Treatment strategies in recurrent and ongoing diverticulitis

Each year approximately 22,000 patients in the Netherlands are seen in the emergency department with suspected diverticulitis. This leads to an estimated 18,000 admissions a year with total estimated costs of 40 to 80 million euro per year. Diverticulitis is thus one of the most common and costly benign gastrointestinal diseases in the western population. It is estimated that 70% of the population aged 70 and older have diverticula in the colon. Of these patients approximately 25% will experience one or more episodes of diverticulitis. In patients with recurrent diverticulitis the frequency of relapses may vary from every three months to once every 10 years. In most cases the first relapse will take place within five years after the initial episode. If symptoms persist after a first or recurrent diverticulitis - such as left lower abdominal pain, persistent fatigue, difficulty with bowel movements, decreased appetite and episodes of fever, referral to a specialist is in place. Several aspects of both the etiology and treatment of patients with diverticulitis are subject of debate. Some of them will be discussed in this thesis.