• Humans
• Middle Aged
• Female
• Male
• Retrospective Studies
• Colectomy/methods
• Recurrence
• Follow-Up Studies
• Elective Surgical Procedures/statistics & numerical data
• Elective Surgical Procedures/methods
• Aged
• Diverticulitis, Colonic/epidemiology
• Diverticulitis, Colonic/surgery
• Risk Factors
• Incidence
• Tomography, X-Ray Computed
• Sigmoid Diseases/epidemiology
• Sigmoid Diseases/surgery

• NA

• acute diverticulitis
• predictive models
• recurrence
• risk factors

• Humans
• Diverticulitis, Colonic/complications
• Diverticulitis, Colonic/surgery
• Recurrence
• Diverticulitis/complications
• Risk Factors
• Prospective Studies
• Retrospective Studies

• colon
• diagnosis
• diverticular disease
• diverticulitis
• inflammation
• treatment

There is no sufficient overview of outcomes in right-sided and left-sided colonic diverticulitis (CD) following non-operative management. This systematic review was conducted to evaluate the recurrence/treatment failure in right-sided and left-sided CD.

A systematic review was conducted following PRISMA guidelines. MEDLINE, Embase, and Cochrane Library from inception to Dec 2021 were searched. The study characteristics, recurrence/treatment failure, and risk factors for recurrence/treatment failure were extracted. Proportional meta-analyses were performed to calculate the pooled recurrent/treatment failure rate of right-sided and left-sided CD using the random effect model. Logistic regression was applied for the factors associated with the recurrence/treatment failure.

Thirty-eight studies with 10,129 patients were included, and only two studies comprised both sides of CD. None of the studies had a high risk of bias although significant heterogeneity existed. The pooled recurrence rate was 10% (95% CI 8–13%, I² = 86%, p < 0.01) in right-sided and 20% (95% CI 16–24%, I² = 92%, p < 0.01) in left-sided CD. For the uncomplicated CD, the pooled recurrence rate was 9% (95% CI 6–13%, I² = 77%, p < 0.01) in right-sided and 15% (95% CI 8–27%, I² = 97%, p < 0.01) in the left-sided. Age and gender were not associated with the recurrence of both sides. The treatment failure rate was 5% (95% CI 2–10%, I² = 84%, p < 0.01) in right-sided and 4% (95% CI 2–7%, I² = 80%, p < 0.01) in left-sided CD. The risk factors for recurrence and treatment failure were limited.

Non-operative management is effective with low rates of recurrence and treatment failure for both right-sided and left-sided CD although left-sided exhibits a higher recurrence. The recurrence rates did not differ between patients receiving antibiotics or not in uncomplicated CD. Age and sex were not associated with the recurrence although other risk factors were dispersing. Further risk factors for recurrence and treatment failure would be investigated for precise clinical decision-making and individualized strategy.

• Colonic diverticulitis
• Left-sided
• Non-operative management
• Recurrence
• Right-sided
• Treatment failure

• Conservative treatment
• Recurrence
• Right-sided diverticulitis
• Uncomplicated diverticulitis

• Adult
• Aged
• Cohort Studies
• Colostomy/statistics & numerical data
• Diverticulitis/surgery
• Elective Surgical Procedures
• Female
• Humans
• Male
• Middle Aged
• Recurrence
• Retrospective Studies
• Risk Assessment

• R01 DK103915 NIDDK NIH HHS
• T32 DK070555 NIDDK NIH HHS

• Acute diverticulitis
• Epidemiology
• National readmission database
• Readmission rates

