Journal Mobile Options
Table of Contents
Vol. 25, No. 2, 2007
Issue release date: April 2007
Section title: Paper
Dig Dis 2007;25:151–159
(DOI:10.1159/000099480)

Diverticular Disease in the Elderly

Comparato G.a · Pilotto A.b · Franzè A.c · Franceschi M.a, b · Di Mario F.a
aChair of Gastroenterology, University of Parma, Parma, bDepartment of Geriatrics, Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, and cGastroenterology and Endoscopy Unit, Azienda Ospedaliera, Parma, Italy
email Corresponding Author

Abstract

There are few diseases whose incidence varies as greatly worldwide as that of diverticulosis. Its prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those ≧65 years of age. Of patients with diverticula, 80–85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15–20% of patients develop symptomatic diverticular disease. Traditional concepts regarding the causes of colonic diverticula include alterations in colonic wall resistance, disordered colonic motility and dietary fiber deficiency. Currently, inflammation has been proposed to play a role in diverticular disease. Goals of therapy in diverticular disease should include improvement of symptoms and prevention of recurrent attacks in symptomatic, uncomplicated diverticular disease, and prevention of the complications of disease such as diverticulitis. Diverticulitis is the most usual clinical complication of diverticular disease, affecting 10–25% of patients with diverticula. Most patients admitted with acute diverticulitis respond to conservative treatment, but 15–30% require surgery. Predictive factors for severe diverticulitis are sex, obesity, immunodeficiency and old age. Surgery for acute complications of diverticular disease of the sigmoid colon carries significant rates of morbidity and mortality, the latter of which occurs predominantly in cases of severe comorbidity. Postoperative mortality and morbidity are to a large extent driven by patient-related factors.

© 2007 S. Karger AG, Basel


  

Key Words

  • Colonic diverticula, causes
  • Diverticular disease, elderly
  • Diverticulitis
  • Diverticulitis, diagnosis
  • Diverticular colitis, pathogenesis
  • Diverticulosis, definitions and epidemiology

References

  1. Jun S, Stollman N: Epidemiology of diverticular disease. Best Pract Res Clin Gastroenterol 2002;16:529–542.
  2. Mendeloff AI: Thoughts on the epidemiology of diverticular disease. Clin Gastroenterol 1986;15:855–877.
  3. Kyle AO, Tinckler LF, De Beaux J: Incidence of diverticulitis. Scand J Gastroenterol 1967;2:77–80.

    External Resources

  4. Hjern F, Johansson C, et al: Diverticular disease and migration – the influence of acculturation to a Western lifestyle on diverticular disease. Aliment Pharmacol Ther 2006;23:797–805.
  5. Painter NS, Burkitt DP: Diverticular disease of the colon: a deficiency disease of Western civilization. BMJ 1971;ii:450–454.
  6. Painter NS, Burkitt DP: Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 1975;4:3–21.
  7. Parks TG: Natural history of diverticular disease of the colon. Clin Gastroenterol 1975;4:53–69.
  8. Salzman H, Lillie D: Diverticular disease: diagnosis and treatment. Am Fam Physician 2005;72:1229–1234.
  9. Reisman Y, Ziv Y, Kravrovitc D, et al: Diverticulitis: the effect of age and location on the course of disease. Int J Colorectal Dis 1999;14:250–254.
  10. Tursi A: Acute diverticulitis of the colon-current medical therapeutic management. Expert Opin Pharmacother 2004;5:55–59.
  11. Roberts PL, Veidenheimer MC: Current management of diverticulitis. Adv Surg 1994;27:189–208.
  12. Reinus JF, Brandt LJ: Vascular ectasias and diverticulosis: common causes of lower intestinal bleeding. Gastroenterol Clin North Am 1994;23:1–20.
  13. Slack W: The anatomy, pathology and some clinical features of diverticulitis of the colon. Br J Surg 1962;50:185–190.
  14. Simpson J, Scholefield JH, Spiller RC: Pathogenesis of colonic diverticula. Br J Surg 2002;89:546–554.
  15. Stollman N, Raskin JB: Diverticular disease of the colon. Lancet 2004;363:631–639.
  16. Di Mario F, Comparato G, et al: Use of mesalazine in diverticular disease. J Clin Gastroenterol 2006;40:S155–S159.
  17. Ghorai S, Ulbright TM, Douglas K, et al: Endoscopic findings of diverticular inflammation in colonoscopy patients with clinical acute diverticulitis: prevalence and endoscopic spectrum. Am J Gastroenterol 2003;98:76–84.

