Diverticular disease

Pathophysiology/epidemiology

Diverticuli, sacs or pouch openings off the main lumen of the gut, occur most commonly in the colon but can also occur at any other GI tract site. They typically arise at the site of penetrating blood vessels which represent "weak" sites in the colon wall. Colonic diverticuli are generally pain free but severe abdominal pain and infection may result if their mouth (opening to the lumen) becomes inflamed and/or obstructed. The disorder is then termed diver-ticulitis and is associated with pain, altered bowel habits, abscess formation, obstruction, colonic distension, and bleeding. In the absence of infection or inflammatory changes, diverticuli may present with recurrent, episodic left lower quadrant colicky pain and the disorder is termed diverticulosis.

Evaluation/treatment

Diverticuli are identified on colonoscopy or via radiographic imaging of the colon. If diverticulitis is present, then evidence of infection coupled with physical exam or radiographic findings of a mass adjacent to the colon forms the diagnosis [16]. Investigative studies that identify diverticuli are often prompted by GI bleeding since colonic diverticuli are the most common source of lower gastrointestinal tract bleeding. Treatment of diverticulitis may be medical with antibiotics or surgical with resection and drainage. Roughly 1% of all patients with colonic diverticula require surgical management. An estimated 15-30%

of patients requiring hospital admission are treated surgically. Follow-up studies of postoperative patients reveal that between 2% and 10% will continue to have major symptoms that they find troublesome, and up to 25% of patients will have minor symptoms [16,17]. Therefore, even though segmental colonic resection may be required for some patients to control bleeding, consensus panels have been unable to definitively recommend surgery for pain control [18].

Preventive treatments for diverticular disease have revolved around fiber and other dietary modifications. Food items such as seeds or corn are discouraged due to the potential for blocking of the mouths of existent diverticuli, but fiber is encouraged because high colonic bulk content decreases the intracolonic pressure that leads to the development of the diver-ticuli [17]. The prophylactic use of antibiotics can also prevent complications from diverticular disease [19-21]. In a study of 307 patients, rifaximin with fiber supplementation was found to be more effective than fiber supplementation alone in reducing symptoms of uncomplicated diverticular disease [19]. Another study compared different doses of both mesalazine and rifaximin and found mesalazine 800 mg twice a day for 10 days out of the month to be the most effective at reducing symptoms [20].

Managing Diverticular Disease

Managing Diverticular Disease

Stop The Pain. Manage Your Diverticular Disease And Live A Pain Free Life. No Pain, No Fear, Full Control Normal Life Again. Diverticular Disease can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows.

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