Diverticular disease of the colon (DDC) includes a spectrum of conditions from asymptomatic
diverticulosis to symptomatic uncomplicated
diverticulosis, segmental
colitis associated with
diverticulosis, and acute
diverticulitis without or with complications that may have serious consequences. Clinical and scientific interest in DDC is increasing because of the rising incidence of all conditions within the DDC spectrum, a better, although still limited understanding of the pathogenic mechanisms involved; the increasing socioeconomic burden; and the new therapeutic options being tested. The goals of treatment in DDC are symptom and
inflammation relief and preventing
disease progression or recurrence. The basis for preventing
disease progression remains a high-fiber diet and physical exercise, although evidence is poor. Other current strategies do not meet expectations or lack a solid mechanistic foundation; these strategies include modulation of gut microbiota or
dysbiosis with
rifaximin or probiotics, or using
mesalazine for low-grade
inflammation in uncomplicated symptomatic
diverticulosis. Most acute
diverticulitis is uncomplicated, and the trend is to avoid hospitalization and unnecessary
antibiotic therapy, but patients with comorbidities,
sepsis, or immunodeficiency should receive broad spectrum and appropriate
antibiotics. Complicated acute
diverticulitis may require interventional radiology or surgery, although the best surgical approach (open versus laparoscopic) remains a matter of discussion. Prevention of acute
diverticulitis recurrence remains undefined, as do therapeutic strategies.
Mesalazine with or without probiotics has failed to prevent
diverticulitis recurrence, whereas new studies are needed to validate preliminary positive results with
rifaximin. Surgery is another option, but the number of acute events cannot guide this indication. We need to identify risk factors and
disease progression or recurrence mechanisms to implement appropriate preventive strategies.