Diverticulosis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Diverticulosis 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] Diverticulosis may be asymptomatic or symptomatic.
Symptomatic Diverticular Diseases
Diverticular disease is defined as clinically significant and symptomatic diverticulosis due to diverticular bleeding, diverticulitis, segmental colitis associated with diverticula or symptomatic uncomplicated diverticular disease.
Historical Perspective
The Diverticulosis described as early as 17th century but, most of the information we now have is based on much of the work during the 20th century[2].
Classification
Diverticulosis may be asymptomatic or symptomatic. Diverticular diseases categorized as their symptoms to the[3]:
- Diverticular bleeding
- Diverticulitis
- Segmental colitis associated with diverticula
- Symptomatic uncomplicated diverticular disease
Pathpphysiology
The most important scenario behind the formation of Diverticula is, weakness in colon wall. Increased motility and increased level of VIP are another factors[4][5][6][7][8][9].
Diffrenetial Diagnosis
It depends on the Pathologic event that causes the symptomatic disease.It may lead to Lower GI Bleeding or diverticulitis. Either of this disorders has it's own related differential diagnosis including: [10][11]: Colonic Ischemia,anorectal source of bleeding(hemorrhoids, anal fissures, rectal ulcers),neoplasia (polyps and cancers),Angiodysplasia,Postpolypectomy,Inflammatory bowel disease,Other colitis (infectious, antibiotic associated, colitis of unclear etiology),Small bowel/upper GI bleed
Epidemiology and Demographics
The prevalence of diverticulosis is age-dependent, increasing from less than 20 percent at age 40 to 60 percent by age 60.[12][13] Western and industrialized nations have prevalence rates of 5 to 45 percent, depending upon the method of diagnosis and age of the population. Approximately, 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.Approximately 95 percent of patients with diverticula have sigmoid diverticula.
Risk Factors
Risk factors for diverticulosis include low intake of dietary fiber, high intake of fat and red meat, and obesity[14][15][16].
Screening
There is insufficient evidence to recommend routine screening for diverticulosis.
natural history, complications and prognosis
Majority of patients with diverticula remain asymptomatic[17],it may progress to symptomatic disease based on the pathologic events that includes:Acute diverticulitis and Lower GI Bleeding Overall prognosis of Diverticulosis is excellent. Once the symptomatic disease occurs mortality rates vary depending on the presence of complications and patient comorbidities[18]. In patients with acute uncomplicated diverticulitis, conservative treatment is successful in 70 to 100 percent of patients and mortality is negligible[18].
History and Symptoms
The most common symptoms including[19]:Bleeding (variable amounts), Bloating, Abdominal pain/cramping after meals or otherwise often in the left lower abdomen, changes in bowel movements (diarrhea or constipation).
Physical examination
Diverticulosis will not cause any physical findings unless progress to symptomatic disease such as: Diverticulitis or Lower gastrointestinal bleeding.
CT scan findings
On contrast imaging of the gastrointestinal tract (e.g, computed tomography [CT]/magnetic resonance [MR] enterography), bowel diverticula appear as globular outpouchings[20].
Colonoscopy findings
Diverticula may be visualized as outpouchings of the wall that have the appearance of a blind sac[21].
Medical Therapy
Often no treatment is needed unless the symptomatic disease develops. If the patient develops the symptomatic disease(Lower GI Bleeding, Diverticulitis) one of medical therapy or surgical therapy based on the condition will be consider.
Primary Prevention
Dietary fiber and a vegetarian diet may reduce the incidence of symptomatic diverticular disease by decreasing intestinal inflammation and altering the intestinal microbiota.[15]. vigorous physical activity appears to reduce the risk of diverticulitis and diverticular bleeding.[22].
References
- ↑ 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.
- ↑ Martel J, Raskin JB (2008). "History, incidence, and epidemiology of diverticulosis". J. Clin. Gastroenterol. 42 (10): 1125–7. doi:10.1097/MCG.0b013e3181865f18. PMID 18936648.
- ↑ N. H. Stollman & J. B. Raskin (1999). "Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology". The American journal of gastroenterology. 94 (11): 3110–3121. doi:10.1111/j.1572-0241.1999.01501.x. PMID 10566700. Unknown parameter
|month=ignored (help) - ↑ Meyers MA, Volberg F, Katzen B, Alonso D, Abbott G (1973). "The angioarchitecture of colonic diverticula. Significance in bleeding diverticulosis". Radiology. 108 (2): 249–61. doi:10.1148/108.2.249. PMID 4541643.
