How often had you heard someone say my “diverticulitis” is acting up? Are they correct? Or are they just suffering from colon spasm or even constipation? This is a good question as the general public has widespread ideas about the true physiology and presentation of this disorder.

 

To begin with, diverticula are nothing more than outpouchings or pockets of the inner lining of the large intestine (also known as the colon). These can be very small openings, or complex and large. When present, patients generally have hundreds or these openings, though lesser numbers are common, too.

 

Diverticular disease refers to either diverticulosis (the presence of diverticula) or diverticulitis (an actual infection involving one or more diverticula). Since its first description in the 1800s, colonic diverticulosis has been recognized as an increasingly common clinical condition in industrialized countries. The presence of diverticulosis is one of the most common gastrointestinal conditions affecting the general population in the U.S.

 

Disease symptoms range from having no symptoms to complicated disease including infection, abscesses, bleeding, perforation or bowel obstruction. Lesser symptoms can include bloating, generalized abdominal pain and an irregular stool pattern.   Symptoms can be acute (rapid onset) or chronic (recurring mild to severe symptoms).

 

The incidence of diverticular disease increases with age. By age 80, about 70 percent of adults have evidence of diverticular disease. Fortunately, less than 20 percent of these individuals will ever have active symptoms of this disease.

 

The cause of diverticular disease is not clear though it is felt a diet low in fiber is a major contributor. This may account for its higher occurrence in the more developed countries of the Western world.

 

Genetic predisposition, age-related changes in the connective tissue of the colon, or chronic constipation may be other factors in development of the diverticula.

 

The diagnosis of diverticular disease is fairly simple.  Most patients with diverticular disease and no symptoms are found during colonoscopy or on an X-ray image. For acute inflammation, blood tests and imaging studies such as a CAT scan can be diagnostic.

 

Once patients develop symptoms of diverticular disease, medical therapy is first employed. The goal of management is to treat infection, improve symptoms, and prevent recurrence of symptoms or the development of serious complications.

 

 

 

Treatment of diverticular disease is determined primarily by symptoms. Therapy may include bowel rest or a severely restricted diet, antibiotics (oral or IV), abscess drainage and possibly surgery.  Fortunately, the need for surgery is infrequent.

 

When there is colon lumen narrowing as a result of diverticular-induced changes, avoidance of certain poorly digestible foods (broccoli, lettuce) can limit symptoms. A moderate amount of dietary fiber is still needed and is actually encouraged in the setting of mild diverticular disease. Dietary fiber goals should be 20-30 grams of fiber daily. Avoidance of seeds and nuts is not necessary, though references to avoidance of these items are commonly seen in the lay press.

 

As our understanding of diverticular disease continues to improve, we now know that diverticular disease cannot only manifest as acute diverticulitis or bleeding episodes, but also as a chronic medical illness. Some recent studies are looking at use of probiotics as a tool for prevention of the acute disease or use of the nonabsorbable antibiotic Rifaximin. Certain anti-inflammatory agents are also being looked at as an option for prevention or treatment of disease.  Additional studies are awaited on the benefits of these potential therapies.

 

Fortunately, diverticular disease for most individuals is minimal. In more advanced circumstances, the diverticular complications may require hospitalization, IV antibiotics and surgery. Not sure if your abdominal discomfort is diverticulitis? Check with your health-care provider.

 

 

 

Thomas Ruffolo, M.D., is a gastro-intestinal and liver specialist with Vidant Gastroenterology Washington and has practiced in eastern North Carolina for more than 22 years.