    External Resources

  18. Makapugay LM, Dean PJ: Diverticular disease-associated chronic colitis. Am J Surg Pathol 1996;20:94–102.
  19. Peppercorn MA: The overlap of inflammatory bowel disease and diverticular disease. J Clin Gastroenterol 2004;38(suppl 1):S8–S10.

    External Resources

  20. Sheperd NA: Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades. Gut 1996;38:801–802.
  21. Tursi A: Mesalazine for diverticular disease of the colon – a new role for an old drug. Expert Opin Pharmacother 2005;6:69–74.
  22. Boulos PB, Karamanolis DG, Salmon PR, Clark CG: Is colonoscopy necessary in diverticular disease? Lancet 1984;i:95–96.

    External Resources

  23. Wolff W, Shinya H: Colonoscopy. N Engl J Med 1973;288:974–975.
  24. Williams CB, Lane RH, Sakai Y: Colonoscopy: an air-pressure hazard. Lancet 1973;ii:729.

    External Resources

  25. Aldoori WH, Giovannucci EL, Rockett HR, Sampson L, Rimm EB, Willett WC: A prospective study of dietary fiber types and symptomatic diverticular disease in men. J Nutr 1998;128:714–719.
  26. Fric P, Zavoral M: The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon. Eur J Gastroenterol Hepatol 2003;15:313–315.
  27. Papi C, Ciaco A, Koch M, et al: Efficacy of rifaximine in the treatment of symptomatic diverticular disease of the colon. A multicentre double-blind placebo-controlled trial. Aliment Pharmacol Ther 1995;9:33–39.
  28. Latella G, Pimpo MT, Sottili S, et al: Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon. Int J Colorectal Dis 2003;18:55–62.
  29. Stollmann NH, Raskin JB: Diagnosis and management of diverticular disease of the colon. Am J Gastroenterol 1999;94:3110–3121.
  30. Gore S, Sheperd NA, Wilkinson SP: Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance. Int J Colorect Dis 1992;7:76–81.
  31. Trespi E, Colla C, Panizza P, Polino MG, Venturini A, Bottani G, De Vecchi P, Matti C: Ruolo terapeutico e profilattico della mesalazina (5-ASA) nella malattia diverticolare sintomatica del crasso. Minerva Gastroenterol Dietol 1999;45:245–252.

    External Resources

  32. Tursi A, Brandimarte G, Daffinà R: Long-term treatment with mesalazine and rifaximin vs. rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon. Dig Liver Dis 2002;34:510–515.
  33. Brandimarte G, Tursi A: Rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease. Med Sci Monit 2004;10:P170–P173.
  34. Di Mario F, Aragona G, Leandro G: Efficacy of mesalazine in the treatment of symptomatic diverticular disease. Dig Dis Sci 2005;50:581–586.
  35. Doringer E: Computerized tomography of colonic diverticulitis. Crit Rev Diagn Imaging 1992;33:421–435.
  36. Hulnick DH, Megibow AJ, Balthazar EJ, Naidich DP, Bosniak MA: Computed tomography in the evaluation of diverticulitis. Radiology 1984;152:491–495.
  37. Cho KC, Morehouse HT, Alterman DD, Thornhill BA: Sigmoid diverticulitis: diagnostic role of CT – comparison with barium enema studies. Radiology 1990;176:111–115.
  38. Ambrosetti P, Jenny A, Becker C, Terrier TF, Morel P: Acute left colonic diverticulitis: compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum 2000;43:1363–1367.
  39. Standards Task Force of the American Society of Colon and Rectal Surgeons: Practice parameters for sigmoid diverticulitis: supporting documentation. Dis Colon Rectum 1995;38:126–132.

