What is diverticular disease?

• This is a condition where there are “pockets” on the colon.
  • These are “ballooned out” areas that form in weak spots on the colon presumably in response to high pressure in the bowel.
  • Diverticular disease is common - and becomes more common with age.
  • More than 1/3 of people over 45 years and 2/3 people over 85 years have diverticular disease.
    
    

• The cause of diverticular disease is unknown.
  • It is a disease that is much more common in Western populations.
  • It is uncommon in Asian and African populations.
  • This has given rise to the idea that the low dietary fibre in the Western diet is the cause of diverticular disease.
• This is only a hypothesis.  There is only limited evidence linking low fibre intake with diverticular disease.
• Large studies in European populations have shown that consuming a vegetarian diet and a high intake of dietary fibre were both associated with a lower risk of hospital admissions and death from diverticular disease.  In particular, it is fibre from fruits and vegetables that is protective.
• There is an association with being overweight and a sedentary lifestyle
• There is probably a genetic factor as there is commonly a family history.   A genetic factor is supported by twin studies that show a 4-7 fold risk. The overall risk for siblings is elevated by 3 times.
• There is an association with a  high red meat diet and a high-fat diet.
• There is a modest positive association between smoking and diverticular complications.
  

What factors alter the risk of getting diverticulitis

• Both vigorous exercise and total physical activity decrease the risk of diverticular complications.
• Obesity is a risk factor for diverticular complications. The association may be stronger for central obesity assessed by waist circumference.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and opiates have been found to increase the risk of diverticulitis and diverticular bleeding.
• Aspirin intake two or more times per week increases the risk for diverticular bleeding and regular users of NSAIDs have an increased risk of diverticulitis and diverticular bleeding.
• There is a twofold increased risk of diverticular perforation in patients taking opioids and a threefold increase of perforation in patients on steroids.