Diverticular disease and diverticulitis are the most common non-cancerous pathology of the colon. It has traditionally been considered a disease of the elderly and associated with cultural and dietary habits. There has been a growing evolution in our understanding and the treatment guidelines for this disease. To provide an updated review of the epidemiology, pathogenesis, classification and highlight changes in the medical and surgical management of diverticulitis. Diverticulitis is increasingly being seen in young patients (< 50 years). Genetic contributions to diverticulitis may be larger than previously thought. Potential similarities and overlap with inflammatory bowel disease and irritable bowel syndrome exist. Computed tomography imaging represents the standard to classify the severity of diverticulitis. Modifications to the traditional Hinchey classification might serve to better delineate mild and intermediate forms as well as better classify chronic presentations of diverticulitis. Non-operative management is primarily based on antibiotics and supportive measures, but antibiotics may be omitted in mild cases. Interval colonoscopy remains advisable after an acute attack, particularly after a complicated form. Acute surgery is needed for the most severe as well as refractory cases, whereas elective resections are individualized and should be considered for chronic, smoldering, or recurrent forms and respective complications (stricture, fistula, etc.) and for patients with factors highly predictive of recurrent attacks. Diverticulitis is no longer a disease of the elderly. Our evolving understanding of diverticulitis as a clinical entity has led into a more nuanced approach in both the medical and surgical management of this common disease. Non-surgical management remains the appropriate treatment for greater than 70% of patients. In individuals with non-relenting, persistent, or recurrent symptoms and those with complicated disease and sequelae, a segmental colectomy remains the most effective surgical treatment in the acute, chronic, or elective-prophylactic setting.

• Diverticulitis
• Epidemiology
• Antibiotics
• Surgical resection
• Laparoscopic lavage
• Classification

• Aged
• Colectomy
• Colon, Sigmoid/surgery
• Diverticulitis/surgery
• Diverticulitis, Colonic/diagnostic imaging
• Diverticulitis, Colonic/epidemiology
• Elective Surgical Procedures
• Humans
• Laparoscopy

• diverticulitis
• medical management
• mesalamine
• probiotics
• uncomplicated diverticulitis

• diverticulitis
• recurrent
• surgery

Elective sigmoid colectomy for recurrent uncomplicated diverticulitis remains controversial and is decided on an individual basis. Eighty patients treated conservatively (44 patients) or by elective surgery (36 patients) for recurrent uncomplicated diverticulitis were contacted and assessed for quality of life. The mean difference in quality of life scores was greater after surgery (overall + 2.14%, laparoscopic resection +4.95%, p = 0.36 and p = 0.11, respectively) as compared to conservative management. Female patients undergoing laparoscopic resection had statistically significantly higher quality of life scores than women treated conservatively (+8.98%; p = 0.049). Twenty-eight of 29 responding patients stated that they were highly satisfied and would have the operation done again. Elective sigmoidectomy is a valid treatment option for recurrent uncomplicated diverticulitis in terms of quality of life. Quality of life improved most if surgery was performed laparoscopically, especially in women.

• Abscess
• Diverticulitis
• Epidemiologic studies
• Hospitalization
• Italy
• Peritonitis
• Risk factors
• Sepsis

• Acute Disease
• Aged
• Diverticulitis/complications
• Diverticulitis/epidemiology
• Diverticulitis/surgery
• Diverticulitis, Colonic/complications
• Diverticulitis, Colonic/epidemiology
• Diverticulitis, Colonic/surgery
• Female
• Hospitalization
• Hospitals
• Humans
• Italy/epidemiology
• Male
• Middle Aged

Colonic diverticular bleeding (CDB) and acute colonic diverticulitis (ACD) show high recurrence rates. The establishment of optimal strategies that prevent the recurrence of CDB and ACD is a major concern among gastroenterologists. This study aimed to assess the efficacy of burdock tea for preventing CDB and ACD recurrences. Newly diagnosed patients with CDB (n = 91) or ACD (n = 70) were randomly assigned into two groups. The experimental group received 1.5 g of burdock tea three times a day, whereas the control group did not receive any treatment. The median (interquartile range) of observation for recurrence of CDB or ACD was 22.0 (14.1) months and 30.3 (18.6), respectively. The burdock tea treatment showed significant preventive effects on recurrence of ACD. A lower ACD recurrence rate (5/47 [10.6%] vs. 14/44 [31.8%]) and longer recurrence-free duration was observed in the burdock tea group (59.3 months [95% CI: 54.0–64.7] vs. 45.1 months [95% CI: 37.1–53.0] by the Kaplan-Meier analysis; p = 0.012 by log rank test) than in the control group, although there was no significant preventive effects on the CDB recurrence. This randomized clinical trial demonstrated that daily intake of burdock tea could be an effective strategy for prevention of ACD recurrence, but not for CDB recurrence.