    External Resources

  40. Parks TG: Natural history of diverticular disease of the colon: a review of 521 cases. BMJ 1969;iv:639–642.
  41. Stollman NH, Raskin JB: Diagnosis and management of diverticular disease of the colon in adults: ad hoc practice parameters committee of the American College of Gastroenterology. Am J Gastroenterol 1999;94:3110–3121.
  42. Kohler L, Sauerland S, Neugebauer E: Diagnosis and treatment of diverticular disease: results of a consensus development conference. Surg Endosc 1999;13:430–436.
  43. Wong WD, Wexner SD, Lowry A, et al: Practice parameters for the treatment of sigmoid diverticulitis: supporting documentation. Dis Colon Rectum 2000;43:290–297.
  44. Franklin ME Jr, Dorman JP, Jacobs M, Plasencia G: Is laparoscopic surgery applicable to complicated colonic diverticular disease? Surg Endosc 1997;11:1021–1025.
  45. Smadja C, Sbai Idrissi M, Tahrat M, et al: Elective laparoscopic sigmoid colectomy for diverticulitis: results of a prospective study. Surg Endosc 1999;13:645–648.
  46. Kockerling F, Schneider C, Reymond MA, et al: Laparoscopic resection of sigmoid diverticulitis: results of a multicenter study. Surg Endosc 1999;13:567–571.
  47. Berthou JC, Charbonneau P: Elective laparoscopic management of sigmoid diverticulitis: results in a series of 110 patients. Surg Endosc 1999;13:457–460.
  48. Stevenson A, Stitz R, Lumley J, Fielding G: Laparoscopically assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients. Ann Surg 1998;227:335–342.
  49. Lauro A, Alonso Poza A, Cirocchi R, et al: Laparoscopic surgery for colon diverticulitis. Minerva Chir 2002;57:1–5.
  50. Oomen JLT, Engel AF, et al: Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient-related factors. Colorectal Dis 2006;8:112–119.
  51. Konvolinka CW: Acute diverticulitis under age forty. Am J Surg 1994;167:562–565.
  52. Freischlag J, Bennion RS, Thompson JE Jr: Complications of diverticular disease of the colon in young people. Dis Colon Rectum 1986;29:639–643.
  53. Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C: Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory? A prospective study of 118 patients. Dis Colon Rectum 2002;45:962–966.
  54. Reisman Y, Ziv Y, Kravrovitc D, Negri M, Wolloch Y, Halevy A: Diverticulitis: the effect of age and location on the course of disease. Int J Colorectal Dis 1999;14:250–254.
  55. Spivak H, Weinrauch S, Harvey JC, Surick B, Ferstenberg H, Friedman I: Acute colonic diverticulitis in the young. Dis Colon Rectum 1997;40:570–574.
  56. Goh H, Bourne R: Non-steroidal anti-inflammatory drugs and perforated diverticular disease: a case-control study. Ann R Coll Surg Engl 2002;84:93–96.
  57. Mitchell KL, Shaheen NJ: Preventive therapy in perforated colonic diverticular disease? Calcium channel blockers may hold the key. Gastroenterology 2004;127:680–682.
  58. Potter GD, Sellin JH: Lower gastrointestinal bleeding. Gastroenterol Clin North Am 1988;17:341–356.
  59. Boley SJ, DiBiase A, Brandt LJ, Sammartano RJ: Lower intestinal bleeding in the elderly. Am J Surg 1979;137:57–64.
  60. Gostout CJ, Wang KK, Ahlquist DA, et al: Acute gastrointestinal bleeding: experience of a specialized management team. J Clin Gastroenterol 1992;14:260–267.
  61. Peura DA, Lanza FL, Gostout CJ, Foutch PG: The American College of Gastroenterology Bleeding Registry: preliminary findings. Am J Gastroenterol 1997;92:924–928.
  62. Longstreth GF: Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1997;92:419–424.
  63. McGuire HH Jr, Haynes BW Jr: Massive hemorrhage for diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in fifty cases. Ann Surg 1972;175:847–855.
  64. Zuckerman GR, Prakash C: Acute lower intestinal bleeding. II. Etiology, therapy, and outcomes. Gastrointest Endosc 1999;49:228–238.
  65. Meyers MA, Alonso DR, Gray GF, Baer JW: Pathogenesis of bleeding colonic diverticulosis. Gastroenterology 1976;71:577–583.
  66. Casarella WJ, Kanter IE, Seaman WB: Right-sided colonic diverticula as a cause of acute rectal hemorrhage. N Engl J Med 1972;286:450–453.
  67. McGuire HH Jr: Bleeding colonic diverticula: a reappraisal of natural history and management. Ann Surg 1994;220:653–656.
  68. Wong SK, Ho YH, Leong AP, Seow-Choen F: Clinical behavior of complicated right-sided and left-sided diverticulosis. Dis Colon Rectum 1997;40:344–348.
  69. Wilcox CM, Alexander LN, Cotsonis GA, Clark WS: Non-steroidal anti-inflammatory drugs are associated with both upper and lower gastrointestinal bleeding. Dig Dis Sci 1997;42:990–997.
  70. Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Willett WC: Use of acetaminophen and non-steroidal anti-inflammatory drugs: a prospective study and the risk of symptomatic diverticular disease in men. Arch Fam Med 1998;7:255–260.