- ↑ MORSON BC (1963). "THE MUSCLE ABNORMALITY IN DIVERTICULAR DISEASE OF THE COLON". Proc. R. Soc. Med. 56: 798–800. PMC 1897181. PMID 14080071.
- ↑ Chia JG, Wilde CC, Ngoi SS, Goh PM, Ong CL (1991). "Trends of diverticular disease of the large bowel in a newly developed country". Dis. Colon Rectum. 34 (6): 498–501. PMID 1645247.
- ↑ Trotman IF, Misiewicz JJ (1988). "Sigmoid motility in diverticular disease and the irritable bowel syndrome". Gut. 29 (2): 218–22. PMC 1433293. PMID 3345933.
- ↑ Bassotti G, Battaglia E, Spinozzi F, Pelli MA, Tonini M (2001). "Twenty-four hour recordings of colonic motility in patients with diverticular disease: evidence for abnormal motility and propulsive activity". Dis. Colon Rectum. 44 (12): 1814–20. PMID 11742167.
- ↑ Milner P, Crowe R, Kamm MA, Lennard-Jones JE, Burnstock G (1990). "Vasoactive intestinal polypeptide levels in sigmoid colon in idiopathic constipation and diverticular disease". Gastroenterology. 99 (3): 666–75. PMID 1696228.
- ↑ Strate LL (2005). "Lower GI bleeding: epidemiology and diagnosis". Gastroenterol. Clin. North Am. 34 (4): 643–64. doi:10.1016/j.gtc.2005.08.007. PMID 16303575.
- ↑ Padidar AM, Jeffrey RB, Mindelzun RE, Dolph JF (1994). "Differentiating sigmoid diverticulitis from carcinoma on CT scans: mesenteric inflammation suggests diverticulitis". AJR Am J Roentgenol. 163 (1): 81–3. doi:10.2214/ajr.163.1.8010253. PMID 8010253.
- ↑ Painter NS, Burkitt DP (1975). "Diverticular disease of the colon, a 20th century problem". Clin Gastroenterol. 4 (1): 3–21. PMID 1109818.
- ↑ Peery AF, Barrett PR, Park D, Rogers AJ, Galanko JA, Martin CF, Sandler RS (2012). "A high-fiber diet does not protect against asymptomatic diverticulosis". Gastroenterology. 142 (2): 266–72.e1. doi:10.1053/j.gastro.2011.10.035.
- ↑ Peery AF, Sandler RS, Ahnen DJ, Galanko JA, Holm AN, Shaukat A, Mott LA, Barry EL, Fried DA, Baron JA (2013). "Constipation and a low-fiber diet are not associated with diverticulosis". Clin. Gastroenterol. Hepatol. 11 (12): 1622–7. doi:10.1016/j.cgh.2013.06.033. PMC 3840096. PMID 23891924.
- ↑ 15.0 15.1 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.
- ↑ Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL (2009). "Obesity increases the risks of diverticulitis and diverticular bleeding". Gastroenterology. 136 (1): 115–122.e1. doi:10.1053/j.gastro.2008.09.025. PMC 2643271. PMID 18996378.
- ↑ Simpson J, Spiller R (2002). "Colonic diverticular disease". Clin Evid (8): 436–44. PMID 12603892.
- ↑ 18.0 18.1 Rafferty J, Shellito P, Hyman NH, Buie WD (2006). "Practice parameters for sigmoid diverticulitis". Dis. Colon Rectum. 49 (7): 939–44. doi:10.1007/s10350-006-0578-2. PMID 16741596.
- ↑ Simpson J, Spiller R (2002). "Colonic diverticular disease". Clin Evid (7): 398–405. PMID 12230665.
- ↑ Vernava AM, Moore BA, Longo WE, Johnson FE (1997). "Lower gastrointestinal bleeding". Dis. Colon Rectum. 40 (7): 846–58. PMID 9221865.
- ↑ Ghorai S, Ulbright TM, Rex DK (2003). "Endoscopic findings of diverticular inflammation in colonoscopy patients without clinical acute diverticulitis: prevalence and endoscopic spectrum". Am. J. Gastroenterol. 98 (4): 802–6. doi:10.1111/j.1572-0241.2003.07383.x. PMID 12738459.
- ↑ Aldoori WH, Giovannucci EL, Rimm EB, Ascherio A, Stampfer MJ, Colditz GA, Wing AL, Trichopoulos DV, Willett WC (1995). "Prospective study of physical activity and the risk of symptomatic diverticular disease in men". Gut. 36 (2): 276–82. PMC 1382417. PMID 7883230.