The Full Wiki

Diverticulosis: Wikis

  
  

Note: Many of our articles have direct quotes from sources you can cite, within the Wikipedia article! This article doesn't yet, but we're working on it! See more info or our list of citable articles.

Encyclopedia

From Wikipedia, the free encyclopedia

Diverticulosis
Classification and external resources

Diverticulosis as seen endoscopically
ICD-10 K57.
ICD-9 562.01
OMIM 223320
DiseasesDB 3871
eMedicine med/3102
MeSH D004240

Diverticulosis, (which, when symptomatic, is known as "diverticular disease)," is the condition of having diverticula in the colon, which are outpocketings of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall. These are more common in the sigmoid colon, which is a common place for increased pressure. This is uncommon before the age of 40, and increases in incidence after that age.[1]

Contents

Signs and symptoms

Often this disorder has no symptoms. When symptoms do occur, the following are reported: bleeding (variable amounts), bloating, abdominal pain/cramping after meals or otherwise often in the left lower abdomen, and changes in bowel movements (diarrhea or constipation). Sometimes, symptoms include nonspecific chronic discomfort in the lower left abdomen, with occasional acute episodes of sharper pain. The discomfort is sometimes described as a general feeling of pressure in the region, or pulling sensation. A tickling sensation may be felt as the small pockets fill and empty; a feeling like gas may be moving in areas outside the colon. Symptoms of anemia may present: fatigue, light-headedness, or shortness of breath.

First time bleeding from the rectum, especially if over age 40, could be due to colon cancer instead of diverticulosis. In small bowel Duodenum is the most common site for Diverticulosis

Causes

Diverticula are thought to be caused by increased pressure within the lumen of the colon. Increased intra-colonic pressure secondary to constipation may lead to weaknesses in the colon walls, giving way to diverticula. Other causes may include a colonic spasm that increases pressure, which may be due to dehydration or low-fiber diets;[2] although this may also be due to constipation. Fiber causes stools to retain more water and become easier to pass (either soluble or insoluble fiber will do this). A diet without sufficient fiber makes the stools small, requiring the bowel to squeeze harder to remove the smaller stool.

Risk factors:

  • a diet that is low in fiber content or high in fat
  • high intake of meat and red meat
  • increasing age
  • constipating conditions
  • connective tissue disorders that may cause weakness in the colon wall (such as Marfan syndrome).

Diagnosis

Colonoscopy is the most used test for diagnosis. This is important for treatment and investigation of other diseases. Other tests include abdominal X-ray, barium enema, CT, or MRI. Note that if Diverticulitis (infection of the diverticula) is evidenced, both colonoscopy and barium enema are contraindicated due to the increased risk of perforation of the diverticula and CT with IV contrast is the best test. An MRI can also be done.

Management

Often, no treatment is needed. Increases in hydration, increasing fibre content in the diet[3] (the American Dietetic Association recommends 20-35 grams each day), or removing factors resulting in constipation help decrease the incidence of new diverticula or possibly keep them from bursting or becoming inflamed (ADA website). Fiber supplements may aid if diet is inadequate. If the diverticula are unusually large (greater than 1 inch), often infected (see diverticulitis), or exhibit uncontrollable bleeding, surgery can be performed to decrease relapse or other complications. The NIDDK says foods such as nuts, popcorn hulls, sunflower seeds, pumpkin seeds, caraway seeds, and sesame seeds have traditionally been labeled as problem foods for people with this condition;[4] however, no scientific data exists to prove this hypothesis. The seeds in tomatoes, zucchini, cucumbers, strawberries, raspberries, and poppy seeds, are not considered harmful by the NIDDK. Treatments, like some colon cleansers, that cause hard stools, constipation, and straining, are not recommended.

Many patients with diverticulosis have minimal or no symptoms, and do not require any specific treatment. A high-fiber diet and fiber supplements are advisable to prevent constipation and the formation of more diverticula. Patients with mild symptoms of bloating or abdominal pain may benefit from anti-spasmodic drugs such as chlordiazepoxide (Librium), dicyclomine (Bentyl), Donnatal, and hyoscyamine (Levsin). Some doctors also recommend avoidance of fried foods, nuts, corn, and seeds to prevent complications of diverticulosis. Whether these diet restrictions are beneficial is uncertain; however, recent studies have stated that nuts and popcorn do not contribute positively or negatively to patients with diverticulosis or diverticular complications.[5][6]

Complications

Infection of a diverticulum can result in diverticulitis. This occurs in 10-25% of persons with diverticulosis (NIDDK website). Tears in the colon leading to bleeding or perforations may occur; intestinal obstruction may occur (constipation or diarrhea does not rule this possibility out); and peritonitis, abscess formation, retroperitoneal fibrosis, sepsis, and fistula formation are also possible occurrences. Rarely, an enterolith may form.

