The Natural History of Colonic Diverticulosis: Much Ado about Nothing?

Rustom, Luma Basma O.; Sharara, Ala I.

doi:10.1159/000490054

Cited by 21 publications

(15 citation statements)

References 25 publications

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“…Diverticulosis of the colon (existence of false diverticulaoutpouchings of mucosa and serosa through openings in the muscular layer of the bowel) develops in the majority of individuals in western countries with increasing age and usually remains asymptomatic [13,14]. Diverticulosis per se should not therefore be considered a disease.…”

Section: Diverticulosis Vs Diverticular Diseasementioning

confidence: 99%

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European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

188

177

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Aim The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. Methods The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. Results This guideline contains 38 evidence based consensus statements on the management of diverticular disease. Conclusion This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.

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Section: Diverticulosis Vs Diverticular Diseasementioning

confidence: 99%

“…There was a clear preponderance of men [24]. In western countries with a predominant Caucasian population, the prevalence is higher [14,15]. Estimated rates of diverticulitis in patients with known diverticulosis are as low as 1%-4% or 1.5-6.0 per 1000 patient-years [25].…”

Section: What Is the Prevalence Of Diverticulosis?mentioning

confidence: 99%

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

188

177

View full text Add to dashboard Cite

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“…The true natural history of colonic diverticulosis is largely unclear [18]. The lifetime risk of acute diverticulitis has been estimated at 10%-25% but these figures were based on older literature without precise studies on prevalence of the uncomplicated diverticula in asymptomatic populations.…”

Section: Discussionmentioning

confidence: 99%

The Natural History of Incidental Colonic Diverticulosis on Screening Colonoscopy

Sharara

Ziade

Shayto

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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Background The natural history of colonic diverticulosis is unclear. Methods Patients with incidental diverticulosis identified in a previous prospective cross-sectional screening colonoscopy study were evaluated retrospectively for clinic or hospital visit(s) for diverticular disease (DD= acute diverticulitis or diverticular bleeding) using review of electronic health records and patient phone interview. Results 826 patients were included in the screening colonoscopy study. Three were excluded for prior DD. In all, 224 patients (27.2%; mean age 62.3 ± 8.2) had incidental diverticulosis distributed in the left colon (67.4%), right colon (5.8%), or both (22.8%). Up-to-date information was available on 194 patients. Of those, 144 (74.2%) could be reached for detailed interview and constituted the study population. Over a mean follow-up of 7.0 ± 1.7 years, DD developed in 6 out of 144 patients (4.2%) (4 acute cases of diverticulitis, 1 probable case of diverticular bleeding, and 1 acute case of diverticulitis and diverticular bleeding). Two patients were hospitalized, and none required surgery. The time to event was 5.1 ± 1.6 years and the incidence rate was 5.9 per 1000 patient-years. On multivariate analysis, none of the variables collected at baseline colonoscopy including age, gender, obesity, exercise, fiber intake, alcohol use, constipation, or use of NSAIDs were associated with DD. Conclusion The natural history of incidental diverticulosis on screening colonoscopy was highly favorable in this well-defined prospectively identified cohort. The common scenario of incidental diverticulosis at screening colonoscopy makes this information clinically relevant and valuable to physicians and patients alike.

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“…DD was classically considered a condition affecting elderly people in developed Western countries, where it has a prevalence of 70% in those aged >70 years [1]. Indeed, DD prevalence constantly increases starting from 50 years of age.…”

Section: Epidemiologymentioning

confidence: 99%

“…Diverticular disease (DD) is an umbrella definition that includes different clinical conditions ranging from diverticulosis—the presence of colonic diverticula without symptoms or signs—to severe and potentially life-threatening complications, such as stercoraceous peritonitis due to overt diverticular perforation [1]. Although only a minority of DD patients develop a clinical condition requiring therapy, hospital admission, or surgical intervention, the wide diffusion of DD in the general population—particularly in Western countries—results in a very high consumption of healthcare resources [2].…”

Section: Introductionmentioning

confidence: 99%

Paradigm shift: the Copernican revolution in diverticular disease

Zullo

Gatta

Vassallo

et al. 2019

aog

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Diverticular disease (DD) is an umbrella definition that includes different clinical conditions ranging from diverticulosis to severe and potentially life-threatening complications. In the last decade, new concepts regarding pathogenetic alterations have been developed, while the diagnostic, clinical and therapeutic approaches to the management of DD patients have changed. The protective role of dietary factors (i.e., fiber) has been questioned, whilst some drugs widely used in clinical practice have been found to have a deleterious effect. The use of antibiotics in all patients with acute uncomplicated diverticulitis was reconsidered, as well as the need for a surgical approach in these patients. Conflicting recommendations in different guidelines were proposed for the treatment of symptomatic uncomplicated DD. An endoscopic classification of DD was introduced, and a "curative" endoscopic approach has been pioneered. Based on these observations, which together amount to a kind of "Copernican revolution" in the management of DD patients, we performed a comprehensive and critical reappraisal of the proposed modifications, aiming to discriminate between certainties and doubts on this issue.

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The Natural History of Colonic Diverticulosis: Much Ado about Nothing?

Cited by 21 publications

References 25 publications

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

The Natural History of Incidental Colonic Diverticulosis on Screening Colonoscopy

Paradigm shift: the Copernican revolution in diverticular disease

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