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Broad and learned
clinical background

Gut Reaction #30: Colonic Diverticulosis and Diverticulitis

What is it?

  • Colonic diverticulosis is the condition whereby diverticula, or pockets, form from the lining of the colon. These protrusions of the colon lining occur at sites of weakness in the muscle wall possibly due to increased pressure from muscle contractions.
  • Diverticulitis is an inflammatory process that causes acute symptoms and may be associated with serious complications.

What may cause it?

  • Potential risk factors include increasing age; diets low in fibre, high in red meat and refined carbohydrates; obesity.
  • There is no evidence that seeds or nuts cause diverticulitis.
  • Changes in the biodiversity of the colonic bacteria

What are the symptoms?

  • Diverticulosis is often asymptomatic and found on investigation by colonoscopy or CT scanning. It may be associated with low abdominal cramping, bloating or constipation.
  • Diverticulitis, due to infection or inflammation of the diverticula, may cause localized lower left sided abdominal pain with either diarrhoea or constipation and fever. Bleeding may occur.

How common is it?

  • Classically, this is a disease process that predominantly affects people over the age of 70 years and is more common in developed countries. It is however getting more common in younger people possibly related to obesity.

What tests are needed to diagnose it?

  • A colonoscopy enables the gastroenterologist to examine the lining of the colon to confirm diverticulosis and to exclude colon cancer or inflammatory bowel disease.
  • An abdominal CT scan is a radiological test used to diagnose diverticulitis and to look for complications.
  • A blood test may be performed to look for any signs of infection or inflammation within the colon.

How do you treat it?

  • Individuals with diverticulosis are advised to eat a healthy and balanced diet, avoid too much red meat and to lose weight if obese. Use of a prebiotic and/or a probiotic may be of benefit but at present this is an evidence-free zone.
  • Mild diverticulitis is usually treated with oral antibiotics. A recent placebo-controlled trial however did not show, in the outpatient setting, that antibiotics were any better than placebo.
  • Patients with complications of acute severe diverticulitis such as an abscess (collection of pus) or perforation (a hole in the colon) require emergency admission to hospital for intravenous antibiotics and sometimes urgent surgery.
  • Long-standing severe diverticulosis or following recurrent attacks of diverticulitis the colon may get narrowed (stricture formation) and surgery may be required to avoid obstruction.

If you have any questions, please do not hesitate to contact Dr. Harris.