Symptomatic uncomplicated diverticular disease: a critical appraisal

ABSTRACT

Introduction

Symptomatic uncomplicated diverticular disease (SUDD) is a clinical condition included in the spectrum of symptomatic diverticular disease. The symptom profile associated with SUDD is highly heterogeneous, as there are currently discordant definitions, that encompass many clinical scenarios.

Areas covered

We conducted a narrative review to assess the symptom profile and diagnostic criteria of SUDD based on the available evidence. A thorough literature search was performed on PubMed following the SANRA scale. Abdominal pain, regardless of its duration and location, emerges as the cardinal symptom of SUDD, suggesting that it should be central to its diagnosis. Although abdominal bloating and changes in bowel habits are commonly reported, they do not appear to be specifically attributable to SUDD. Other issues considered are the possible overlap with irritable bowel syndrome and the identification of a subcategory of SUDD patients with chronic symptoms following an episode of acute diverticulitis.

Expert opinion

The future agenda should include the development of shared diagnostic criteria for SUDD, including well-defined inclusion and exclusion clinical features and symptom patterns.

KEYWORDS:

• Symptomatic uncomplicated diverticular disease
• colonic diverticulosis
• diverticular disease
• abdominal pain
• abdominal bloating
• irritable bowel syndrome
• acute diverticulitis
• diarrhea
• constipation

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ARTICLE HIGHLIGHTS

• Diagnostic criteria for symptomatic uncomplicated diverticular disease (SUDD) vary widely and lack consensus, encompassing many clinical scenarios.

• Abdominal pain is the hallmark symptom of SUDD diagnosis, irrespective of its duration or location. Abdominal bloating and changes in bowel habits (i.e. diarrhea, constipation, mixed bowel habits) are commonly reported, although they do not appear to be specifically attributable to SUDD.

• An accurate assessment of ongoing diverticular inflammation and/or diverticular complications should be considered to exclude acute diverticulitis. Other major GI diseases, including colorectal cancer, should be considered in the diagnostic approach.

• The overlap between SUDD and irritable bowel syndrome remains a challenging issue.

• After an episode of acute diverticulitis, the onset of lower gastrointestinal symptoms compatible with SUDD may be defined as post-diverticulitis SUDD.

• The future agenda should focus on establishing standardized diagnostic criteria, that include well-defined clinical features for inclusion and exclusion. Hopefully, a clinical scoring system could be developed that assigns different weights to each gastrointestinal symptom and patient history.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.