Do diverticula provide a unique niche for microbiota which can lead to activation of the innate immune system?

As individuals living a Western lifestyle age, the prevalence of diverticulosis steadily rises reaching around 50% over the age of 75 years.1 While for most this is a harmless ageing change reflecting weakening of colonic connective tissue, around 30% suffer recurrent abdominal pain, often with diarrhoea,2 and 1–4% will be hospitalised with diverticulitis.3 As our population steadily ages this represents a substantial health burden, however, we know surprisingly little about the underlying mechanisms of this disease.

Heritability of symptomatic diverticular disease is around 40%,4 however, studies of immigrants from low-risk areas to high-risk countries show that environmental factors are equally important.3 Once hospitalised with diverticulitis the risk of further hospitalisation is around 1% per year but the majority continue to suffer pain or bowel disturbance, at least for the 1st year after discharge.5 Diverticulitis is associated with inflammation,...

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