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Diverticulitis

This article is about intestinal pouches that are inflamed. For non-inflamed pouches, see Diverticulosis.
Diverticulitis
Other namesColonic diverticulitis
Section of the large bowel (sigmoid colon) showing multiple pouches (diverticula). The diverticula appear on either side of the longitudinal muscle bundle (taenium), which runs horizontally across the specimen in an arc.
SpecialtyGeneral surgery
SymptomsAbdominal pain, fever, nausea, diarrhea, constipation, blood in the stool[1]
ComplicationsAbscess, fistula, bowel perforation[1]
Usual onsetSudden, age > 50[1]
CausesUncertain[1]
Risk factorsObesity, lack of exercise, smoking, family history, nonsteroidal anti-inflammatory drugs[1][2]
Diagnostic methodBlood tests, CT scan, colonoscopy, lower gastrointestinal series[1]
Differential diagnosisIrritable bowel syndrome[2]
PreventionMesalazine, rifaximin[2]
TreatmentAntibiotics, liquid diet, hospital admission[1]
Frequency3.3% (developed world)[1][3]

Diverticulitis, also called colonic diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches—diverticula—that can develop in the wall of the large intestine.[1] Symptoms typically include lower abdominal pain of sudden onset, but the onset may also occur over a few days.[1] There may also be nausea, diarrhea or constipation.[1] Fever or blood in the stool suggests a complication.[1] People may experience a single attack, repeated attacks, or ongoing "smouldering" diverticulitis.[2][4][5]

The causes of diverticulitis are unclear.[1] Risk factors may include obesity, lack of exercise, smoking, a family history of the disease, and use of nonsteroidal anti-inflammatory drugs (NSAIDs).[1][2] The role of a low fiber diet as a risk factor is unclear.[2] Having pouches in the large intestine that are not inflamed is known as diverticulosis.[1] Inflammation occurs in between 10% and 25% at some point in time, and is due to a bacterial infection.[2][6] Diagnosis is typically by CT scan, though blood tests, colonoscopy, or a lower gastrointestinal series may also be supportive.[1] The differential diagnoses include irritable bowel syndrome.[2]

Preventive measures include altering risk factors such as obesity, inactivity, and smoking.[2] Mesalazine and rifaximin appear useful for preventing attacks in those with diverticulosis.[2] Avoiding nuts and seeds as a preventive measure is no longer recommended since there is no evidence these play a role in initiating inflammation in diverticula.[1][7] For mild diverticulitis, antibiotics by mouth and a liquid diet are recommended.[1] For severe cases, intravenous antibiotics, hospital admission, and complete bowel rest may be recommended.[1] Probiotics are of unclear value.[2] Complications such as abscess formation, fistula formation, and perforation of the colon may require surgery.[1]

The disease is common in the Western world and uncommon in Africa and Asia.[1] In the Western world about 35% of people have diverticulosis while it affects less than 1% of those in rural Africa,[6] and 4–15% of those may go on to develop diverticulitis.[3] In North America and Europe the abdominal pain is usually on the left lower side (sigmoid colon), while in Asia it is usually on the right (ascending colon).[2][8] The disease becomes more frequent with age, ranging from 5% for those under 40 years of age to 50% over the age of 60.[9][1] It has also become more common in all parts of the world.[2] In 2003 in Europe, it resulted in approximately 13,000 deaths.[2] It is the most frequent anatomic disease of the colon.[2] Costs associated with diverticular disease were around US$2.4 billion a year in the United States in 2013.[2]

  1. ^ a b c d e f g h i j k l m n o p q r s t u v "Diverticular Disease". www.niddk.nih.gov. September 2013. Archived from the original on 13 June 2016. Retrieved 12 June 2016.
  2. ^ a b c d e f g h i j k l m n o p Tursi A (March 2016). "Diverticulosis today: unfashionable and still under-researched". Therapeutic Advances in Gastroenterology. 9 (2): 213–28. doi:10.1177/1756283x15621228. PMC 4749857. PMID 26929783.
  3. ^ a b Cite error: The named reference UpToDate was invoked but never defined (see the help page).
  4. ^ Rink AD, Nousinanou ME, Hahn J, Dikermann M, Paul C, Vestweber KH (October 12, 2019). "[Smoldering diverticultis - still a type of chronic recurrent diverticulitis with good indication for surgery? - Surgery for smoldering diverticulitis]". Zeitschrift Fur Gastroenterologie. 57 (10): 1200–1208. doi:10.1055/a-0991-0700. PMID 31610583. S2CID 204702433.
  5. ^ "Colonic Diverticular Disease".
  6. ^ a b Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Churchill Livingstone. 2014. p. 986. ISBN 9781455748013. Archived from the original on 2016-08-08.
  7. ^ Young-Fadok TM (October 2018). "Diverticulitis". New England Journal of Medicine. 379 (17): 1635–42. doi:10.1056/NEJMcp1800468. PMID 30354951. S2CID 239933906.
  8. ^ Feldman M (2010). Sleisenger & Fordtran's Gastrointestinal and liver disease pathophysiology, diagnosis, management (9th ed.). [S.l.]: MD Consult. p. 2084. ISBN 9781437727678. Archived from the original on 2016-08-08.
  9. ^ Young-Fadok TM (2018). "Diverticulitis". The New England Journal of Medicine. 379 (17): 1635–1642. doi:10.1056/NEJMcp1800468. PMID 30354951. S2CID 239933906.

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