International Consensus on Diverticulosis and Diverticular Disease. Statements from the 3rd International Symposium on Diverticular Disease

Abstract

The statements produced by the Chairmen and Speakers of the 3rd International Symposium on Diverticular Disease, held in Madrid on April 11th-13th 2019, are reported. Topics such as current and evolving concepts on the pathogenesis, the course of the disease, the news in diagnosing, hot topics in medical and surgical treatments, and finally, critical issues on the disease were reviewed by the Chairmen who proposed 39 statements graded according to level of evidence and strength of recommendation. Each topic was explored focusing on the more relevant clinical questions. The vote was conducted on a 6-point scale and consensus was defined a priori as 67% agreement of the participants. The voting group consisted of 124 physicians from 18 countries, and agreement with all statements was provided. Comments were added explaining some controversial areas.

Colonic diverticulosis and diet: is it useful?

“…11 As a consequence, the current guidelines identify SUDD as a distinct clinical syndrome. 12 Acute diverticulitis The term "acute diverticulitis" describes the macroscopic inflammation of diverticula. The condition can be uncomplicated or complicated.…”

“…colonic wall thickening with fat stranding, while it is complicated when CT detects features of inflammatory complications (abscess, peritonitis, obstruction, fistulas). 12 The management of acute diverticulitis is associated with significant direct and indirect costs for national health systems. 13 Even if the disease seems to occur less frequently than previously estimated, 14 it has been shown to relapse more frequently.…”

Role of Inflammation in the Pathogenesis of Diverticular Disease

“…Some studies tried to show that these are flaw evidences, since patients having diverticulosis and chronic abdominal symptoms do not show any evidence of inflammation [9]. However, the definition of "abdominal chronic symptoms in diverticulosis" does not fulfil the current definition of SUDD [46]. On the contrary, patients fulfilling the correct definition of SUDD show all the reported evidences on the role of inflammation in the pathogenesis of SUDD [47].…”

“…Recent studies demonstrated that DD is associated with peculiar alterations of the enteric nervous system (ENS), encompassing myenteric oligoneuronal hypoganglionosis, decreased intramuscular nerve fibers, and altered neurochemical coding [40][41][42][43][44][45][46][47][48][49][50][51][52][53]. Analyzing the expression of the glial markers S100β, Cossais et al found very recently that S100β expression was increased in the submucosal and myenteric plexus of patients with DD compared with that in controls, whereas the expression of other glial factors remained unchanged.…”

“…It is a common finding especially in developed countries: by the age of 85, the large majority of the population living in developed countries will have developed colonic diverticula [1]. Recent ?epidemiology studies found different prevalence in European countries according to socioeconomic status: countries with a lower socioeconomic status report a 5.3% frequency of diverticulosis in patients aged [30][31][32][33][34][35][36][37][38][39]8.7% in those aged [40][41][42][43][44][45][46][47][48][49]19.4% between 50 and 59, and up to 29.6% in subjects over the seventh decade, while maximal incidences were found in patients aged 70-79 and above 80 of 40.2% and 57.9%, respectively [2]. Although diverticulosis prevalence in Africa and Asia remains low, more recent epidemiology studies found its prevalence increasing also in the developing world, probably because of changes in lifestyle [2].…”