Current Diagnosis of Symptomatic Uncomplicated Diverticular Disease May Be Inaccurate

Researchers examined whether patients with diverticulosis had a higher risk for irritable bowel syndrome, abdominal pain, or altered bowel habits.

Diverticulosis is associated with more frequent bowel movements, instead of constipation, and is not associated with irritable bowel syndrome (IBS) symptoms or abdominal pain, as previously believed, according to a study published in Gastro Hep Advances. Given the study findings, researchers recommend that clinicians reconsider a diagnosis of symptomatic uncomplicated diverticular disease (SUDD).

Researchers conducted a prospective cohort study, which included 310 participants (51% men; 80% White, 19% Black) given a first-time screening colonoscopy between 2013 and 2015 at the University of North Carolina. A diverticulosis screening was included in this colonoscopy. In 2019 and 2020, participants completed a follow-up interview on their gastrointestinal (GI) symptoms and bowel habits (mean follow-up, 6.8±0.2 years after baseline). The correlation between colonic diverticulosis and GI symptoms was assessed using modified Poisson regression and represented using relative risk (RR).

Baseline diverticulosis was observed in 41% of the study participants. No association was identified between diverticulosis and abdominal pain lasting more than 24 hours (RR, 0.40; 95% CI, 0.05-3.45). Rome III IBS criteria were fulfilled by 13% of those with diverticulosis and 11% of those without, though no association between IBS and diverticulosis was identified (RR, 1.30; 95% CI, 0.69-2.42).

Individuals with vs without diverticulosis were more likely to have between 2 bowel movements per day compared with 1 (RR, 1.60; 95% CI, 1.05-2.44); this association was stronger among those with more than 10 diverticula (RR, 2.03; 95% CI, 1.19-3.48). Altered stool consistency was not associated with diverticulosis.

Study limitations included a small cohort, potential bias from the development of diverticulosis after baseline colonoscopy, and certain underpowered subanalyses.

The study researchers concluded that “providers should hesitate to make a diagnosis of SUDD in patients with diverticulosis and chronic, painful abdominal symptoms. Instead, an alternative diagnosis should be sought. Diverticulosis is associated with more frequent bowel movements, not infrequent bowel movements. Research using high quality assessments of colonic motility will be an important next step in understanding this common condition.”


Peery AF, Keku TO, Galanko JA, Sandler RS. Colonic diverticulosis is not associated with painful abdominal symptoms in a US population. Gastro Hep Advances. Published online April 28, 2022. doi:10.1016/j.gastha.2022.04.001