Table of Contents
Diverticular Disease Definition
A chronic condition in which pockets of the gastrointestinal mucosa (inner lining of the intestines) bulge through weakened areas of the intestinal wall, forming HERNIA-like protrusions called diverticula.Diverticula may form anywhere along the gastrointestinal tract from the ESOPHAGUS to the RECTUM, though are most common in the sigmoid COLON.
Most diverticular disease develops over decades and manifests symptoms after age 60. A congenital form of diverticular disease, Meckel’s diverticulum, affects the SMALL INTESTINE, typically the ILEUM. Meckel’s diverticulum is uncommon. Diverticulosis is the presence of multiple diverticula; diverticulitis occurs when diverticula become inflamed or infected. Doctors suspect diverticular disease results from changes in the gastrointestinal system that occur with aging. Though for some people the condition is debilitating, many people who have diverticular disease have few symptoms. Diverticular disease tends to have a more intense course in people who are under age 50 at the time of diagnosis.
Symptoms of Diverticular Disease and Diagnostic Path
Diverticulosis often presents mild and vague symptoms such as intermittent lower abdominal discomfort or shows up incidentally on diagnostic testing for other reasons. Large or multiple diverticula may cause intestinal bleeding that may appear as darkened stools or obvious bleeding with bowel movements. Localized PAIN, especially REBOUND TENDERNESS, and FEVER suggest diverticulitis though also are symptoms of APPENDICITIS.
The diagnostic path may include DIGITAL RECTAL EXAMINATION (DRE), FECAL OCCULT BLOOD TEST (FOBT) to check for microscopic bleeding, abdominal Xray, BARIUM ENEMA, and sigmoidoscopy or COLONOSCOPY. These procedures help distinguish between diverticulitis and appendicitis though sometimes the distinction is difficult. Diverticula often are apparent though barium enema and either sigmoidoscopy or colonoscopy provides definitive diagnosis. Occasionally the doctor may request COMPUTED TOMOGRAPHY (CT) SCAN or MAGNETIC RESONANCE IMAGING (MRI) to obtain detailed information on the extent of the condition or to identify a surgical emergency such as ABSCESS or PERITONITIS.
|Symptoms of Diverticular Disease|
|painless rectal bleeding||pronounced and localized ABDOMINAL PAIN|
|ABDOMINAL DISTENTION or rigidity|
Diverticular Disease Treatment Options and Outlook
Diverticulitis requires treatment with ANTIBIOTIC MEDICATIONS to eradicate the INFECTION and calm the INFLAMMATION. Oral antibiotics successfully treat many people; widespread or deep infection may require intravenous antibiotics or even surgical intervention to drain the infection and remove any portions of damaged bowel. Untreated diverticulitis can result in abscess or peritonitis, which are life-threatening complications. Other complications include intestinal obstructions and fistulas (areas where the bowel erodes and establishes an opening into another structure such as the BLADDER or the VAGINA. These complications require surgical repair; a complete intestinal obstruction is an emergency.
Diverticulosis with no symptoms does not require treatment. Because diverticulosis is so prevalent among people age 50 and older, many gastroenterologists consider it nonpathologic (not a threat to health). Dietary measures such as increased fiber consumption may be enough to relieve mild symptoms such as occasional abdominal discomfort. It is important to determine the source of any intestinal bleeding, and to undergo regular COLORECTAL CANCER screening such as FOBT, sigmoidoscopy, or COLONOSCOPY. The gastroenterologist should evaluate any changes in bowel habits, persistent abdominal distention, or other circumstances that could suggest a different diagnosis.
Risk Factors and Preventive Measures
The primary risk factor for diverticulosis appears to be aging. Doctors commonly detect diverticula that do not cause symptoms in people who have gastrointestinal imaging procedures done for other reasons. People who are aware they have diverticulosis should try to maintain eating habits that support good gastrointestinal health, making sure they consume enough dietary fiber and water.