title: Epidemiology of perforated colonic diverticular disease.
abstract: Perforated colonic diverticular disease results in considerable mortality and morbidity. This review appraises existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition. Computerised searches were used to identify published articles relating to the epidemiology, pathophysiology, and clinical features of perforated colonic diverticular disease. Several drug and dietary exposures have potential biological mechanisms for causing perforation. Of these only non-steroidal anti-inflammatory drugs have been consistently identified as risk factors in aetiological studies. The causes of perforated colonic diverticular disease remain largely unknown. Further aetiological studies, looking specifically at perforation, are required to investigate whether cause-effect relationships exist for both drug and dietary exposures. The identification of risk factors for perforation would allow primary public health prevention, secondary risk factor modification, and early prophylactic surgery to be aimed at people at high risk.
authors.affiliation: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK. christopher.morris@uea.ac.uk
authors.forename: C R
authors.initials: CR
authors.lastname: Morris
authors.forename: I M
authors.initials: IM
authors.lastname: Harvey
authors.forename: W S L
authors.initials: WS
authors.lastname: Stebbings
authors.forename: C T M
authors.initials: CT
authors.lastname: Speakman
authors.forename: H J
authors.initials: HJ
authors.lastname: Kennedy
authors.forename: A R
authors.initials: AR
authors.lastname: Hart
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D004032:Diet / Q000009:adverse effects; D004239:Diverticulitis, Colonic / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D014943:Global Health; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal