Diverticular disease (DD) refers to the presence of diverticula throughout the gastrointestinal (GI) tract, mainly along colon. DD might evolve into diverticulitis that is accompanied by severe clinical presentation, which includes abscess formation, perforation, stricture, obstruction and/or fistula.Except from common predisposing parameters, several genetic mutations, immune factors, neurotransmitters,hormones and protein dysfunctions have been associated to the early onset of DD symptoms, pathogenesis and prognosis of the disease. Specific structural changes in the colonic wall, altered matrix composition and compromised motility have been verified as possible pathogenic factors for the development of DD. Dysregulation in peristaltic activity and reduced ability of the longitudinal muscle to relax following contraction has been also associated with DD evolution. In addition, it has been suspected that genetic defects combined with alterations in intestinal microbiota might play an important role in diverticulitis presentation.

     Except from common predisposing parameters, several genetic mutations, immune factors, neurotransmitters, hormones,and protein dysfunctions have been associated to the early onset of DD symptoms and pathogenesis and prognosis of the disease. Specific structural changes in the colonic wall,along with the detection of an altered matrix composition and compromised motility, have been verified as major pathogenic factors in the development of DD. Dysregulation in peristaltic activity and a reduced ability of the longitudinal muscle to relax following contraction has been also associate with DD evolution. It has been also suspected that genetic defects combined with alterations in intestinal microbiota might play an important role in diverticulitis presentation. A deeper understanding of the aforementioned factors’ impact could provide specific biomarkers for early diagnosis and prompt therapeutic interventions for this disease.Taking all these risk factors into account, it is evident that endoscopic features as well as a specific combination of the abovementioned molecular and genetic predisposing parameters have an important role in predicting both the occurrence and recurrence of diverticulitis. Future prospective trials regarding the choice of the suitable pattern of overexpressed or downregulatedmolecular structures that could be indicative of developing DD are highly recommended. Therefore, it is crucial to create a classification system for DD-affected patients diagnosed incidentally through endoscopy based on a wellestablished panel of both molecular and genetic factors indicative of an increased possibility of DD evolution to diverticulitis.Furthermore, additional evaluation of the diagnostic consequence of specific biomarkers for DD development and the clarification of its beneficial contribution in DD patients on the basis of their molecular and genetic characteristics are highly warranted.