This term covers heartburn (a central chest discomfort) and upper abdominal discomfort or pain. Possible causes include reflux, ulcers and functional dyspepsia - even sometimes irritable bowel syndrome...


Diverticular disease (view from the inside - at colonoscopy). Note that the "pockets" are wide-mouthed
Viewed from the outside

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.





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