Diverticular disease of the colon is a common diseaseworldwide.Although the disease is asymptomatic in about70-80 % of patients,it represents,at least in Westerncountries,one of the most important gastrointestinal diseasesin terms of direct and indirect health costs.Pathogenesis ofthe disease is still unknown.However,it is the result ofcomplex interactions between colonic structure,intestinalmotility,diet and genetic factors.Whilst efficacious preventivestrategies remain to be identified,fibre supplementation inthe diet is recommended.Why symptoms develop is stillunclear.Results of recent experimental studies on irritablebowel syndrome speculated that low grade inflammation ofcolonic mucosa,induced by changes in bacterial microflora,could affect the enteric nervous system,which is crucial fornormal gut function,thus favouring symptom development.This hypothesis could be extrapolated also for diverticulardisease,since bacterial overgrowth is present,at least in asubgroup of patients.These perspectives on symptomdevelopment are reviewed and new therapeutic approachesare hypothesized. Diverticular disease of the colon is a common diseaseworldwide. Although the disease is asymptomatic in about 70-80% of patients, it represents at least in Western countries, one of the most important gastrointestinal diseases in terms of direct and indirect health costs. Pathogenesis of the disease is still unknown. Still, it is the result of complex interactions between colonic structure, intestinal motility, diet and genetic factors. Still vigorous preventive strategies remain to be identified, fib supple supplementation in diet is recommended. Symptoms of recent experimental studies on irritable bowel syndrome speculated that low grade inflammation ofcolonic mucosa, induced by changes in bacterial microflora, could be the crucial fornormal gut function, thus favoring symptom development. This hypothesis could be extrapolated also for diverticular disease, since bacterial overgrowth is present, at least in asubgroup of patients.The se perspectives on symptomdevelopment are reviewed and new therapeutic approachesare hypothesized.