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WHAT IS DIVERTICULAR DISEASE – DIVERTICULOSIS AND DIVERTICULITIS

Diverticulosis describes the existence of diverticuli, a common finding on colonoscopy or flexible sigmoidoscopy. Diverticula are “pocket” structures in the colon wall arising in areas of muscle weakness. Their development is thought to be due to complex interactions of several factors such as, colon structure, age, diet and genetics.  Its prevalence is higher in the Western world but recently has increased in developing countries. Diverticulitis occurs when there is inflammation of a diverticuli or segment of diverticulosis.  This may be caused by hard pieces of stool that increase pressure within the diverticulum leading to thinning of its wall and swelling/inflammation.

SYMPTOMS

Diverticulosis is asymptomatic in the majority of patients. However, the symptoms and severity of  diverticulitis depends upon the degree of inflammation.  Left lower quadrant stomach pain and fever are the most common symptoms, and can be accompanied by nausea, vomiting, constipation, diarrhea and urinary complaints.

Diverticulosis is asymptomatic in the majority of patients. However, the symptoms and severity of diverticulitis depends upon the degree of inflammation.  Left lower quadrant stomach pain and fever are the most common symptoms, and can be accompanied by nausea, vomiting, constipation, diarrhea and urinary complaints.

Diverticulitis is divided into simple and complicated forms. Simple can be treated as an outpatient, and complicated may require hospitalization. Complicated diverticulitis occurs when the inflammation evolves into a few patterns. These include: 1.) A sealed off infection, called an abscess. 2) Inflammation progressing to a point of rupturing the colon wall called a perforation 3) Obstruction occurs when the inflammation causes swelling to a point of colon blockage and 4) Fistula formation is a connection that abnormally forms between tissue organs, such as the colon and bladder due to the inflammation causing tissue injury.

DIAGNOSIS

The diagnosis is commonly based on clinical criteria, specifically the patient’s symptoms and physical exam. In addition, basic laboratory tests are helpful and include a complete blood cell count and urinalysis. A CT scan imaging can be used to confirm the diagnosis and evaluate for complications associated with severe diverticulitis. This imaging may include findings of abscess, fistula tract between the colon and bladder, peritonitis, blockage of the colon or urinary tube (ureter that connects the kidney to the bladder.)

TREATMENT

Diverticulosis typically does not require any treatment. However, most physicians will recommend a high fiber diet and water. No specific diet, including nuts, seeds or popcorn has been shown to trigger diverticulitis.

The severity of the determines the treatment. The majority of people with uncomplicated diverticulitis are successfully treated with outpatient medical treatments.  This includes oral antibiotics a clear liquid diet for a few days, and possibly an over-the-counter pain medication, such as acetaminophen (e.g., Tylenol).  There have been some experts who describe effective alternative treatments with a drug called Mesalazine that is more commonly used in inflammatory bowel disease.   Complicated diverticulitis may require hospitalization for IV antibiotics and treatment of complications, such as drainage of an abscess with a tube placement into the abscess through the patient’s skin.  If this treatment is not effective, surgery might be required to remove a segment of the colon to treat an abscess, perforation, obstruction and/or fistula. Multiple bouts of uncomplicated diverticulitis sometimes require surgery to prevent future episodes or complication.

Follow-up treatment might include a colonoscopy approximately 6 weeks or more following an attack of diverticulitis for those patients who have not had a recent colonoscopy. This helps the doctors exclude a colon cancer as the cause of the symptoms versus the diverticular disease. Diverticulitis or diverticulosis is not a cause of colon cancer.

Long-term Prognosis of Diverticulitis

The majority of people with uncomplicated diverticulitis respond to medical management. Approximately 15 percent of patients eventually need an operation for the treatment of their diverticulitis. After successful treatment of a first episode of diverticulitis, one-third of people will remain asymptomatic, one-third will have mild symptoms, and one-third will have another incident of diverticulitis. To date no established method is known to prevent recurrence, or diet that triggers diverticulitis.