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Diverticulitis is a common and potentially serious condition that requires a comprehensive understanding of its epidemiology, pathophysiology, clinical presentation, and management strategies. Advances in the understanding of the disease have led to less aggressive and more nuanced treatment approaches, emphasizing the importance of individualized patient care. Ongoing research is needed to further elucidate the pathogenesis of diverticulitis and optimize treatment algorithms.
Diverticulitis is a common gastrointestinal condition characterized by the inflammation of diverticula, which are small, bulging pouches that can form in the lining of the digestive system. This condition primarily affects the colon and can lead to significant morbidity and healthcare costs. Understanding the epidemiology, pathophysiology, risk factors, and management strategies for diverticulitis is crucial for effective treatment and prevention.
Epidemiology
Diverticulitis is a prevalent condition, particularly in developed countries. The prevalence of diverticular disease has been increasing, with significant health and economic burdens. For instance, the prevalence of perforated sigmoid diverticular disease in developed countries rose from 2.4 per 100,000 in 1986 to 3.8 per 100,000 in 20001. In the United States alone, diverticular disease is one of the five most costly gastrointestinal disorders1. The incidence of diverticulitis increases with age, affecting up to 50% of people by the fifth decade and 67% by the eighth decade1 4.
Pathophysiology
Diverticulitis occurs when diverticula, which are herniations of the colonic mucosa and submucosa through defects in the circular muscle layers, become inflamed2 4. The exact cause of this inflammation is not fully understood, but it is believed to involve a combination of genetic predisposition, lifestyle factors, and alterations in the gut microbiome5 10. Risk factors for developing diverticulitis include obesity, smoking, use of nonsteroidal anti-inflammatory drugs (NSAIDs), and a low-fiber diet2 5 7.
Clinical Presentation
Patients with diverticulitis typically present with acute or subacute onset of abdominal pain, usually localized to the left lower quadrant. Other common symptoms include low-grade fever, leukocytosis, and changes in bowel habits such as constipation or diarrhea4 7. Diverticulitis can be classified as uncomplicated or complicated based on imaging findings. Complicated diverticulitis may involve abscess formation, perforation, fistula, or obstruction4 7.
Diagnosis
The diagnosis of diverticulitis is often confirmed through imaging studies, with computed tomography (CT) being the most commonly used modality3 4. CT imaging helps differentiate between uncomplicated and complicated diverticulitis and guides management decisions. In some cases, colonoscopy may be performed after the acute episode to rule out other conditions such as colon cancer3.
Management
The management of diverticulitis depends on the severity of the disease. For uncomplicated diverticulitis, recent evidence suggests that antibiotics may not be necessary for all patients, and a conservative approach with dietary modifications and observation may be sufficient2 3 8. In cases of complicated diverticulitis, intravenous antibiotics and surgical intervention may be required2 7. Elective surgical resection is no longer recommended solely based on the number of recurrent episodes but should be considered based on the severity of the disease and patient preferences3 5.
Prevention
Preventive strategies for diverticulitis focus on lifestyle modifications. A high-fiber diet, regular physical activity, maintaining a healthy body weight, and avoiding smoking and NSAID use are recommended to reduce the risk of diverticulitis3 5 7. Additionally, patients should be educated about the genetic factors that may contribute to their risk of developing diverticulitis3.