Diverticular disease imposes a significant burden on Western and industrialized societies. The traditional pathogenesis model posits that low
dietary fiber predisposes to
diverticulosis, and
fecalith obstruction prompts acute
diverticulitis that is managed with broad-spectrum
antibiotics or surgery. However, a growing body of knowledge is shifting the paradigm of
diverticular disease from an acute surgical illness to a chronic bowel disorder composed of recurrent abdominal symptoms and considerable psychosocial impact. New research implicates a role for low-grade
inflammation, sensory-motor nerve damage, and
dysbiosis in a clinical picture that mimics
irritable bowel syndrome (IBS) and even
inflammatory bowel disease (IBD). Far from being an isolated event, acute
diverticulitis may be the catalyst for chronic symptoms including
abdominal pain, cramping, bloating,
diarrhea,
constipation, and "post-
diverticulitis IBS." In addition, studies reveal lower health-related quality of life in patients with chronic
diverticular disease vs. controls. Health-care providers should maintain a high index of suspicion for the multifaceted presentations of
diverticular disease, and remain aware that it might contribute to long-term emotional distress beyond traditional
diverticulitis attacks. These developments are prompting a shift in therapeutic approaches from widespread antimicrobials and supportive care to the use of probiotics,
mesalamine, and gut-directed
antibiotics. This review addresses the emerging literature regarding epidemiology, pathophysiology, and management of chronic, symptomatic
diverticular disease, and provides current answers to common clinical questions.