diverticulosis
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Introduction
Multiple herniations of mucosa (diverticula) through the muscular wall of the intestine generally the colon.
Also see diverticulum.
Etiology
- constipation & low fiber diets are predisposing factors
- high fiber diet may not be protective[6]
- diarrhea-predominant irritable bowel syndrome may be risk factor
Epidemiology
- common in elderly (Western societies)
- 40% by age 60, 60% by age 80 years[4]
Pathology
- generally occurs at points of vascular penetration of the smooth muscle surrounding the colon
- increased intralumenal pressures
- sigmoid colon is the most frequent site of diverticula formation
Clinical manifestations
- most cases asymptomatic
- symptoms of diarrhea-predominant irritable bowel syndrome in symptomatic patients[11]
- left-lower quadrant pain in patients > 60 years
- no evidence that colonic diverticulosis is associated with mucosal inflammation or gastrointestinal symptoms[12]
- diverticular bleed; painless passage of BRBPR
Complications
- diverticulitis occurs when diverticulum becomes inflamed
- 20% of patients with diverticulosis[4]
- diverticular bleeding (lower GI bleed)
- complications in < 25% of patients
- no increase risk of colorectal adenomas[10]
Management
- Most cases asymptomatic & do not require treatment
- lower GI bleeding may occur which in most cases resolves spontaneously
- avoid constipation
- patients need not avoid nuts or popcorn[3]
More general terms
More specific terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 350-52
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 360
- ↑ 3.0 3.1 Strate LL et al. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA 2008 Aug 27; 300:907. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18728264
- ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2022
- ↑ Jung HK et al. Diarrhea-predominant irritable bowel syndrome is associated with diverticular disease: A population-based study. Am J Gastroenterol 2010 Mar; 105:652. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19861955
- ↑ 6.0 6.1 6.2 Peery AF et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology 2012 Feb; 142:266. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22062360
- ↑ Hemming J, Floch M. Features and management of colonic diverticular disease. Curr Gastroenterol Rep. 2010 Oct;12(5):399-407 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20694839
- ↑ Wilkins T, Baird C, Pearson AN, Schade RR. Diverticular bleeding. Am Fam Physician. 2009 Nov 1;80(9):977-83. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19873964
- ↑ Touzios JG, Dozois EJ. Diverticulosis and acute diverticulitis. Gastroenterol Clin North Am. 2009 Sep;38(3):513-25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19699411
- ↑ 10.0 10.1 Peery AF, Martin CF, Levinson SE, Sandler RS Colonic Diverticula Are Not Associated With an Increased Risk of Colorectal Adenomas. Am J Gastroenterol. 2015 Dec;110(12):1694-7. Epub 2015 Nov 3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26526082
- ↑ 11.0 11.1 Jarbrink Sehgal ME, Andreasson A et al. Symptomatic diverticulosis is characterized by loose stools. Clin Gastroenterol Hepatol 2016 Jun 21 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27353142 <Internet> http://www.cghjournal.org/article/S1542-3565(16)30318-4/abstract
- ↑ 12.0 12.1 Swift D Study Finds No Ties Between Colonic Diverticulosis, Inflammation Researchers question if 'symptomatic uncomplicated diverticular disease is a legitimate condition' MedPage Today, May 31, 2018 https://www.medpagetoday.com/gastroenterology/generalgastroenterology/73195
Peery AF, Keku TO, Addamo C et al Colonic diverticula are not associated with mucosal inflammation or chronic gastrointestinal symptoms. Clin Gastroenterol Hepatol. June 2018 16(6):884-891 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28603053 https://www.cghjournal.org/article/S1542-3565(17)30694-8/fulltext
Ma W, Chan AT Does subclinical inflammation play a role in the pathogenesis of diverticulosis? Clin Gastroenterol Hepatol. June 2018 16(6):817-818 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29155169 https://www.cghjournal.org/article/S1542-3565(17)31357-5/fulltext - ↑ 13.0 13.1 American Society for Gastrointestinal Endoscopy Understanding Diverticulosis http://www.asge.org/PatientInfoIndex.aspx?id=6818
- ↑ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diverticular Disease https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis