title: Diverticular disease: evolving concepts in classification, presentation, and management.
abstract: OBJECTIVE
  Diverticular disease is the most commonly reported finding at the time of colonoscopy and one of the most common gastrointestinal indications for hospitalization. Much of our previous understanding of diverticular disease has recently been challenged.
  
  
  RESULTS
  There is emerging evidence that the long-accepted hypothesis of diverticulosis as a consequence of fiber deficiency may be more complex than commonly thought, with recent evidence suggesting that high-fiber diet and frequent bowel movements are associated with a greater and not lower prevalence of diverticular disease. There is also emerging support for the concept of low-grade inflammation in symptomatic uncomplicated diverticular disease (SUDD), and the role of anti-inflammatory treatment with mesalamine is being actively investigated. Additionally, elective 'prophylactic' surgery after diverticulitis, previously considered after a second confirmed diverticulitis episode, is being increasingly deferred.
  
  
  CONCLUSIONS
  The pathogenesis of diverticular disease is likely multifactorial and complex. More studies are needed to evaluate the role of fiber in the pathogenesis and treatment of diverticular disease. The search for an effective medical therapy for SUDD and to prevent recurrent diverticulitis is being actively investigated. The efficacy of mesalamine does not appear to be strong data supported.
authors.affiliation: aAlameda Health System, Highland Hospital bAlta Bates Summit Medical Center, Northern California Gastroenterology Consultants, Inc., Oakland, California, USA.
authors.forename: Sasan
authors.initials: S
authors.lastname: Mosadeghi
authors.forename: Taft
authors.initials: T
authors.lastname: Bhuket
authors.forename: Neil
authors.initials: N
authors.lastname: Stollman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects; D003113:Colonoscopy; D004043:Dietary Fiber / Q000009:adverse effects; D043963:Diverticulosis, Colonic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D019804:Mesalamine / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004043:Dietary Fiber; D019804:Mesalamine; D001241:Aspirin