Bowel Symptoms: A Red Flag for Diverticulitis?
Review by Prof. Angela Carbajal (Peru)
Study Summary
Constipation and diarrhea are often viewed as minor annoyances—but this large, prospective study suggests they may be doing more than just causing discomfort. In 871 newly diagnosed patients with diverticular disease (DD) from 43 centers worldwide, researchers found that abnormal bowel habits at baseline were closely tied to disease severity and future risk of acute diverticulitis. Both symptoms independently predicted higher DICA (Diverticular Inflammation and Complication Assessment classification), and CODA (Combined Overview on Diverticular Assessment) scores and were linked to elevated fecal calprotectin, a marker of intestinal inflammation. Perhaps most importantly, the risk of diverticulitis increased steadily with each point of symptom severity. Bowel habits may matter more than we thought.
Commentary
There’s something both intuitive and surprising about these findings. We’ve long known that bowel habits reflect gut health—but this study shows that even mild constipation or diarrhea may signal more severe diverticular disease and predict future complications like diverticulitis. What makes this study stand out is how many patients were followed over time and how clearly the patterns emerged. But the real challenge is practical: bowel symptoms are often dismissed or normalized. While the patterns seem consistent globally, cultural and dietary differences—especially between Western countries and places like Japan—may shape symptom expression. The next step is clear: clinicians should take bowel habit changes seriously, not just as symptoms, but as warning signs.
Citation
https://pubmed.ncbi.nlm.nih.gov/39129357/
Tursi A, Piovani D, Brandimarte G, Di Mario F, Elisei W, Picchio M, Figlioli G, Bassotti G, Allegretta L, Annunziata ML, Bafutto M, Bianco MA, Colucci R, Conigliaro R, Dumitrascu DL, Escalante R, Ferrini L, Forti G, Franceschi M, Graziani MG, Lammert F, Latella G, Lisi D, Maconi G, Compare D, Nardone G, Camara de Castro Oliveira L, Enio CO, Papagrigoriadis S, Pietrzak A, Pontone S, Stundiene I, Poškus T, Pranzo G, Reichert MC, Rodino S, Regula J, Scaccianoce G, Scaldaferri F, Vassallo R, Zampaletta C, Zullo A, Spaziani E, Bonovas S, Papa A, Danese S; DICA International Group. Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study. Intest Res. 2025 Jan;23(1):96-106. doi: 10.5217/ir.2024.00046. Epub 2024 Aug 12. PMID: 39129357; PMCID: PMC11834362.
Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study - PubMed
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