Course of the diverticular disease: What is changing?

In this session several critical issues in diverticular disease were considered, including “It is symptomatic diverticular disease or irritable bowel syndrome?”, “What do determine evolution to diverticulitis, bowel habits alteration or inflammation?”, and “Prevention of acute diverticulitis: Is it at all possible?”. The first part compared symptoms and laboratory findings between symptomatic uncomplicated diverticular disease (SUDD) and irritable bowel syndrome (IBS). Although both diseases share same symptoms, and although IBS can occur in patients having diverticulosis, SUDD and IBS can be distinguished using a combination of symptoms and laboratory tools. The second part of this session debated what are the most important risk factors for the evolution towards acute diverticulitis (AD). Current data seem to exclude a significant role of bowel habits alteration, while inflammation seems to have a stronger role, especially in causing acute diverticulitis recurrence. The third part analyzed the prevention of acute diverticulitis. In primary prevention mesalazine seems to be useful, while no definite conclusion can be drawn about the use of fiber and rifaximin. For secondary prevention, no drugs can be currently advised. At the same time, surgery should be advised on case-by-case basis.