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Irritable bowel syndrome and colonic diverticular disease

overlapping symptoms and overlapping therapeutic approaches

Alamo, Rommel Zerpa; Quigley, Eamonn M.M.

Current Opinion in Gastroenterology: January 2019 - Volume 35 - Issue 1 - p 27–33
doi: 10.1097/MOG.0000000000000499
LARGE INTESTINE: Edited by Eamonn M.M. Quigley
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Purpose of review Irritable bowel syndrome (IBS) is a common symptomatic disorder in the Western world and colonic diverticula are also prevalent; however, relationships between IBS-type symptoms and diverticula have been a source of much debate. Our goal was to reassess these relationships in the light of new data.

Recent findings On removing from consideration clinical scenarios which are directly related to diverticula (i.e., diverticulitis, diverticular hemorrhage, and complications of diverticulitis, such as stricture and fistula), relationships between IBS and diverticula can be seen to revolve around a number of questions. First, are IBS and symptomatic uncomplicated diverticular disease (SUDD) the same condition? Or, in other words is SUDD no more than IBS in an individual who just happens to have diverticula? Although coincident IBS and diverticula inevitably do occur there is some evidence to indicate that SUDD may be somewhat distinctive with SUDD being characterized by more frequent and severe pain. Second, and analogous to interactions between IBS and inflammatory bowel disease or celiac disease, can an episode of acute diverticulitis lead to the de novo development of IBS? There is now epidemiological and pathophysiological evidence to support this occurrence.

Summary Although relationships between uncomplicated diverticular disease and IBS have been reexamined their status remains unclear. As yet, however, none of the newer concepts related to this relationship have led to new therapeutic approaches in IBS or diverticular disease.

Division of Gastroenterology and Hepatology, Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas, USA

Correspondence to Eamonn M.M. Quigley, MD, FACP, MACG, Division of Gastroenterology and Hepatology, Houston Methodist Hospital, 6550 Fannin St., SM 1201, Houston, TX 77030, USA. E-mail: equigley@houstonmethoodist.org

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