Case Closed?

Abstract

A major advance in understanding diverticular disease occurred decades ago with the epidemiologic association between fiber intake and the development of diverticular disease. This association has been well documented with investigations into the emergence of diverticular disease in underdeveloped countries where the disease had been virtually unknown before the adoption of a westernized diet, low in fiber. The high frequency of right-sided diverticular disease in Asian countries diverges from what is seen in the West. The physiologic effects of insoluble fiber has been well examined as well, increasing bulk and decreasing transit time, with a deficiency contributing to the high pressures implicated in the physiology which leads to diverticular disease. However, at most, 10% to 25% of individuals with diverticular disease will develop diverticulitis. Risk factors for symptomatic diverticular have been increasingly described in recent years with obesity and red meat intake being of particular importance, in addition to age. However, the known factors poorly identify those at increased risk and the predisposing pathophysiology is incompletely understood as well. Insoluble fiber, but not soluble fiber, has been viewed as the principal component which has been deficient in western diets and is the culprit which leads to the establishment of diverticular disease and in turn, diverticulitis. Soluble fiber and its effect on the intestinal flora is proposed as having significant influence on the development of diverticulitis. This understanding, if demonstrated, would have important implications for the primary and secondary prevention of diverticulitis.

Association between Diverticular Disease and Pre-Neoplastic Colorectal Lesions in an Urban African-American Population

“…Diverticulosis and colorectal adenoma or carcinoma is rare among the Africans and people of the other developing countries. Studies suggest an increasing incidence of DD due to westernization of dietary habits and lifestyle [2, 3]. …”

“…In recent years, there has been an increase in the prevalence of DD and colorectal carcinoma [2, 4–6], both of which seem to share a common etio-pathology related to low fiber diet and increasing age. Colon cancer is found in 17% of patients thought to have complicated DD.…”

“…Colon cancer is found in 17% of patients thought to have complicated DD. Studies have suggested that factors like advancing age, low fiber diet [2, 3], low physical activity [7], and obesity [8] had a link to both DD and colorectal neoplasia [9–13], However, previous studies that have evaluated the association between DD and colorectal neoplasia have shown inconsistent results with some showing a positive association [10, 11] and some not showing [14]. In this study, we evaluated the association between diverticulosis and pre-neoplastic colonic lesions among an urban African-American population in Washington, D.C.…”

Increased Risk of Pyogenic Liver Abscess Among Patients With Colonic Diverticular Diseases

“…7 Autopsy studies have estimated the diverticular-disease prevalence at 5% to 52% in Western countries, and 1% to 19% in Asia. 8 Approximately one-third of the population older than 45 years is estimated to have diverticular disease. 9 Diverticular diseases can lead to disruption of the colonic mucosal barrier and therefore major clinical morbidities, including inflammation, obstruction, infection, hemorrhage, fistula formation, perforation, and peritonitis.…”

The relationship between colonic diverticulosis and abdominal visceral and subcutaneous fat accumulation measured by abdominal CT scan

“…Although age is the most powerful risk factor for this disorder, dietary meat intake and Western lifestyles are known to be significantly associated with it. In addition to these risk factors, other researchers have reported that physical inactivity, decreased intake of dietary fiber, genetic factors, and use of aspirin or nonsteroidal anti-inflammatory drugs may be risk factors for diverticulosis or complicated diverticular diseases (6)(7)(8)(9)(10). It has also been reported that obesity increases the risk of complicated diverticular diseases, such as diverticulitis or diverticular bleeding (7,(11)(12)(13)(14)(15)(16).…”