Infection of a diverticulum often occurs as a result of stool collecting in a diverticulum.

Epidemiology

About 10% of the US population over the age of 40 and half over the age of 60 has diverticulosis. This disease is common in the US, Britain, Australia, Canada, and is uncommon in Asia and Africa. It is the most common cause for rectal bleeding in US adults over the age of 40 years.

Studies have identified dietary factors as potential explanations for the large variation in the disease. High intake of fiber, fruits and vegetables, and brown bread was associated with approximately 40-50% reductions in the risk.[7][8][9] On the other hand, higher intake of both red and processed meat increased the risk 2-4 fold in two studies,[7][8] while a third study found a 24-fold increase in the risk with higher total meat intake.[9] This could explain the lower risk among vegetarians.[10]

Dr. Denis Burkitt(1911-1993), who was the main proponent of the fiber theory, also believed that the use of the unnatural sitting posture for defecation is a major contributing factor in diverticulosis and other GI disorders (including hiatus hernias.)[11]

Contrary to a common recommendation to avoid eating popcorn, nuts, and corn to prevent diverticular complications, a large prospective study of men indicates that the consumption of these foods does not increase the risk of diverticulosis or diverticular complications.[12][13]

Large-mouth diverticula are associated with scleroderma.

References

  1. ^ Comparato G, Pilotto A, Franzè A, Franceschi M, Di Mario F (2007). "Diverticular disease in the elderly". Digestive diseases (Basel, Switzerland) 25 (2): 151–9. doi:10.1159/000099480. PMID 17468551. 
  2. ^ Diverticulitis at Merck Manual of Diagnosis and Therapy Home Edition
  3. ^ Eglash A, Lane CH, Schneider DM (2006). "Clinical inquiries. What is the most beneficial diet for patients with diverticulosis?". The Journal of family practice 55 (9): 813–5. PMID 16948968. 
  4. ^ "Diverticulosis and Diverticulitis". http://www.digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/. Retrieved 2007-11-19. 
  5. ^ Strate LL; Liu YL; Syngal S; Aldoori WH; Giovannucci EL (2008). "Nut, Corn, and Popcorn Consumption and the Incidence of Diverticular Disease.". JAMA. 300 (8): 907–914. doi:10.1001/jama.300.8.907. http://jama.ama-assn.org/cgi/content/abstract/300/8/907. 
  6. ^ Eating Nuts, Popcorn Not Linked With Higher Risk of Diverticulosis Newswise, Retrieved on August 26, 2008.
  7. ^ a b Manousos O, Day NE, Tzonou A, et al. (1985). "Diet and other factors in the aetiology of diverticulosis: an epidemiological study in Greece". Gut 26 (6): 544–9. doi:10.1136/gut.26.6.544. PMID 3924745.& PMC 1432747. http://gut.bmj.com/cgi/reprint/26/6/544. 
  8. ^ a b Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC (1994). "A prospective study of diet and the risk of symptomatic diverticular disease in men". Am. J. Clin. Nutr. 60 (5): 757–64. PMID 7942584. http://www.ajcn.org/cgi/reprint/60/5/757. 
  9. ^ a b SpringerLink - Resource Secured
  10. ^ Gear JS, Ware A, Fursdon P, et al. (1979). "Symptomless diverticular disease and intake of dietary fibre". Lancet 1 (8115): 511–4. doi:10.1016/S0140-6736(79)90942-5. PMID 85104. http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(79)90942-5. 
  11. ^ Burkitt DP (1981). "Hiatus hernia: is it preventable?". Am. J. Clin. Nutr. 34 (3): 428–31. PMID 6259926. http://www.ajcn.org/cgi/reprint/34/3/428.pdf. 
  12. ^ Strate LL; Liu YL; Syngal S; Aldoori WH; Giovannucci EL (2008). "Nut, Corn, and Popcorn Consumption and the Incidence of Diverticular Disease.". JAMA. 300 (8): 907–914. doi:10.1001/jama.300.8.907. http://jama.ama-assn.org/cgi/content/abstract/300/8/907. 
  13. ^ Eating Nuts, Popcorn Not Linked With Higher Risk of Diverticulosis Newswise, Retrieved on August 26, 2008.

External links








Got something to say? Make a comment.
Your name
Your email address
Message