  

Author Contacts

Prof. Francesco Di Mario
Dipartimento di Scienze Cliniche, Sezione di Gastroenterologia
Università degli Studi di Parma
Via Gramsci 14, IT–43100 Parma (Italy)
Tel. +39 0521 702 772, Fax +39 0521 291 582, E-Mail francesco.dimario@unipr.it

  

Article Information

Number of Print Pages : 9
Number of Figures : 2, Number of Tables : 3, Number of References : 70

  

Publication Details

Digestive Diseases (Clinical Reviews)

Vol. 25, No. 2, Year 2007 (Cover Date: April 2007)

Journal Editor: Malfertheiner, P. (Magdeburg)
ISSN: 0257–2753 (print), 1421–9875 (Online)

For additional information: http://www.karger.com/DDI


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

There are few diseases whose incidence varies as greatly worldwide as that of diverticulosis. Its prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those ≧65 years of age. Of patients with diverticula, 80–85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15–20% of patients develop symptomatic diverticular disease. Traditional concepts regarding the causes of colonic diverticula include alterations in colonic wall resistance, disordered colonic motility and dietary fiber deficiency. Currently, inflammation has been proposed to play a role in diverticular disease. Goals of therapy in diverticular disease should include improvement of symptoms and prevention of recurrent attacks in symptomatic, uncomplicated diverticular disease, and prevention of the complications of disease such as diverticulitis. Diverticulitis is the most usual clinical complication of diverticular disease, affecting 10–25% of patients with diverticula. Most patients admitted with acute diverticulitis respond to conservative treatment, but 15–30% require surgery. Predictive factors for severe diverticulitis are sex, obesity, immunodeficiency and old age. Surgery for acute complications of diverticular disease of the sigmoid colon carries significant rates of morbidity and mortality, the latter of which occurs predominantly in cases of severe comorbidity. Postoperative mortality and morbidity are to a large extent driven by patient-related factors.

© 2007 S. Karger AG, Basel


  

Author Contacts

Prof. Francesco Di Mario
Dipartimento di Scienze Cliniche, Sezione di Gastroenterologia
Università degli Studi di Parma
Via Gramsci 14, IT–43100 Parma (Italy)
Tel. +39 0521 702 772, Fax +39 0521 291 582, E-Mail francesco.dimario@unipr.it

  

Article Information

Number of Print Pages : 9
Number of Figures : 2, Number of Tables : 3, Number of References : 70

  

Publication Details

Digestive Diseases (Clinical Reviews)

Vol. 25, No. 2, Year 2007 (Cover Date: April 2007)

Journal Editor: Malfertheiner, P. (Magdeburg)
ISSN: 0257–2753 (print), 1421–9875 (Online)

For additional information: http://www.karger.com/DDI


Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: 5/4/2007
Issue release date: April 2007

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 3

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Jun S, Stollman N: Epidemiology of diverticular disease. Best Pract Res Clin Gastroenterol 2002;16:529–542.
  2. Mendeloff AI: Thoughts on the epidemiology of diverticular disease. Clin Gastroenterol 1986;15:855–877.
  3. Kyle AO, Tinckler LF, De Beaux J: Incidence of diverticulitis. Scand J Gastroenterol 1967;2:77–80.

