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What is diverticular disease?

Diverticular disease occurs when weak spots in the muscle layer of the large intestine or bowel allow the lining of the intestine to bulge through. The bulging intestinal lining can develop small pouches, or “diverticula.” Though diverticula don’t necessarily cause any symptoms or discomfort, they are susceptible to inflammation, irritation, and infection. Diverticula are often found during a test, such as a colonoscopy.

The presence of diverticula is called “diverticular disease,” or “diverticulosis.” “Diverticulitis” occurs when the diverticula become inflamed. Together, diverticulosis and diverticulitis make up diverticular disease.

Diverticular disease is very common in Western and industrialized countries, affecting nearly 70% of individuals aged 80 or older in the United States.1 Diverticular disease is beginning to appear in younger groups, as well.2

What are common symptoms?

Diverticular disease is associated with a wide range of symptoms – from very mild to severe, chronic, and recurrent – depending on the stage of the disease. The stages occur as follows3:

  1. Development of diverticula
  2. Symptom-free stage
  3. Symptomatic uncomplicated diverticular disease. This stage may include episodes of abdominal pain, diarrhea, constipation, nausea, or vomiting
  4. Complicated diverticular disease, involving the development of abscesses, fistulas, or more serious infections

Symptoms of diverticular disease resemble those of irritable bowel syndrome,4 including 3:

  • Bloating
  • Constipation and other gastrointestinal disorders
  • Diarrhea
  • Lower abdominal pain or discomfort that lasts longer than 24 hours
  • Sleep disturbance
  • Tenesmus (a painful sensation of incomplete evacuation of the bowel)

What are the causes?

For now, scientists haven’t identified the exact cause or causes of diverticular disease. Generally, studies show that diverticula develop when poor diet affects the movement of food through the intestines and colon.5 Evidence increasingly shows that dietary habits, obesity, smoking habits, and alcohol consumption contribute to the development of diverticula.6

How does this topic relate to my microbiome?

As diverticular disease progresses, the gut microbiome changes in a way that causes inflammation.7 Bacterial genera belonging to the Clostridium cluster IV – such as Clostridium spp., Eubacterium spp., Ruminococcus spp., and Anaerofilum spp. – decrease during diverticular disease.7,8 Similar decreases have been noted for bacterial genera from Clostridium cluster IX,7,9 Fusobacterium spp., and Akkermansia spp.7 Some of the bacterial species that increase during diverticular disease include Faecalibacterium prausnitzii, Clostridium difficile, Parabacteroides distasonis, and members of the Streptococcus genus.10 According to recent animal models, species like Bilophila wadsworthia, which usually occupy the gut without any problems, can overgrow as diverticular disease develops. When this happens, B. wadsworthia can become problematic.11

Which diseases/topics are related to diverticular disease?

Diverticular disease is also associated with these conditions12,13:

  • Cardiovascular disease
  • Diabetes mellitus
  • Leukocytosis, as a sign of increased inflammation in the body
  • Liver disease
  • Obesity
  • Peptic ulcers
  • Renal failure

Recently, diverticular disease has been associated with inflammatory bowel disease since their symptoms are so similar. However, the link between the two has not yet been determined.14

How can people take action?

Though diverticular disease is a progressive condition, a range of treatments and guidelines can help reverse damage associated with the disease.15 Preventive measures include16:

  • Fiber-rich diet
  • Limiting red meat consumption
  • Low alcohol consumption
  • Non-smoking habits
  • Physical exercise


1. Strate, L. L., Modi, R., Cohen, E., & Spiegel, B. M. R. (2012). Diverticular Disease as a Chronic Illness: Evolving Epidemiologic and Clinical Insights. The American Journal of Gastroenterology, 107(10), 1486–1493.

2. Klarenbeek, B. R., de Korte, N., van der Peet, D. L., & Cuesta, M. A. (2012). Review of current classifications for diverticular disease and a translation into clinical practice. International Journal of Colorectal Disease, 27(2), 207–214.

3. Cuomo, R., Barbara, G., Andreozzi, P., Bassotti, G., Casetti, T., Grassini, M., … Annibale, B. (2013). Symptom patterns can distinguish diverticular disease from irritable bowel syndrome. European Journal of Clinical Investigation, n/a-n/a.

4. Tursi, A., Elisei, W., Picchio, M., Giorgetti, G. M., & Brandimarte, G. (2015). Moderate to Severe and Prolonged Left Lower-abdominal Pain is the Best Symptom Characterizing Symptomatic Uncomplicated Diverticular Disease of the Colon. Journal of Clinical Gastroenterology, 49(3), 218–221.

5. Petruzziello, L., Iacopini, F., Bulajic, M., Shah, S., & Costamagna, G. (2006). Review article: Uncomplicated diverticular disease of the colon. Alimentary Pharmacology and Therapeutics, 23(10), 1379–1391.

6. Strate, L. L. (2012b). Diverticulosis and Dietary Fiber: Rethinking the Relationship. Gastroenterology, 142(2), 205–207.

7. Barbara, G., Scaioli, E., Barbaro, M. R., Biagi, E., Laghi, L., Cremon, C., … Festi, D. (2016). Gut microbiota, metabolome and immune signatures in patients with uncomplicated diverticular disease. Gut, 66(7), 1252–1261.

8. Lopetuso, L. R., Scaldaferri, F., Petito, V., & Gasbarrini, A. (2013). Commensal Clostridia: leading players in the maintenance of gut homeostasis. Gut Pathogens, 5(1), 23.

9. Van den Abbeele, P., Grootaert, C., Marzorati, M., Possemiers, S., Verstraete, W., Gerard, P., … Van de Wiele, T. (2010). Microbial Community Development in a Dynamic Gut Model Is Reproducible, Colon Region Specific, and Selective for Bacteroidetes and Clostridium Cluster IX. Applied and Environmental Microbiology, 76(15), 5237–5246.

10. Lopetuso, L. R., Petito, V., Graziani, C., … Gasbarrini, A. (2018). Gut Microbiota in Health, Diverticular Disease, Irritable Bowel Syndrome, and Inflammatory Bowel Diseases: Time for Microbial Marker of Gastrointestinal Disorders. Digestive Diseases, 36(1), 56-65.

11. Spiller, R. C. (2015). Changing views on diverticular disease: impact of aging, obesity, diet, and microbiota. Neurogastroenterology & Motility, 27(3), 305–312.

12. Chen, C.-Y., Wu, C.-C., Jao, S.-W., Pai, L., & Hsiao, C.-W. (2009). Colonic Diverticular Bleeding with Comorbid Diseases may Need Elective Colectomy. Journal of Gastrointestinal Surgery, 13(3), 516–520.

13. Rodríguez-Cerrillo, M., Poza-Montoro, A., Fernandez-Diaz, E., & Romero, A. I. (2010). Patients with uncomplicated diverticulitis and comorbidity can be treated at home. European Journal of Internal Medicine, 21(6), 553–554.

14. von Rahden, B. H. A., & Germer, C.-T. (2012). Pathogenesis of colonic diverticular disease. Langenbeck”s Archives of Surgery, 397(7), 1025–1033.

15. Weizman, A. V, & Nguyen, G. C. (2011). Diverticular Disease: Epidemiology and Management. Canadian Journal of Gastroenterology, 25(7), 385–389.

16. Andeweg, C. S., Mulder, I. M., Felt-Bersma, R. J. F., Verbon, A., van der Wilt, G. J., van Goor, H., … Bleichrodt, R. P. (2013). Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis. Digestive Surgery, 30(4–6), 278–292.