Intestinal microbiota, low-grade inflammation and probiotic modulation in symptomatic uncomplicated diverticular disease: experimental and clinical perspectives. A narrative review

Symptomatic Uncomplicated Diverticular Disease (SUDD) of the colon represents one of the most common gastrointestinal disorders in Western countries, with prevalence increasing significantly with age. Among its clinical manifestations, SUDD is characterized by recurrent abdominal pain, bloating, and alterations in bowel habits in the absence of overt inflammatory complications. Although the pathogenesis of diverticular disease has traditionally been attributed to mechanical factors such as increased intraluminal pressure and structural weakness of the colonic wall, growing evidence suggests that intestinal dysbiosis and low-grade mucosal inflammation play a crucial role in the development of symptoms. Alterations in gut microbiota composition may disrupt epithelial barrier integrity, promote inflammatory signaling pathways, and contribute to visceral hypersensitivity. In recent years, probiotics and symbiotic formulations have been investigated as potential therapeutic strategies aimed at restoring intestinal microbial equilibrium and modulating inflammatory responses. This mini-review summarizes the current knowledge regarding the pathophysiology of SUDD, with particular emphasis on microbiota-host interactions, and discusses the experimental and clinical evidence supporting the use of probiotics in the management of SUDD.