Pathogenesis of colonic diverticula

Background: Diverticula are herniations through the colonic wall and are therefore likely to be due to a weakness within the wall, an alteration in intracolonic pressures or a combination of these factors. This article reviews these aspects in relation to the pathogenesis of colonic diverticula. Methods: Medline and Science Citation Index searches were performed to locate English language articles relating to the pathogenesis of colonic diverticulosis published since 1960. Manual cross-referencing was also performed and some historical articles were included. Results and conclusions: Several theories now exist about the development of colonic diverticula. The majority of the evidence suggests that the morphological changes are the response to a lifelong consumption of a low-residue diet. However, there are complex relations between colonic structure, motility and dietary factors, and it is likely that all of these (and possibly genetic influences) play a role in the pathogenesis to a greater or lesser degree.