing controversy and changing views about the relative importance of diverticular disease as a cause of gastro-intestinal haemorrhage. In the 1920s neoplasms were thought to be the commonest cause of colonic bleeding, then in the 1950s diverticulitis and subsequently diverticulosis. However, at that time the diagnosis of diverticular haemorrhage was mostly one of exclusion. In the 1960s an attempt was made to identify the site of bleeding and it was found that even though diverticula are mostly in the left colon, bleeding occurred from the right colon. A partial explanation for this came with the advent of arteriography and the discovery of caecal angiodysplasias. The relative importance of the two conditions remains uncertain but it is clear that, in patients with gastro-intestinal haemorrhage, the presence of diverticula should not stop a thorough search for other causes of bleeding.