Origin of symptoms in diverticular disease

Background: A significant number of patients with colonic diverticula experience unexplained, recurrent, short‐lived but often debilitating abdominal pain and alteration in bowel habit. Such patients account for many medical consultations every year but, as our understanding of the cause of their symptoms remains imperfect, treatment options are limited. This article reviews the possible mechanisms that may be responsible for the symptoms of diverticular disease. Methods: Medline and Science Citation Index searches were performed to locate English language articles relating to colonic diverticula and symptoms published between January 1966 and July 2002. Manual cross‐referencing was also performed and some historical articles were included. Results and conclusion: Several theories now exist about the mechanisms underlying the symptoms of diverticular disease. Initial studies suggested that they may be due to alterations in the intracolonic pressure, extrapolating earlier thoughts on the likely pathogenesis of diverticula. It seems more likely, however, that several inter‐related processes, such as muscular dysfunction, visceral hypersensitivity and inflammation, are involved in symptom generation. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Inflammation a likelier culprit than altered intracolonic pressure