UpFront

Abstract

Diverticular disease is common, affecting 70% of the western population by the age of 80. In this issue Williams and colleagues provide a comprehensive overview discussing pathophysiology, classification and management. The incidence is rapidly increasing in younger age groups. Complications include acute diverticulitis, abscess, bleeding and perforation—most complications occur during the primary episode. Chronic symptoms are common and present a significant healthcare burden. The pathophysiology is complex with diet a significant contributory factor—nicely summarised in figure 1. Disease can be asymptomatic or symptomatic and then uncomplicated or complicated with complicated diverticulitis further categorised by the Hinchey and modified Hinchey classifications (figure 2) which guide treatment. The authors discuss preventative and treatment strategies (figure 3) including diet, lifestyle, probiotics and antibiotics (not always indicated) with endoscopic clipping and surgical intervention indicated in a proportion of cases. The review is authoritative, practical and up to date and as such essential reading. (See page 50). Alcohol-related hepatitis is the most florid presentation of alcohol-related liver disease and carries a high short-term and long-term mortality rate. In this issue Shearer and colleagues …