What is diverticular disease? How is it diagnosed? What are the symptoms of diverticular disease and diverticulitis? Find comprehensive answers to your questions about this common gastrointestinal condition.

Understanding Diverticular Disease

Diverticular disease and diverticulosis are interchangeable terms that refer to the presence of diverticula, or small sac-like outpouchings, in the large intestine or colon. These diverticula occur most frequently in the lower section of the colon, known as the sigmoid colon, which is located on the left side of the pelvis.

Diverticular disease is a common condition, affecting around 5% of the Western adult population under the age of 40, and rising sharply to affect at least 50% of those over the age of 60. It is a disease that primarily affects the elderly, with 65% of those over 85 years of age having diverticulosis.

Causes of Diverticular Disease

The exact cause of diverticular disease remains unknown, but one theory suggests that it develops when pressure, such as that caused by straining during constipation, builds up inside the colon, causing the intestinal wall to balloon out in weak spots between the muscle bundles. This dietary factor is supported by the wide geographic variability of the disease and its strong correlation with an urban diet.

Symptoms of Diverticular Disease

Diverticulosis, the condition of having diverticula, is often present without any symptoms. Many of the symptoms are similar to those of irritable bowel syndrome (IBS), including changing bowel activities such as constipation, diarrhea, or alternating between the two.

Diverticulitis, the inflammation and/or infection of the diverticula, can present with more severe symptoms, including increased diarrhea, cramping, bowel irritability, intense pain, abdominal cramping, bleeding, bloating, and fever. The pain and tenderness is often felt in the left lower portion of the abdomen.

Diagnosing Diverticular Disease

Diagnosing diverticular disease can be challenging, as many patients are asymptomatic, and the symptoms can overlap with those of IBS. Your healthcare provider will typically start with a thorough symptom history and physical examination to look for clues.

Additional tests that may be used to diagnose diverticular disease include:

• X-rays with a barium-containing enema to observe the shape and function of the colon
• Colonoscopy to directly view the inside of the colon
• Flexible sigmoidoscopy to examine the lower portion of the colon
• Computed tomography (CT) scans or virtual colonoscopy during flare-ups, when the bowel may be too tender for other procedures

Complications of Diverticular Disease

In around 10-25% of diverticular disease patients, the diverticula become inflamed, leading to the development of diverticulitis. Complications of diverticulitis can include fistulae (abnormal connections between the colon and other organs), bowel obstruction, lower intestinal hemorrhage, and perforation of the diverticulum, which can cause a local abscess and severe pain.

These complications may require urgent surgical intervention in some cases.

Managing Diverticular Disease

The management of diverticular disease typically involves dietary and lifestyle modifications to prevent complications and flare-ups. This may include increasing fiber intake, staying hydrated, and avoiding foods that seem to trigger symptoms.

During acute flare-ups of diverticulitis, treatment may involve antibiotics, pain medication, and in some cases, hospitalization for intravenous fluids and close monitoring. In severe or recurrent cases, surgical intervention may be recommended.

Conclusion

Diverticular disease is a common gastrointestinal condition that primarily affects the elderly. While many individuals with diverticulosis may be asymptomatic, the development of diverticulitis can lead to severe symptoms and complications that may require medical intervention. By understanding the causes, symptoms, and diagnostic approaches, individuals can work with their healthcare providers to manage this condition and prevent complications.

Diverticular Disease | Gastrointestinal Society

Click here to download a PDF of this information.

Diverticular disease and diverticulosis are interchangeable terms meaning the presence of diverticula in the large intestine (colon). Diverticula are small sac-like out-pouchings of the colon lining that balloon through the outer colon wall, occurring most frequently in the lower section of the colon (sigmoid), which is located on the left side of the pelvis.

Diverticular disease occurs in about 5% of the Western adult population who are younger than forty years of age, but it rises sharply to occur in at least 50% of those who are older than sixty years of age. It’s a disease most prevalent in the elderly; 65% of those who are older than eighty-five years of age have diverticulosis.

