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diverticulosis

Multiple herniations of mucosa (diverticula) through the muscular wall of the intestine generally the colon. Also see diverticulum. Etiology: 1) constipation & low fiber diets are predisposing factors - high fiber diet may not be protective [6] 2) 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: 1) generally occurs at points of vascular penetration of the smooth muscle surrounding the colon 2) increased intralumenal pressures 3) 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: 1) diverticulitis occurs when diverticulum becomes inflamed - 20% of patients with diverticulosis [4] 2) diverticular bleeding (lower GI bleed) 3) complications in < 25% of patients 4) no increase risk of colorectal adenomas [10] Management: 1) Most cases asymptomatic & do not require treatment 2) lower GI bleeding may occur which in most cases resolves spontaneously 3) avoid constipation - high fiber diet may not be protective [6] - gradual implementation of a high-fiber diet is treatment of choice (MKSAP19) [13] 4) patients need not avoid nuts or popcorn [3]

Related

diverticulum

Specific

diverticulitis

General

intestinal disease chronic gastrointestinal disease

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 350-52
  2. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 360
  3. Strate LL et al. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA 2008 Aug 27; 300:907. PMID: 18728264
  4. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2022
  5. 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: 19861955
  6. Peery AF et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology 2012 Feb; 142:266. PMID: 22062360
  7. Hemming J, Floch M. Features and management of colonic diverticular disease. Curr Gastroenterol Rep. 2010 Oct;12(5):399-407 PMID: 20694839
  8. Wilkins T, Baird C, Pearson AN, Schade RR. Diverticular bleeding. Am Fam Physician. 2009 Nov 1;80(9):977-83. PMID: 19873964
  9. Touzios JG, Dozois EJ. Diverticulosis and acute diverticulitis. Gastroenterol Clin North Am. 2009 Sep;38(3):513-25 PMID: 19699411
  10. 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: 26526082
  11. Jarbrink Sehgal ME, Andreasson A et al. Symptomatic diverticulosis is characterized by loose stools. Clin Gastroenterol Hepatol 2016 Jun 21 PMID: 27353142 http://www.cghjournal.org/article/S1542-3565(16)30318-4/abstract
  12. 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: 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: 29155169 https://www.cghjournal.org/article/S1542-3565(17)31357-5/fulltext
  13. American Society for Gastrointestinal Endoscopy Understanding Diverticulosis http://www.asge.org/PatientInfoIndex.aspx?id=6818
  14. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diverticular Disease https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis