title: Acute colonic diverticulitis: modern understanding of pathomechanisms, risk factors, disease burden and severity.
abstract: BACKGROUND
  Conservative, non-antibiotic and non-surgical management of acute diverticulitis is currently being investigated. To better inform clinical decisions, better understanding of disease mechanisms, disease burden and severity is needed.
  
  
  METHODS
  Literature search of risk factors, pathophysiology, epidemiology and disease burden/severity reported over the last decade.
  
  
  RESULTS
  Acute diverticulitis is a common disease and has a high disease burden. Incidence of hospital admissions is reported around 71 per 100,000 population, with reported increase in several subpopulations over the last decades. The incidence is likely to increase further with the aging populations. Risk factors for left-sided acute diverticulitis include dietary, anthropometric and lifestyle factors. Disease mechanisms are still poorly understood, but a distinction between inflammation and infection is emerging. The integrative and complex role of the gut microbiota has become an interesting factor for both understanding the disease as well as a potential target for intervention using probiotics. Mild, self-limiting events are increasingly reported from studies of successful non-antibiotic management in a considerable number of cases. Risk markers of progression to or presence of severe, complicated disease are needed for better disease stratification. Current risk stratification by clinical, imaging or endoscopic means is imperfect and needs validation. Long-term results from minimal-invasive and comparative surgical trials may better help inform clinicians and patients.
  
  
  CONCLUSIONS
  Over- and under-treatment as well as over- and under-diagnosis of severity is likely to continue in clinical practice due to lack of reliable, robust and universal severity and classification systems. Better understanding of pathophysiology is needed.
authors.affiliation: a Department of Gastrointestinal Surgery , Stavanger University Hospital , Stavanger , Norway.|b Department of Clinical Medicine , University of Bergen , Bergen , Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Søreide
authors.affiliation: c Department of Surgery , Academic Medical Center , Amsterdam , the Netherlands.
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
authors.affiliation: d Division of Epidemiology and Public Health , School of Community Health Sciences, University of Nottingham , Nottingham , UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Humes
authors.affiliation: e Division of Trauma Emergency Surgery and Surgical Critical Care , Massachusetts General Hospital , Boston , MA , USA.|f Harvard Medical School , Boston , MA , USA.
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
mesh_terms: D000208:Acute Disease; D018450:Disease Progression; D004239:Diverticulitis, Colonic / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D019936:Probiotics; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors
keywords: Diverticulitis; classification; colonic-disorders; emergency; epidemiology; pathophysiology; prevention; severity