The number of diverticula in the gut can vary from a single occurrence (diverticulum) to hundreds. Generally, diverticula increase in number and in size over time. They are characteristically 0. 5-1 cm (0.2-0.4″) in diameter but can exceed 2 cm (0.8″). Although rare, physicians have reported some extreme cases of large diverticula, spanning up to 25 cm (10″).

There is a wide geographic variability of diverticular disease and a striking correlation with an urban diet, which suggests a dietary factor as its root. However, the exact cause of this disease remains unknown. One theory is that diverticula occur when pressure, such as that caused by straining during constipation, builds up inside the colon and makes the intestinal wall balloon out in spots where the wall is weak. These weak spots are the sites between the muscle bundles, which run both lengthwise and circularly throughout the colon. In addition, the bowel tends to become irritable and spastic when there is inadequate bulk passing through and it must contract more intensely to pass contents along.

In about 10-25% of diverticular disease patients, the diverticula become inflamed (diverticulitis).

Symptoms of Diverticular Disease

Please pay close attention to the use of the similar but distinctly different definitions: the condition of diverticular disease (diverticulosis) and inflammation of the diverticula (diverticulitis).

Diverticulosis is often present without any symptoms. Many symptoms are similar to those of irritable bowel syndrome (IBS) and often include changing bowel activities such as constipation, diarrhea, or alternating between the two extreme stool consistencies.

Diverticulitis (flare-up) occurs when the diverticula become inflamed and/or infected. There might be an increase in diarrhea, cramping, and bowel irritability, and symptoms can include intense pain, abdominal cramping, bleeding, bloating, and fever. The pain and tenderness is often in the left lower portion of the abdomen.

Rarely, fistulae, bowel obstruction, and lower intestinal hemorrhage occur, or a diverticulum can perforate, causing a local abscess with a marked increase in the degree and nature of the pain. Additional symptoms are likely to include fever, nausea, and vomiting. Sometimes these complications require urgent surgery.

Diagnosing Diverticular Disease

The presence of colonic diverticula is challenging to diagnose as most patients are asymptomatic and the nonspecific symptoms overlap considerably with those of IBS. Your symptom history and a careful physical examination can reveal important clues to your physician. It is easier to diagnose this condition during a flare-up, as this typically presents with a fever, more tenderness over the abdomen, and more severe symptoms.

Blood tests may reveal the degree of inflammation present and a number of other tests can help pinpoint a diagnosis. X-rays can be helpful to observe the shape and function of the colon. For this test, you undergo a barium-containing enema, which shows up as bright white on X-rays, providing a contrasting picture of the contours of the bowel. Another method is by colonoscopy examination, during which a physician inserts an instrument called a colonoscope via the anus to view the inside of the colon. The scope is made of a hollow, flexible tube with a tiny light and video camera.

Colonoscopies usually require conscious sedation; however, since most diverticula form in the sigmoid colon, your physician might suggest a flexible sigmoidoscopy examination instead. This is a less invasive procedure during which the physician looks at only the lower portion of the bowel, and sedation is not typically required. During periods of flare-up, the bowel might be too tender to perform these investigations and the risk of bowel perforation might be too high, so a physician might choose a computed tomography (CT) scan or an even less invasive procedure known as virtual colonoscopy (VC) during diverticulitis. All imaging tests for the colon require some advance bowel preparation.

Your physician will also consider other conditions that could be causing your symptoms and will eliminate these as possibilities before confirming a diverticular disease diagnosis.

Management of Diverticulosis

Recommendations for the ongoing dietary management of diverticular disease include consuming well-balanced meals and snacks, and ensuring high-fibre content and adequate fluid intake, as outlined in Canada’s Food Guide. Fibre and fluid help soften stool, allowing it to move more quickly and easily through the colon, thereby avoiding excessive pressure against the colon wall.

