Update on Diverticular Disease and Implications for Primary Care

• The incidence of diverticulosis is increasing with the increasingly elderly population. The incidence of diverticulitis will therefore increase.
• Of the patients with diverticulosis, 10%-25% will develop diverticulitis. Other complications of diverticular disease include rectal bleeding, colitis, abscess, perforation, fistula, and stricture formation.
• There is an increase risk of malignancy in the first year after the diagnosis of diverticular disease.
• The use of anti-inflammatory medications, calcium channel blockers, anticoagulants, aspirin, steroids, and opiates are risk factors for complications of diverticular disease.
• The presence of chronic inflammation with or without symptoms of diverticular disease has been documented on colonoscopy and should be addressed by specialty care.

Recent data would seem to suggest a change in primary care management of diverticulosis. Studies now question the etiology, management, and recommendations for primary and secondary prevention of diverticular disease in the primary care setting. Although diverticulosis is commonly found on colonoscopy, few patients will go on to develop diverticular disease, which is characterized by abdominal symptoms and the presence of chronic inflammation in some cases. Data suggest more active management and specialty referral for patients with diverticular disease to prevent complications of bleeding, diverticulitis, colitis, abscess formation, fistula, stricture, and perforation and, possibly, neoplasia.