Critical issues on diverticular disease

In this session diverse critical issues in diverticular disease (DD) were considered, including “In or outpatient management of uncomplicated diverticulitis?”, “Segmental colitis associated with diverticulosis: what is it?”and “Diverticular inflammation is a risk factor for colorectal cancer?”. The conclusions drawn are outlined in the statements but in summary, outpatient management is safe in selected patients, as long as correct diagnosis and stage are assured, and this can allow a cost effective treatment. Non-antibiotic management is also safe but should be confined as an outpatient treatment in carefully selected patients. Segmental colitis associated with diverticulosis (SCAD) is a defined pathological entity (only diagnosed on biopsy) characterized by an inflammatory bowel disease (IBD)-like pathology, occurring principally in the sigmoid colon, with rectal and right colon sparing. The pathogenesis is unclear but may include a genetic predisposition, microbiome alteration and ischaemia. Treatment can last months, and depends on severity, options include antibiotics, 5-ASA and probiotics for mild cases. Severe disease needs systemic steroids or even anti TNFα treatment. Whether diverticular inflammation is a risk factor for colorectal cancer (CRC) was debated and the conclusion was that within the first eighteen months of diagnosis of DD, associations with cancer are found, likely due to similar symptoms and misclassification of disease. After that time, DD does not increase the risk of CRC. Therefore, it is recommended to exclude cancer with imaging and colonoscopy after healing of the first episode of diverticulitis.