The Natural History and Risk Stratification of Diverticulitis: Who Progresses to Complications?

Diverticulosis and its progression to diverticulitis remain a highly studied topic in gastrointestinal disease. Although up to 60% of the population in Western countries may have diverticulosis, risk factors for progression to diverticulitis, particularly complicated disease that requires surgical management, remain poorly characterized and lack validated, universally accepted risk stratification tools. The classically recognized risk factors of diverticulitis, like diet, activity level, and other modifiable behaviors, are now more clearly linked to chronic inflammation and its effects on the gut microbiome and multiple areas of gene expression, including connective tissue function and colon motility. More work remains to study the exact extent to which risk for severe diverticulitis is modifiable or whether this process is influenced more by nonmodifiable genetic factors. This information can help inform screenings of patients diagnosed with diverticulitis or those with family histories of the disease. Overall, better prediction of diverticulitis occurrence and progression to complications will help surgeons promote an individualized, patient-centered approach to disease education and operative management of patients.