    External Resources

  4. Hjern F, Johansson C, et al: Diverticular disease and migration – the influence of acculturation to a Western lifestyle on diverticular disease. Aliment Pharmacol Ther 2006;23:797–805.
  5. Painter NS, Burkitt DP: Diverticular disease of the colon: a deficiency disease of Western civilization. BMJ 1971;ii:450–454.
  6. Painter NS, Burkitt DP: Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 1975;4:3–21.
  7. Parks TG: Natural history of diverticular disease of the colon. Clin Gastroenterol 1975;4:53–69.
  8. Salzman H, Lillie D: Diverticular disease: diagnosis and treatment. Am Fam Physician 2005;72:1229–1234.
  9. Reisman Y, Ziv Y, Kravrovitc D, et al: Diverticulitis: the effect of age and location on the course of disease. Int J Colorectal Dis 1999;14:250–254.
  10. Tursi A: Acute diverticulitis of the colon-current medical therapeutic management. Expert Opin Pharmacother 2004;5:55–59.
  11. Roberts PL, Veidenheimer MC: Current management of diverticulitis. Adv Surg 1994;27:189–208.
  12. Reinus JF, Brandt LJ: Vascular ectasias and diverticulosis: common causes of lower intestinal bleeding. Gastroenterol Clin North Am 1994;23:1–20.
  13. Slack W: The anatomy, pathology and some clinical features of diverticulitis of the colon. Br J Surg 1962;50:185–190.
  14. Simpson J, Scholefield JH, Spiller RC: Pathogenesis of colonic diverticula. Br J Surg 2002;89:546–554.
  15. Stollman N, Raskin JB: Diverticular disease of the colon. Lancet 2004;363:631–639.
  16. Di Mario F, Comparato G, et al: Use of mesalazine in diverticular disease. J Clin Gastroenterol 2006;40:S155–S159.
  17. Ghorai S, Ulbright TM, Douglas K, et al: Endoscopic findings of diverticular inflammation in colonoscopy patients with clinical acute diverticulitis: prevalence and endoscopic spectrum. Am J Gastroenterol 2003;98:76–84.

    External Resources

  18. Makapugay LM, Dean PJ: Diverticular disease-associated chronic colitis. Am J Surg Pathol 1996;20:94–102.
  19. Peppercorn MA: The overlap of inflammatory bowel disease and diverticular disease. J Clin Gastroenterol 2004;38(suppl 1):S8–S10.

    External Resources

  20. Sheperd NA: Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades. Gut 1996;38:801–802.
  21. Tursi A: Mesalazine for diverticular disease of the colon – a new role for an old drug. Expert Opin Pharmacother 2005;6:69–74.
  22. Boulos PB, Karamanolis DG, Salmon PR, Clark CG: Is colonoscopy necessary in diverticular disease? Lancet 1984;i:95–96.

    External Resources

  23. Wolff W, Shinya H: Colonoscopy. N Engl J Med 1973;288:974–975.
  24. Williams CB, Lane RH, Sakai Y: Colonoscopy: an air-pressure hazard. Lancet 1973;ii:729.

    External Resources

  25. Aldoori WH, Giovannucci EL, Rockett HR, Sampson L, Rimm EB, Willett WC: A prospective study of dietary fiber types and symptomatic diverticular disease in men. J Nutr 1998;128:714–719.
  26. Fric P, Zavoral M: The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon. Eur J Gastroenterol Hepatol 2003;15:313–315.
  27. Papi C, Ciaco A, Koch M, et al: Efficacy of rifaximine in the treatment of symptomatic diverticular disease of the colon. A multicentre double-blind placebo-controlled trial. Aliment Pharmacol Ther 1995;9:33–39.
  28. Latella G, Pimpo MT, Sottili S, et al: Rifaximin improves symptoms of acquired uncomplicated diverticular disease of the colon. Int J Colorectal Dis 2003;18:55–62.
  29. Stollmann NH, Raskin JB: Diagnosis and management of diverticular disease of the colon. Am J Gastroenterol 1999;94:3110–3121.
  30. Gore S, Sheperd NA, Wilkinson SP: Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance. Int J Colorect Dis 1992;7:76–81.
  31. Trespi E, Colla C, Panizza P, Polino MG, Venturini A, Bottani G, De Vecchi P, Matti C: Ruolo terapeutico e profilattico della mesalazina (5-ASA) nella malattia diverticolare sintomatica del crasso. Minerva Gastroenterol Dietol 1999;45:245–252.

