Pathophysiology and prevention of diverticulitis and perforation

Objective: This article gives an overview of the current evidence and theories in the pathophysiology of diverticulosis, diverticulitis and perforation and discusses its prevention. Background: Diverticular disease is one of the most common diseases related to the gastrointestinal tract in Western countries. The pathogenesis of this disease process is probably multifactorial, but remains poorly understood and inadequately investigated. Methods: A literature search was performed in order to give an overview of the current evidence and theories in the pathophysiology of diverticula formation and the factors related to progression towards inflammation and even perforation. Strategies for prevention of (perforated) diverticulitis are also discussed. Results/conclusion: The pathogenesis of diverticular disease and its complications seems to be a result of a complex interaction between exposure to a low-fibre diet, possible genetic influences, the coexistence of other bowel diseases and the impact of medicine use. This eventually leads to alterations in colonic pressures and motility and structural changes of the colon wall. Unfortunately the evidence is frequently conflicting in the present literature or lacking altogether.