Key Points
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Diverticular disease comprises acute and chronic as well as uncomplicated and complicated disease courses
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Classification is an inevitable requirement for appropriate management
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Classification needs clinical examination and cross-sectional imaging by CT or ultrasonography
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Antibiotics should be confined to treatment of more complicated disease
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Uncomplicated diverticular disease is a case for conservative management and not for surgery
Abstract
Diverticular disease is a common condition in Western countries and the incidence and prevalence of the disease is increasing. The pathogenetic factors involved include structural changes in the gut that increase with age, a diet low in fibre and rich in meat, changes in intestinal motility, the concept of enteric neuropathy and an underlying genetic background. Current treatment strategies are hampered by insufficient options to stratify patients according to individual risk. One of the main reasons is the lack of an all-encompassing classification system of diverticular disease. In response, the German Society for Gastroenterology and Digestive Diseases (DGVS) has proposed a classification system as part of its new guideline for the diagnosis and management of diverticular disease. The classification system includes five main types of disease: asymptomatic diverticulosis, acute uncomplicated and complicated diverticulitis, as well as chronic diverticular disease and diverticular bleeding. Here, we review prevention and treatment strategies stratified by these five main types of disease, from prevention of the first attack of diverticulitis to the management of chronic complications and diverticular bleeding.
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Pfützer, R., Kruis, W. Management of diverticular disease. Nat Rev Gastroenterol Hepatol 12, 629–638 (2015). https://doi.org/10.1038/nrgastro.2015.115
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DOI: https://doi.org/10.1038/nrgastro.2015.115
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