• Chronic Manifestations
• Functional Symptoms
• Immunosuppression
• Laparoscopic Lavage
• Smoldering Diverticulitis

• Diverticulitis, Colonic/diagnosis
• Diverticulitis, Colonic/epidemiology
• Diverticulitis, Colonic/physiopathology
• Diverticulitis, Colonic/therapy
• Humans
• Risk Factors
• Treatment Outcome

• R01 DK101495 NIDDK NIH HHS

• antibiotics
• diverticular disease
• diverticulitis
• fiber
• mesalazine
• probiotics
• rifaximin
• treatment

• Acute Disease
• Aged
• Diverticulitis/surgery
• Female
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Laparoscopy/mortality
• Length of Stay
• Male
• Middle Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/mortality
• Quality of Life
• Randomized Controlled Trials as Topic
• Reoperation/statistics & numerical data
• Sigmoid Diseases/surgery

• Diverticular abscess
• Diverticulitis complications
• Percutaneous drainage

• Colonic diverticula
• Diverticulitis
• Economic burden
• Economics
• Hospital admission

• acute diverticulitis
• fiber
• mesalazine
• primary prevention
• probiotics
• rifaximin
• secondary prevention
• treatment

• age groups
• colorectal surgery
• complications
• diverticulitis
• epidemiology

• CT scan
• Complications
• Diverticulitis
• Outcome
• Recurrence

While diverticular disease is extremely common, the natural history (NH) of its most frequent presentation (i.e., sigmoid diverticulitis) is poorly investigated. Relevant information is mostly restricted to population-based or retrospective studies. This comprehensive review aimed to evaluate the NH of simple sigmoid diverticulitis. While there is a clear lack of uniformity in terminology, which results in difficulties interpreting and comparing findings between studies, this review demonstrates the benign nature of simple sigmoid diverticulitis. The overall recurrence rate is relatively low, ranging from 13% to 47%, depending on the definition used by the authors. Among different risk factors for recurrence, patients with C-reactive protein > 240 mg/L are three times more likely to recur. Other risk factors include: Young age, a history of several episodes of acute diverticulitis, medical vs surgical management, male patients, radiological signs of complicated first episode, higher comorbidity index, family history of diverticulitis, and length of involved colon > 5 cm. The risk of developing a complicated second episode (and its corollary to require an emergency operation) is less than 2%-5%. In fact, the old rationale for elective surgery as a preventive treatment, based mainly on concerns that recurrence would result in a progressively increased risk of sepsis or the need for a colostomy, is not upheld by the current evidence.

• Diverticulitis
• Colon
• Cohort
• Recurrence
• Natural history

• Colon
• Diverticular disease
• Diverticulitis
• Diverticulosis

• Abscess/etiology
• Abscess/surgery
• Anti-Bacterial Agents/therapeutic use
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Colectomy/methods
• Colon/pathology
• Colon/surgery
• Colonography, Computed Tomographic
• Colonoscopy
• Colorectal Surgery/standards
• Diet/methods
• Dietary Fiber
• Diverticulum, Colon/complications
• Diverticulum, Colon/diagnosis
• Diverticulum, Colon/therapy
• Elective Surgical Procedures/methods
• Gastrointestinal Agents/therapeutic use
• Humans
• Italy
• Laparoscopy/methods
• Mesalamine/therapeutic use
• Multidetector Computed Tomography/methods
• Peritonitis/etiology
• Peritonitis/surgery
• Probiotics/therapeutic use
• Rifamycins/therapeutic use
• Rifaximin

• Complicated diverticulitis
• Diverticulitis
• Hartmann procedure
• Laparoscopic peritoneal lavage
• Recurrent diverticulitis

• Colectomy
• Colon, Sigmoid/surgery
• Decision Making
• Diverticulitis, Colonic/surgery
• Humans

• APACHE
• Acute Disease
• Colon, Sigmoid
• Diverticulitis/complications
• Humans
• Intestinal Perforation/complications
• Length of Stay
• Peritonitis/etiology
• Peritonitis/surgery
• Time Factors