Aim for 20-35 g of fibre daily, consumed evenly throughout the day. To help monitor your fibre intake, check the nutrient content on the labels of packaged foods. In the Nutrition Facts table, you will find fibre listed in grams (g) and the percentage (%) of the recommended Daily Value (DV) per serving. When the content has less than 5%, the product has a low-fibre content; when the content has 15% or greater, the product has a high-fibre content.

Make gradual changes while increasing fibre intake, as this approach will help avoid bloating, gas, and general abdominal discomfort that can occur as your body adapts to the dietary modifications. Be sure to increase the amount of liquid you drink, especially when increasing fibre.

There is no evidence that excluding whole pieces of fibre from the diet, such as nuts, corn, and seeds, will benefit the disease course, so there is no reason to avoid your favourite high-fibre foods, even if they contain small seeds. Ask us for information regarding a high-fibre diet or consult a registered dietitian in your area, or check our website.

Antispasmodic medication may provide bowel symptom relief; however, this could be treating co-existing irritable bowel syndrome rather than the diverticular disease itself.

Management of Diverticulitis

When a flare-up (diverticulitis) occurs, your physician will most likely recommend an immediate transition to a restricted-fibre or fluid diet and physical rest, and is likely to prescribe antibiotics, possibly antispasmodics, and pain medications. In severe cases, your physician might recommend hospital admission for intravenous feeding so that your bowel may rest for a few days.

Diverticulitis may respond to medical management, but if episodes become frequent, then surgical resection of the affected area might be necessary. Only about 1% of those with diverticular disease require surgery. In many cases, the surgeon can remove the damaged portion of the bowel (colectomy) and connect the remaining ends together. If this is not safe or possible, the surgeon may bring the end of the colon to a new surgical opening through the abdominal wall (colostomy). The patient then wears a removable appliance to collect the bowel contents. A colostomy might be required temporarily or permanently, depending upon the particular circumstances.

Diverticular Disease Outlook

Once a diverticulum forms, it does not go away on its own. The best preventative measure to avoid diverticular disease would seem to be a well-balanced, high-fibre diet beginning as early on in life as possible. There are many other health benefits associated with this diet. By also drinking adequate fluids, and staying physically active, you might be able to prevent further diverticula from forming and avoid unpleasant flare-ups. Many individuals are able to live symptom-free with diverticular disease by making these lifestyle changes. Medical and surgical treatments are available for those whose disease is persistent and unresponsive to these modifications.

Want to learn more about diverticular disease?

We have several related articles that may be helpful:

Image Credit: © bigstockphoto.com/pressmaster

Foods To Avoid with Diverticulitis

Sometimes, especially as they get older, people can develop little bulging pouches in the lining of the large intestine. These are called diverticula, and the condition is known as diverticulosis.

When the pouches become inflamed or infected, it leads to a sometimes very painful condition called diverticulitis. In addition to having abdominal pain, people with diverticulitis may experience nausea, vomiting, bloating, fever, constipation, or diarrhea.

Many experts believe that a low-fiber diet can lead to diverticulosis and diverticulitis. This may be why people in Asia and Africa, where the diet tends to be higher in fiber, have a very low incidence of the condition.

Diverticulosis usually causes no or few symptoms; leaving many people unaware that they even have diverticula present.

Diverticulitis may need to be treated with antibiotics or, in severe cases, surgery.

Diet for Diverticulitis

If you’re experiencing severe symptoms from diverticulitis, your doctor may recommend a liquid diverticulitis diet as part of your treatment, which can include:

• Water
• Fruit juices
• Broth
• Ice pops

Gradually you can ease back into a regular diet. Your doctor may advise you to start with low-fiber foods (white bread, meat, poultry, fish, eggs, and dairy products) before introducing high-fiber foods.

Fiber softens and adds bulk to stools, helping them pass more easily through the colon. It also reduces pressure in the digestive tract.

Many studies show that eating fiber-rich foods can help control diverticular symptoms. Women younger than 51 should aim for 25 grams of fiber daily. Men younger than 51 should aim for 38 grams of fiber daily. Women 51 and older should get 21 grams daily. Men 51 and older should get 30 grams daily.  

