K. Lung1, J. Yun2, D. Vyas1,3 1California Northstate University College of Medicine,Elk Grove, CA, USA 2Touro University of California,Vallejo, CA, USA 3San Joaquin General Hospital,Department Of Surgery,French Camp, CA, USA
Introduction: Diverticular disease (DD) is among the most prevalent conditions in Western societies with incidence steadily increasing worldwide, resulting in mounting financial burden to healthcare systems globally. With this comes a notable rise in the total costs and hospitalizations attributable to DD. Once considered a phenomenon of Western cultures, DD has been increasingly documented in countries with historically low prevalence rates, such as Japan and Thailand. In today’s society, the blending of various ethnic cultures and diets across the globe has obfuscated our previous understanding of DD prevalence trends internationally. With the rise of DD worldwide, it is increasingly important to assess its prevalence, especially in non-Western societies where there is a growing influence of a Westernized diet.
Methods: Literature search was performed using Pubmed, MEDLINE, and Scopus databases using MeSH terms: ‘diverticular disease’, ‘diverticulosis’, ‘diverticulitis’, and ‘dietary fiber’ with the Boolean operator ‘AND’ (all synonyms were combined with the Boolean operator ‘OR’). DD was defined as complications due to colonic diverticulosis, including lower gastrointestinal bleeding, inflammation, abscess, fistula, perforation, and death, as diagnosed via CT scan, barium enema, or histology post-operatively. Articles describing patients with surgical findings consistent with colorectal cancer were excluded. Retrospective and prospective population studies were used to determine prevalence in Western and non-Western countries.
Results: Data for DD prevalence rates of major nations (patients > age 50) were categorized as high (>40%), moderate (20-39%), low (5-19%), and very low (<5%). Countries with the highest prevalence were the most industrialized nations, notably the United Kingdom (47%) and the United States (41.7%). Japan (20.3%) and Thailand (28.5%) had moderate prevalence rates, while South Korea (12.1%), Mexico (6.65%), and Kenya (5.3%) recorded lower overall prevalence. China (1.97%) and India (4.4%) had the lowest prevalence rates. 0.77% of the global population are considered to have high DD prevalence (>40%), while 0.19% are considered to have very low DD prevalence (<5%).
Conclusion: With increasing global immigration and cultural and dietary assimilation, the etiology of DD, once considered related to ethnic dietary patterns, is called into question as possible genetics may be at play. Long-term this may influence the current prevalence trends, hence, it is important to identify potential factors that may mitigate DD incidence in high prevalence countries, while tempering possible increases within the low prevalence countries.
