Etiology and treatment of diverticulosis, diverticulitis and abdominal infection A new piece of the puzzle?

Aetiology and pathogenesis of diverticulosis and diverticulitis is one of the main themes of this thesis. There are many theories about the development of diverticula and diverticulitis as complication of diverticulosis and still many uncertainties. Fibre deficiency and microbiome alterations are commonly known hypotheses for the development of diverticulosis or diverticulitis. In the first part of this thesis we try to formulate a new hypothesis of an association between connective tissue diseases (more specifically alpha-1-antitrypsin deficiency) and colonic diverticula. We also performed a pilot study in which relatively new biomarkers were tested in a cohort of patients with an abdominal infection. Main focus was whether these markers were distinctive for mild versus severe abdominal infection. We also aimed to identify risk factors in initially computed tomography (CT)-proven uncomplicated diverticulitis for yet a complicated disease course. In the second part of this thesis we create an overview of the literature on (conservative) treatment options and proper follow-up after an episode of acute diverticulitis. Finally we discussed frequently made mistakes when managing patients with acute diverticulitis to give medical doctors advise in how to treat patients with this complicated disease.