Here are a few fiber-rich foods to include in meals:

• Whole-grain breads, pastas, and cereals
• Beans (kidney beans and black beans, for example)
• Fresh fruits (apples, pears, prunes)
• Vegetables (squash, potatoes, peas, spinach)

If you’re having difficulty structuring a diet on your own, consult your doctor or a dietitian. They can set up a meal plan that works for you.

Your doctor may also recommend a fiber supplement, such as psyllium (Metamucil) or methylcellulose (Citrucel) one to three times a day. Drinking enough water and other fluids throughout the day will also help prevent constipation.

Foods to Avoid With Diverticulitis

In the past, doctors had recommended that people with diverticular disease (diverticulosis or diverticulitis) avoid hard-to-digest foods such as nuts, corn, popcorn, and seeds, for fear that these foods would get stuck in the diverticula and lead to inflammation. However, recent research has noted that there is no real scientific evidence to back up this recommendation.

In fact, nuts and seeds are components of many high-fiber foods, which are recommended for people with diverticular disease.

Diverticulitis Diet | Meal Plan, PDF, Foods to Eat & Avoid

Diverticulitis Details: Acute Diverticulitis and Perforated Diverticulitis

Acute Diverticulitis

Acute Diverticulitis symptoms are similar to other inflammatory bowel conditions, but the location of the symptoms is different from other GI issues (Ulcerative Colitis, Crohn’s, etc.). Typically, diverticulitis will present in the lower left abdomen, while other GI conditions cause more widespread pain. Symptoms of Acute Diverticulitis include:

• Pain in the lower left abdomen that persists for several days
• Nausea
• Vomiting
• Fever
• Abdominal tenderness
• Constipation

Learn more about Acute Diverticulitis, including how it’s treated over both the short and long term, in our full write up.

Perforated Diverticulitis

Perforated Diverticulitis symptoms are similar to an acute Diverticulitis attack, only worse. Additional symptoms include an indication of sepsis, which is a severe bodily infection. Symptoms of perforated Diverticulitis are listed below:

• Increased abdominal pain/tenderness
• Rapid pulse
• Rapid breathing
• Fever/chills
• Decreased urination
• Diarrhea
• Nausea/vomiting
• Difficulty breathing
• Very low body temperature

If your Diverticulitis symptoms worsen or you experience 3 or more of the above symptoms at once, contact your doctor.

Learn more about Perforated Diverticulitis, including treatment options, on our blog.

Will I ever be able to eat my favorite foods again?

Yes, you should be able to. Unless you have an extreme condition, your GI system should be able to tolerate most foods within a few weeks after a flare-up or “attack”.

You may choose to avoid foods that cause severe issues for your body, such as whole intact seeds. Your diverticulitis diet should always feel as though you are in control of your routine and your food choices.

Even after a flare-up, do your best to not fear food! We can help!

Diverticular disease and diverticulitis – NHS

Diverticular disease and diverticulitis are related digestive conditions that affect the large intestine (bowel).

Diverticula are small bulges or pockets that can develop in the lining of the intestine as you get older.

Most people with diverticula do not get any symptoms and only know they have them after having a scan for another reason.

When there are no symptoms, it is called diverticulosis.

When diverticula cause symptoms, such as pain in the lower tummy, it’s called diverticular disease.

If the diverticula become inflamed or infected, causing more severe symptoms, it’s called diverticulitis.

You’re more likely to get diverticular disease and diverticulitis if you do not get enough fibre in your diet.

Symptoms of diverticular disease and diverticulitis

Symptoms of diverticular disease include:

• tummy pain, usually in your lower left side, that tends to come and go and gets worse during or shortly after eating (pooing or farting eases it)
• constipation, diarrhoea, or both
• occasionally, blood in your poo

If your diverticula become infected and inflamed (diverticulitis), you may suddenly:

• get constant, more severe tummy pain
• have a high temperature
• have diarrhoea or constipation
• get mucus or blood in your poo, or bleeding from your bottom (rectal bleeding)

When to get medical advice

Contact a GP as soon as possible if you have symptoms of diverticular disease or diverticulitis.