    External Resources

  32. Tursi A, Brandimarte G, Daffinà R: Long-term treatment with mesalazine and rifaximin vs. rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon. Dig Liver Dis 2002;34:510–515.
  33. Brandimarte G, Tursi A: Rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease. Med Sci Monit 2004;10:P170–P173.
  34. Di Mario F, Aragona G, Leandro G: Efficacy of mesalazine in the treatment of symptomatic diverticular disease. Dig Dis Sci 2005;50:581–586.
  35. Doringer E: Computerized tomography of colonic diverticulitis. Crit Rev Diagn Imaging 1992;33:421–435.
  36. Hulnick DH, Megibow AJ, Balthazar EJ, Naidich DP, Bosniak MA: Computed tomography in the evaluation of diverticulitis. Radiology 1984;152:491–495.
  37. Cho KC, Morehouse HT, Alterman DD, Thornhill BA: Sigmoid diverticulitis: diagnostic role of CT – comparison with barium enema studies. Radiology 1990;176:111–115.
  38. Ambrosetti P, Jenny A, Becker C, Terrier TF, Morel P: Acute left colonic diverticulitis: compared performance of computed tomography and water-soluble contrast enema: prospective evaluation of 420 patients. Dis Colon Rectum 2000;43:1363–1367.
  39. Standards Task Force of the American Society of Colon and Rectal Surgeons: Practice parameters for sigmoid diverticulitis: supporting documentation. Dis Colon Rectum 1995;38:126–132.

    External Resources

  40. Parks TG: Natural history of diverticular disease of the colon: a review of 521 cases. BMJ 1969;iv:639–642.
  41. Stollman NH, Raskin JB: Diagnosis and management of diverticular disease of the colon in adults: ad hoc practice parameters committee of the American College of Gastroenterology. Am J Gastroenterol 1999;94:3110–3121.
  42. Kohler L, Sauerland S, Neugebauer E: Diagnosis and treatment of diverticular disease: results of a consensus development conference. Surg Endosc 1999;13:430–436.
  43. Wong WD, Wexner SD, Lowry A, et al: Practice parameters for the treatment of sigmoid diverticulitis: supporting documentation. Dis Colon Rectum 2000;43:290–297.
  44. Franklin ME Jr, Dorman JP, Jacobs M, Plasencia G: Is laparoscopic surgery applicable to complicated colonic diverticular disease? Surg Endosc 1997;11:1021–1025.
  45. Smadja C, Sbai Idrissi M, Tahrat M, et al: Elective laparoscopic sigmoid colectomy for diverticulitis: results of a prospective study. Surg Endosc 1999;13:645–648.
  46. Kockerling F, Schneider C, Reymond MA, et al: Laparoscopic resection of sigmoid diverticulitis: results of a multicenter study. Surg Endosc 1999;13:567–571.
  47. Berthou JC, Charbonneau P: Elective laparoscopic management of sigmoid diverticulitis: results in a series of 110 patients. Surg Endosc 1999;13:457–460.
  48. Stevenson A, Stitz R, Lumley J, Fielding G: Laparoscopically assisted anterior resection for diverticular disease: follow-up of 100 consecutive patients. Ann Surg 1998;227:335–342.
  49. Lauro A, Alonso Poza A, Cirocchi R, et al: Laparoscopic surgery for colon diverticulitis. Minerva Chir 2002;57:1–5.
  50. Oomen JLT, Engel AF, et al: Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient-related factors. Colorectal Dis 2006;8:112–119.
  51. Konvolinka CW: Acute diverticulitis under age forty. Am J Surg 1994;167:562–565.
  52. Freischlag J, Bennion RS, Thompson JE Jr: Complications of diverticular disease of the colon in young people. Dis Colon Rectum 1986;29:639–643.
  53. Chautems RC, Ambrosetti P, Ludwig A, Mermillod B, Morel P, Soravia C: Long-term follow-up after first acute episode of sigmoid diverticulitis: is surgery mandatory? A prospective study of 118 patients. Dis Colon Rectum 2002;45:962–966.
  54. Reisman Y, Ziv Y, Kravrovitc D, Negri M, Wolloch Y, Halevy A: Diverticulitis: the effect of age and location on the course of disease. Int J Colorectal Dis 1999;14:250–254.
  55. Spivak H, Weinrauch S, Harvey JC, Surick B, Ferstenberg H, Friedman I: Acute colonic diverticulitis in the young. Dis Colon Rectum 1997;40:570–574.
  56. Goh H, Bourne R: Non-steroidal anti-inflammatory drugs and perforated diverticular disease: a case-control study. Ann R Coll Surg Engl 2002;84:93–96.
  57. Mitchell KL, Shaheen NJ: Preventive therapy in perforated colonic diverticular disease? Calcium channel blockers may hold the key. Gastroenterology 2004;127:680–682.
  58. Potter GD, Sellin JH: Lower gastrointestinal bleeding. Gastroenterol Clin North Am 1988;17:341–356.
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