Abstract

Gut microbiota composition and functionality are involved in the pathophysiology of several intestinal and
extraintestinal diseases, and are increasingly considered a modulator of local and systemic inflammation.
However, the involvement of gut microbiota in diverticulosis and in diverticular disease is still poorly
investigated. In this review, we critically analyze the existing evidence on the fecal and mucosa-associated
microbiota composition and functionality across different stages of diverticular disease. We also explore
the influence of risk factors for diverticulosis on gut microbiota composition, and speculate on the possible
relevance of these associations for the pathogenesis of diverticula. We overview the current treatments of
diverticular disease targeting the intestinal microbiome, highlighting the current areas of uncertainty and
the need for future studies. Although no conclusive remarks on the relationship between microbiota and
diverticular disease can be made, preliminary data suggest that abdominal symptoms are associated with
reduced representation of taxa with a possible anti-inflammatory effect, such as Clostridium cluster IV, and
overgrowth of Enterobacteriaceae, Bifidobacteria and Akkermansia. The role of the microbiota in the early
stages of the disease is still very uncertain. Future studies should help to disentangle the role of the microbiome
in the pathogenesis of diverticular disease and its progression towards more severe forms.

Keywords

diverticulosis, microbiome, mucosa-associated microbiome, fecal microbiota, metagenomics, acute diverticulitis, dysbiosis, diet, constipation