If you’ve already been diagnosed with diverticular disease, you usually do not need to contact a GP – the symptoms can be treated at home.

But if you have any bleeding or severe pain, seek immediate medical advice.

Contact a GP or, if this is not possible, call NHS 111 or your local out-of-hours service.

Tests for diverticular disease and diverticulitis

After taking your medical history and listening to your symptoms, the GP may first want to rule out other conditions, such as irritable bowel syndrome (IBS), coeliac disease or bowel cancer. 

These often have very similar symptoms to diverticular disease.

This may involve blood tests. If necessary, you’ll be referred for a colonoscopy, a CT scan, or sometimes both.

Colonoscopy

A colonoscopy is where a thin tube with a camera at the end (a colonoscope) is inserted into your bottom and guided up into your bowel.

The doctor will then look for any diverticula or signs of diverticulitis. You’ll be given a laxative beforehand to clear out your bowels.

A colonoscopy should not be painful, but can feel uncomfortable.

You may be offered painkilling medicine and a sedative to make you feel more relaxed and reduce any discomfort.

CT scan

Sometimes you may need to have a CT scan. This might be done instead of a colonoscopy or in combination with one called a CT colonography or virtual colonoscopy. Cancer Research UK has more information about a CT colonography or virtual colonoscopy.

For a CT colonoscopy, the scan is done after you’ve had the laxative.

Treatment for diverticular disease and diverticulitis

Treatments for diverticular disease

Diet

Eating a high-fibre diet may help ease the symptoms of diverticular disease and stop you developing diverticulitis.

Generally, adults should aim to eat 30g of fibre a day.

Good sources of fibre include fresh and dried fruits, vegetables, beans and pulses, nuts, cereals and starchy foods.

Fibre supplements, usually in the form of sachets of powder that you mix with water, are also available from pharmacists and health food shops.

Find out how to get more fibre in your diet

Gradually increasing your fibre intake over a few weeks and drinking plenty of fluids can help prevent side effects associated with a high-fibre diet, such as bloating and farting.

Medicine

Paracetamol can be used to relieve pain.

Some painkillers, including aspirin and ibuprofen, should not be taken regularly as they can cause stomach upsets. Ask a pharmacist about this.

Speak to a GP if paracetamol alone is not working.

You may be prescribed a bulk-forming laxative to help ease any constipation or diarrhoea.

Treatments for diverticulitis

Diet

If you have diverticulitis, a GP may recommend that you stick to a fluid-only diet for a few days until your symptoms improve.

While you’re recovering you should eat a very low-fibre diet to rest your digestive system.

Once the symptoms have gone, you can return to a higher-fibre diet, aiming to eat about 30g of fibre a day.

Medicine

Diverticulitis can usually be treated at home with antibiotics prescribed by a GP.

You can take paracetamol to help relieve any pain. Talk to a GP if paracetamol alone is not working.

Do not take aspirin or ibuprofen, as they can cause stomach upsets.

More serious cases of diverticulitis may need hospital treatment.

In hospital, you’ll probably get injections of antibiotics, and be kept hydrated and nourished using a tube directly connected to your vein (intravenous drip).

You may also be prescribed a stronger painkiller if paracetamol is not helping.

Surgery

In rare cases, surgery may be needed to treat serious complications of diverticulitis.

Surgery usually involves removing the affected section of your large intestine.

This is known as a colectomy. This is the treatment for rare complications such as fistulas, peritonitis or a blockage in your intestines.

After a colectomy, you may have a temporary or permanent colostomy, where one end of your bowel is diverted through an opening in your tummy.

The most common complication of diverticulitis is developing abscesses.

These are usually treated with a technique known as percutaneous drainage, which is done by a radiologist.

If surgery is being considered, your doctor should discuss the benefits and the risks very carefully with you.

Causes

It’s not known exactly why some people get diverticular disease, but it seems to be linked to age, diet and lifestyle, and genetics.

