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Colonic diverticular disease

An Author Correction to this article was published on 17 June 2020

A Publisher Correction to this article was published on 29 April 2020

This article has been updated

Abstract

Diverticula are outpouchings of the intestinal wall and are common anatomical alterations detected in the human colon. Colonic diverticulosis (the presence of diverticula in the colon; referred to as diverticulosis) remains asymptomatic in most individuals but ~25% of individuals will develop symptomatic diverticulosis, termed colonic diverticular disease (also known as diverticular disease). Diverticular disease can range in severity from symptomatic uncomplicated diverticular disease (SUDD) to symptomatic disease with complications such as acute diverticulitis or diverticular haemorrhage. Since the early 2000s, a greater understanding of the pathophysiology of diverticulosis and diverticular disease, which encompasses genetic alterations, chronic low-grade inflammation and gut dysbiosis, has led to improvements in diagnosis and management. Diagnosis of diverticular disease relies on imaging approaches, such as ultrasonography, CT and MRI, as biomarkers alone are insufficient to establish a diagnosis despite their role in determining disease severity and progression as well as in differential diagnosis. Treatments for diverticular disease include dietary fibre, pharmacological treatments such as antibiotics (rifaximin), anti-inflammatory drugs (mesalazine) and probiotics, alone or in combination, and eventually surgery. Despite being effective in treating primary disease, their effectiveness in primary and secondary prevention of complications is still uncertain.

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Fig. 1: Diverticulosis and diverticular disease.
Fig. 2: Proposed biological mechanisms for diverticular disease.
Fig. 3: Cross-sectional imaging of diverticulosis and diverticular disease.
Fig. 4: The DICA classification system.
Fig. 5: Clinical presentations of acute diverticulitis.
Fig. 6: Algorithm for the management of acute uncomplicated diverticulitis.
Fig. 7: Management of acute complicated diverticulitis.
Fig. 8: Current and future predictors of outcome in diverticular disease.

Change history

  • 17 June 2020

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.

  • 29 April 2020

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.

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Acknowledgements

The authors thank R. H. Hunt (McMaster University) for critical reading of the manuscript, useful discussions and suggestions, and G. A. Binda (Biomedical Institute, Genoa) for useful discussion and reviewing the section devoted to surgical management. L.L.S. acknowledges NIH funding for her research (R01DK101495 and R01DK103915).

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Introduction (A.T. and S.D.); Epidemiology (A. Lanas); Mechanisms/pathophysiology (L.L.S.); Diagnosis, screening and prevention (W.K.); Management (C.S.); Quality of life (A. Lahat); Outlook (A.T., C.S. and S.D.); Overview of Primer (A.T.). A.T. and C.S. contributed equally and are co-first authors.

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Correspondence to Antonio Tursi.

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Competing interests

C.S. and A. Lanas are members of the Speakers’ Bureau and of the Scientific Advisory Board of Alfasigma SpA. W.K. served as speaker, consultant and/or advisory board member for Abbvie, Ardeypharm, Falk, Ferring, Genetic Analysis, Gräfe & Unze, Institut Allergosan, Nikkiso, Otsuka and Tillots. S.D. served as speaker, consultant, and/or advisory board member for Abbvie, Allergan, Alfa Wassermann, Biogen, Boehringer Ingelheim, Celgene, Celltrion, Ferring, Gilead, Hospira, Johnson and Johnson, Merck, MSD, Mundipharma, Pfizer Inc., Sandoz, Takeda, Tigenix, UCB Pharma, Vifor. The remaining authors declare no competing interests.

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Tursi, A., Scarpignato, C., Strate, L.L. et al. Colonic diverticular disease. Nat Rev Dis Primers 6, 20 (2020). https://doi.org/10.1038/s41572-020-0153-5

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