Colonic diverticulosis--current issues in etiopathogenesis, diagnosis and treatment

Diverticular disease of the colon, which is an acquired disorder caused by mucosal herniation through the colonic wall, has been termed both a "disease of the 20th century" and a "disease of Western civilization" due to its increasing prevalence in modern times and its striking geographical variability. There are complex relations between colonic structure, motility, and dietary factors, and it is likely that all of these play a role in the pathogenesis to a greater or lesser degree. Although present in two thirds of the elderly population, the large majority of patients will remain entirely asymptomatic. Nonetheless, 20% of those affected may manifest clinical illness and complications. Barium exploration indicates the extent and severity of colonic diverticular disease. Colonoscopy is preferred in positive diagnosis of uncomplicated diverticulosis. Computed tomography is especially useful in complicated diverticular disease. The use of high fibre diets in the prevention and treatment of the symptoms of diverticular disease has now become commonplace. The morbidity and mortality associated with complications, demand that this condition should receive greater attention in terms of aetiology, prevention and management.