The microbiome of diverticulitis

Despite a marked impact on society in terms of patient suffering and healthcare expenditure, colonic diverticulitis has a relative scarcity of published literature examining its pathophysiology. Based on preliminary studies, akin to other gastrointestinal diseases, alterations of the microbiome appear to be associated with diverticulitis. In fact, these perturbations in the microbiome can be detected when comparing segments of diseased and non-diseased colonic tissues within the same individual. Unfortunately, differentiating cause from effect is not feasible without longitudinal studies. While the use of antibiotics for the treatment of uncomplicated diverticulitis is waning, studies utilizing rifaximin, probiotics, and even fecal microbiota transplantation are growing. At present, treatment recommendations are limited by significant heterogeneity in the study populations as well as confounding bias. Ultimately, while dysbiosis is likely to play a role in diverticulitis, a lack of animal models upon which to perform mechanistic study has limited evidence-based recommendations.