title: Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon.
abstract: BACKGROUND
  The incidence of diverticulosis and diverticular disease of the colon, including diverticulitis, is increasing worldwide, and becoming a significant burden on national health systems. Treatment of patients with diverticulosis and DD is generally based on high-fibre diet and antibiotics, respectively. However, new pathophysiological knowledge suggests that further treatment may be useful.
  
  
  OBJECTIVE
  To review the current treatment of diverticulosis and diverticular disease.
  
  
  METHODS
  A search of PubMed and Medline databases was performed to identify articles relevant to the management of diverticulosis and diverticular disease. Major international conferences were also reviewed.
  
  
  RESULTS
  Two randomised controlled trials (RCT) found the role of antibiotics in managing acute diverticulitis to be questionable, particularly in patients with no complicating comorbidities. One RCT found mesalazine to be effective in preventing acute diverticulitis in patients with symptomatic uncomplicated diverticular disease. The role of rifaximin or mesalazine in preventing diverticulitis recurrence, based on the results of 1 and 4 RCTs, respectively, remains unclear. RCTs found rifaximin and mesalazine to be effective in treating symptomatic uncomplicated diverticular disease. The use of probiotics in diverticular disease and in preventing acute diverticulitis occurrence/recurrence appears promising but unconclusive. Finally, the role of fibre in treating diverticulosis remains unclear.
  
  
  CONCLUSIONS
  Available evidence suggests that antibiotics have a role only in the treatment of complicated diverticulitis. It appears to be some evidence for a role for rifaximin and mesalazine in treating symptomatic uncomplicated diverticular disease. Finally, there is not currently adequate evidence to recommend any medical treatment for the prevention of diverticulitis recurrence.
authors.affiliation: Gastroenterology Service, ASL BAT, Andria, BT, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Tursi
authors.affiliation: Division of Internal Medicine and Gastroenterology, Complesso Integrato "Columbus", Catholic University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Papa
authors.affiliation: IBD Unit, IRCCS "Humanitas", Rozzano, MI, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Danese
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004043:Dietary Fiber / Q000627:therapeutic use; D004239:Diverticulitis, Colonic / Q000188:drug therapy* / Q000503:physiopathology*; D004240:Diverticulum / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D019804:Mesalamine / Q000627:therapeutic use; D019936:Probiotics / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012294:Rifamycins / Q000627:therapeutic use; D000078262:Rifaximin
chemical_list: D000900:Anti-Bacterial Agents; D004043:Dietary Fiber; D012294:Rifamycins; D019804:Mesalamine; D000078262:Rifaximin