During the last decade there have been a number of reports using routinely collected health care administration data and from large cohort studies that have attempted to describe changes in the occurrence and identify risk factors for the development of the condition along with reporting its associated mortality. This article identified all studies reporting the occurrence and mortality associated with diverticulosis, diverticular disease and the complications of diverticular disease, notably, bleeding, perforation, fistula, stricture and abscess formation which show that there is strong evidence of an increasing health care burden associated with diverticular disease in terms of hospitalization. There is evidence of an increase in the incidence of some of the associated complications of diverticular disease, notably perforation. A number of risk factors such as body mass index, comorbidity, smoking and concurrent medications such as opiate analgesics and steroids may predispose to the development of complications. The mortality associated with hospital admission for diverticular disease is significant as is the excess mortality associated with a diagnosis of one of the complications of diverticular disease.

1.
Sandler RS, Everhart JE, Donowitz M, et al: The burden of selected digestive diseases in the United States. Gastroenterology 2002;122:1500–1511.
2.
Parks TG: Natural history of diverticular disease of the colon. A review of 521 cases. BMJ 1969;4:639–642.
3.
Tudor RG, Farmakis N, Keighley MR: National audit of complicated diverticular disease: analysis of index cases. Br J Surg 1994;81:730–732.
4.
Elliott T, Yego S, Irvin T: Five-year audit of the acute complications of diverticular disease. Br J Surg 1997;84:535–539.
5.
Bahadursingh AM, Virgo KS, Kaminski DL, Longo WE: Spectrum of disease and outcome of complicated diverticular disease. Am J Surg 2003;186:696–701.
6.
Manousos ON, Truelove SC, Lumsden K: Prevalence of colonic diverticulosis in general population of Oxford area. BMJ 1967;3:762–763.
7.
Gear JSS, Fursdon P, Nolan DJ, et al: Symptomless diverticular disease and intake of dietary fibre. The Lancet 1979;313:511–514.
8.
Eastwood MA, Sanderson J, Pocock SJ, Mitchell WD: Variation in the incidence of diverticular disease within the city of Edinburgh. Gut 1977;18:571–574.
9.
Crowe FL, Appleby PN, Allen NE, Key TJ: Diet and risk of diverticular disease in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford cohort: a prospective study of British vegetarians and non-vegetarians. BMJ 2011;343: d4131.
10.
Kyle J, Davidson AI: The changing pattern of hospital admissions for divertical disease of the colon. Br J Surg 1975;62:537–541.
11.
Kang JY, Hoare J, Tinto A, et al: Diverticular disease of the colon on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther 2003;17:1189–1195.
12.
Jeyarajah S, Faiz O, Bottle A, et al: Diverticular disease hospital admissions are increasing, with poor outcomes in the elderly and emergency admissions. Aliment Pharmacol Ther 2009;30:1171–1182.
13.
Etzioni DA, Mack TM, Beart RWJ, Kaiser AM: Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 2009;249:210–217.
14.
Nguyen GC, Steinhart AH: Nationwide patterns of hospitalizations to centers with high volume of admissions for inflammatory bowel disease and their impact on mortality. Inflamm Bowel Dis 2008;14:1688–1694.
15.
Masoomi H, Buchberg BS, Magno C, Mills SD, Stamos MJ: Trends in diverticulitis management in the United States from 2002 to 2007. Arch Surg 2011;146:400–406.
16.
Nguyen GC, Sam J, Anand N: Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States. World J Gastroenterol 2011;17:1600–1605.
17.
Strate L, Liu Y, Aldoori W, Syngal S, Giovannucci E: Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology 2009;136:115–122.e1.
18.
Strate LL, Liu YL, Aldoori WH, Giovannucci EL: Physical activity decreases diverticular complications. Am J Gastroenterol 2009;104:1221–1230.
19.
Strate LL, Liu YL, Huang ES, Giovannucci EL, Chan AT: Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology 2011;140:1427–1433.
20.
Tønnesen H, Engholm G, Møller H: Association between alcoholism and diverticulitis. Br J Surg 1999;86:1067–1068.
21.
Broderick-Villa G, Burchette RJ, Collins JC, Abbas MA, Haigh PI: Hospitalization for acute diverticulitis does not mandate routine elective colectomy. Arch Surg 2005;140:576–581, discussion 581–583.
22.
Tudor R, Farmakis N, Keighley M: National audit of complicated diverticular disease: analysis of index cases. Br J Surg 1994;81:730–732.
23.
Constantinides V, Tekkis P, Senapati A: Prospective multicentre evaluation of adverse outcomes following treatment for complicated diverticular disease. Br J Surg 2006;93:1503–1513.
24.
Hart AR, Kennedy HJ, Stebbings WS, Day NE: How frequently do large bowel diverticula perforate? An incidence and cross-sectional study. Eur J Gastroenterol Hepatol 2000;12:661–665.
25.
Makela J, Kiviniemi H, Laitinen S: Prevalence of perforated sigmoid diverticulitis is increasing. Dis Colon Rectum 2002;45:955–961.
26.
Humes DJ, Solaymani-Dodaran M, Fleming KM, Simpson J, Spiller RC, West J: A population-based study of perforated diverticular disease incidence and associated mortality. Gastroenterology 2009;136:1198–1205.
27.
Wong W, Wexner S, Lowry A, et al: Practice parameters for the treatment of sigmoid diverticulitis – supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 2000;43:290–297.
28.
Janes S, Meagher A, Frizelle FA: Elective surgery after acute diverticulitis. Br J Surg 2005;92:133–142.
29.
Chapman J, Davies M, Wolff B, et al: Complicated diverticulitis: is it time to rethink the rules? Ann Surg 2005;242:576–581, discussion 581–583.
30.
Chapman JR, Dozois EJ, Wolff BG, Gullerud RE, Larson DR: Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes? Ann Surg 2006;243:876–830, discussion 580–583.
31.
Humes DJ, West J: The role of acute diverticulitis in the development of complicated colonic diverticular disease and one year mortality following diagnosis in the UK: population based cohort study. Gut 2012;61:95–100.
32.
Rafferty J, Shellito P, Hyman N, Buie W: Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 2006;49:939–944.
33.
Humes DJ, Fleming KM, Spiller RC, West J: Concurrent medication use and the risk of perforated colonic diverticular disease: a population-based case control study. Gut 2011;60:219–224.
34.
Hjern F, Wolk A, Håkansson N: Smoking and the risk of diverticular disease in women. Br J Surg 2011;98:997–1002.
35.
Simpson J, Spiller R: Colonic diverticular disease. Clin Evid 2004:599–609.
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