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Review
. 2018 Dec;3(2):61-68.
doi: 10.1159/000492178. Epub 2018 Aug 7.

The Burden of Diverticular Disease and Its Complications: West versus East

Hiroyuki Imaeda  1 , Toshifumi Hibi  2
Affiliations
Review

The Burden of Diverticular Disease and Its Complications: West versus East

Hiroyuki Imaeda et al. Inflamm Intest Dis. 2018 Dec.

Abstract

Background: Colonic diverticulosis is prevalent and increasing not only in Western but also in Asian countries. Diverticulosis can be complicated by diverticulitis and diverticular bleeding. Diverticular disease is a burdensome digestive disease, because it is a major cause of hospital admissions and is associated with significant health-care costs.

Summary: The incidence of diverticulosis increases with age. Most cases of diverticulosis in Western countries involve the left side of the colon, while diverticulosis is predominantly present on the right side of the colon in Asian countries. The incidence of diverticulitis also increases with age. Diverticulitis is predominantly located on the left side of the colon in Western countries, while it is predominantly located on the right side of the colon in Asian countries. The overall complication rate is higher in left-sided than in right-sided diverticulitis. The incidence of diverticular bleeding also increases with age. The right colon is the source of diverticular bleeding in more than 50% of patients in Western countries. In Asian countries, age greater than 70 years and both-sided diverticulosis increase the bleeding risk.

Key messages: In Western countries, diverticulosis and diverticulitis are predominantly located on the left side of the colon, whereas they are predominantly present on the right side of the colon in Asian countries. Diverticular bleeding is predominantly located on the right side in Western countries, and both-sided diverticulosis increases the risk of bleeding in Asian countries. Diverticular disease with complications requires admission and operation; moreover, it recurs frequently. Therefore, diverticular disease is associated with a significant economic burden in terms of health-care costs and resource utilization.

Keywords: Diverticular bleeding; Diverticulitis; Diverticulosis; East; West.

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Figures

Fig. 1
Fig. 1
a A 41-year-old Japanese man with diverticulitis in the sigmoid colon. A computed tomography (CT) scan shows a diverticulum with a thick wall and mild induration of the perisigmoid fat, as well as thickening of the sigmoid mesocolon. b The same man with recurrence of diverticulitis in the sigmoid colon 2 years later. A CT scan shows a diverticulum with a thick wall and mild induration of the perisigmoid fat, as well as thickening of the sigmoid mesocolon. c The same man with recurrence of diverticulitis in the ascending colon 4 years later. A CT scan shows a diverticulum with a thick wall and mild induration of the periascending fat, as well as thickening of the ascending mesocolon.
Fig. 2
Fig. 2
A 72-year-old Japanese man with diverticular bleeding in the ascending colon. Colonoscopy shows bleeding from the base of a diverticulum.
See this image and copyright information in PMC

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