title: Diverticular disease: changing epidemiology and management.
abstract: Diverticulosis is the most common pathological finding in routine colonoscopy. Diverticular disease comprises both diverticulitis and diverticular hemorrhage. This review examines the pathophysiological basis for disease including the importance of the elastin/collagen profile in diverticula formation. It summarizes the latest epidemiological findings with an emphasis on age- and sex-related differences. Risk factors including obesity, medications, hereditary factors, and diet are critically reviewed with the most up-to-date evidence. A detailed appraisal of therapeutic options is provided with special emphasis on 5-aminosalicylate, probiotics, mesalamine, percutaneous abscess drainage, and image-guided embolization. The role of antibiotics and surgery is discussed and compared with guideline recommendations. A more conservative approach, averting admission and even antibiotics, is explored. Finally, a careful review of the data surrounding the utility of colonoscopy in diagnosis and management is provided given the increasing number of reports citing the low incidence of colorectal neoplasia after an episode of diverticulitis. Throughout the review we focus on the older patient with diverticular disease.
authors.affiliation: Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, 600 University Ave, Suite 437, Toronto, ON, M5G 1X5, Canada, roshan.razik@utoronto.ca.
authors.forename: Roshan
authors.initials: R
authors.lastname: Razik
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D004238:Diverticulitis / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*; D043963:Diverticulosis, Colonic / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D012307:Risk Factors