Diverticular Disease Diagnosis and Management

Diverticular disease encompasses a spectrum from asymptomatic diverticulosis to complicated diverticulitis, affecting predominantly older populations worldwide. Diverticulosis arises when mucosal and submucosal layers herniate through the colonic muscular wall, most commonly in the sigmoid colon. While many individuals remain symptom-free, around 10–25% will develop diverticulitis, marked by inflammation, microperforation or abscess formation. Diagnosis relies on a combination of clinical assessment and imaging, with computed tomography providing high sensitivity for disease severity and complications. Colonoscopy is used after acute inflammation has resolved to evaluate for alternative pathology. Management strategies are guided by disease severity: uncomplicated diverticulitis is often treated conservatively with bowel rest, broad-spectrum antibiotics and dietary modulation, whereas complicated presentations may require percutaneous drainage or surgery. Elective sigmoid resection is considered for recurrent or persistent symptoms, balancing the risks of surgery against quality-of-life improvements. Emerging endoscopic techniques aim to combine diagnostic visualisation with targeted therapy, and growing interest in the gut microbiome suggests that microbial dysbiosis may influence disease onset and progression. International guidelines are increasingly emphasising individualised care, integrating patient preferences, prognostic biomarkers and minimally invasive approaches to reduce morbidity and optimise outcomes.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Diverticular Disease Diagnosis and Management publication trend

The graph below shows the total number of articles in diverticular disease diagnosis and management across all publications each year (not limited to Nature Index journals).

Technical terms

Diverticulosis: Presence of multiple sac-like protrusions of the colonic mucosa through the muscular layer without inflammation.

Diverticulitis: Inflammatory complication of diverticula, ranging from mild inflammation to perforation and abscess formation.

Hinchey classification: Four-stage radiological system grading acute diverticulitis from localised pericolic inflammation (Stage I) to diffuse faecal peritonitis (Stage IV).

Elective sigmoid resection: Planned surgical excision of the sigmoid colon to prevent recurrent diverticulitis and improve quality of life.

Gut microbiome: Collective community of microorganisms inhabiting the gastrointestinal tract, influencing mucosal immunity and metabolic functions.

References

1. Gut microbiome structure and function in asymptomatic diverticulosis. Genome Medicine (2024).
2. Quality-of-Life and Recurrence Outcomes Following Laparoscopic Elective Sigmoid Resection vs Conservative Treatment Following Diverticulitis. JAMA Surgery (2023).
3. Endoscopic direct diverticulitis therapy for acute uncomplicated diverticulitis. Endoscopy (2025).