Diverticular Disease

Diverticular Disease: Overview

Alternative Names: Diverticulosis, Diverticulitis

Diverticulosis is a condition whereby diverticula (small pouches) develop in the lining of the large intestine, extending into and through the muscular tissue surrounding the intestine.  If these pouches become infected or inflamed, the condition becomes known as diverticulitis.  Rarely, diverticula may also occur in the stomach or small intestine.

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Incidence; Causes and Development

Diverticulosis used to be a rare disease and even today it is almost nonexistent in certain parts of the world.  However, in developed countries like the United States over half of people over 60 have it and most of them are unaware of their condition.

Diverticulosis is a "lifestyle disease" that is easily prevented through dietary modifications.  Insufficient fiber in the diet is the chief cause as the large intestine must work overtime to produce small, hard stools that ultimately stress the colon beyond its endurance.  In addition, increasing pressure in the colon is experienced when trying to evacuate the firmer stools.  This pressure causes weak spots in the wall, forcing the tissue to bulge out.

Signs and Symptoms

The disease usually remains dormant, with the pockets uninfected.  Unfortunately, by the time most people realize they have it, it's too late and the disease is established.

Diagnosis and Tests

In over 90% of cases, serious diverticulitis affects the sigmoid colon, in the lower left side of the abdomen.  The diagnosis can be confirmed by a barium enema X-ray.  If it is known that pockets are present, signs and symptoms alone are enough to make the diagnosis of diverticulitis, and further testing is not usually required.

Laboratory Findings:

Treatment and Prevention

The good news is that simple changes in the diet will prevent it from ever becoming a serious problem.

Conventional treatment of minor diverticulitis can take place at home with rest, a liquid diet, and oral antibiotics.  Symptoms usually subside rapidly.  The diet transitions to soft low-roughage foods and a daily psyllium seed preparation.  Eventually a high-roughage diet is resumed.  If the patient has severe symptoms or complications such as peritonitis or obstruction, hospitalization is necessary.

Prognosis; Complications

Overall, about 80% of patients can be treated successfully without surgery.

Possible complications include Intestinal hemorrhage; Peritonitis due to perforation; Obstruction of colon; Pyelonephritis or cystitis due to inflammation from adherent diverticulitis.

Conditions that suggest Diverticular Disease:

Digestion

Lab Values

Symptoms - Gas-Int - General

Risk factors for Diverticular Disease:

Diet

Digestion

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Diverticular Disease suggests the following may be present:

Digestion

Diverticular Disease can lead to:

Digestion

Lab Values

Recommendations for Diverticular Disease:

Diet

Liquid Diet

The liquid diet should be used for a short time when symptoms are present, in order to give the colon a rest.

High/Increased Fiber Diet

A high fiber diet can help relieve symptoms for most people with diverticulosis.  The suggested daily total should be 20-35gm.  Both soluble and insoluble fibers are important in helping to maintain regular bowel movements.  Complications from intestinal diseases such as diverticulosis or irritable bowel syndrome (IBS) are prevented by a diet rich in high fiber foods.

The fiber supplements of choice for diverticulosis are psyllium, methylcellulose or polycarbophil.  These are available over-the-counter in commercial products such as Metamucil (psyllium), Citrucel (methylcellulose) and Fibercon (polycarbophil), among others.

If you suspect that your diverticulosis has turned into diverticulitis, call your doctor and restrict fiber until instructed otherwise.

Drug

Preventive measures against Diverticular Disease:

Habits

Aerobic Exercise

In one of the few studies that have been done, the most active men had a 37% lower risk of symptomatic diverticular disease than the least active men.  Most of the protection against diverticulitis was due to vigorous activities such as jogging and running, rather than moderate activities like walking.  [Gut 36: p.276, 1995]

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