Age

As you get older, the walls of your large intestine become weaker and the pressure of hard stools passing through your intestines can cause diverticula to form.

The majority of people will have some diverticula by the time they’re 80 years old.

Diet and lifestyle

Not eating enough fibre is thought to be linked to developing diverticular disease and diverticulitis.

Fibre helps to make your stools softer and larger so they put less pressure on the walls of your intestines.

Some other things that seem to increase your risk include:

• smoking
• being overweight or obese
• having a history of constipation
• long-term regular use of painkillers such as ibuprofen or aspirin

Genetics

You’re more likely to develop diverticula if you have a close relative with diverticular disease, especially if they developed it before they were 50.

More information and support

Page last reviewed: 29 September 2020
Next review due: 29 September 2023

Low FODMAP Diet for Prevention of Diverticulitis

Low FODMAP Diet & Digestive Health News

With the public’s growing concern for eating healthy and more awareness about Irritable Bowel Syndrome (IBS), we are seeing a greater focus on digestive health. Amidst the publishing of new research and the release of new products targeted at improving digestive health, it can be difficult to keep up-to-date. Here are this week’s highlights.

Monash University is regularly adding new food items to the app and certifying newly released Low FODMAP products. With constant changes it can be difficult to keep up, but our team is working hard to highlight the latest updates to the app as they happen so you can continue eating well for your health and your gut, without all the confusion and guesswork.

If you are following the Low FODMAP diet and haven’t already downloaded the app, we recommend you do. This is the best tool to provide you with an up-to-date list of low, moderate, and high FODMAP foods. New foods are regularly added in addition to updates for existing items based on the latest testing and research.

Getting Enough Calcium on the Low FODMAP Diet 

Monash recently released some helpful tips on meeting your calcium needs while on the Low FODMAP diet. Whether you are in the elimination phase of the Low FODMAP diet or you are lactose intolerant, these easy tips will help you meet your calcium needs when you’re avoiding dairy.

Why is Calcium Important?

Many of us associate calcium with bone health, but it is also important to proper muscle function and helps transmit messages to your brain.

Foods that Contain Calcium

In addition to dairy products, calcium is found in non-dairy beverages, such as, soy or rice milk that have been fortified. Some less familiar sources of calcium include foods like, navy beans, sardines, spinach, sesame seeds, and kale.

3 Tips for Meeting Your Calcium Needs on the Low FODMAP Diet

• Eat hard cheeses like cheddar or parmesan
• Use non-dairy milks like almond or rice milk that are fortified with calcium
• Add plain, firm tofu to your diet (look for tofu that has been set in calcium)

Low FODMAP Diet Relieves IBS

The Washington Post wrote a great overview about the Low FODMAP diet this week in their Wellness Section. The article stresses that the Low FODMAP diet is a “learning diet” that helps identify which foods trigger symptoms. Reviewing the list of foods that are high in FODMAPs you’ll see healthy foods, such as, black beans, artichokes and apples. The objective of the Low FODMAP diet is not to avoid all high FODMAP foods, but to limit the ones that irritate your gut. Due to the complexity of the Low FODMAP diet it is recommended that individuals with IBS work with a dietitian. The symptoms that someone with IBS may experience are likely to change over time. This factor along with the restrictive nature of the Low FODMAP diet means that this dietary intervention is best implemented alongside a healthcare professional.

Many individuals starting on the Low FODMAP diet are tempted to stay on the diet indefinitely once they experience symptom relief. Registered dietitian Kate Scarlata usually finds that most people “will identify 5 to 10 trigger foods on average. Some [people] learn that they have no one specific trigger food, but rather they exacerbate their IBS symptoms when they consume too many FODMAP-containing foods at one meal”.

And it’s why I created the Low FODMAP Diet Getting Started Guide. It’s a short eBook that will help you better understand the Low FODMAP diet so you know what you need to know about FODMAPs and if this diet is right for you. Click here to get a copy emailed to you now.

Microbiome and IBS

A pharmaceutical company, 4D Pharma PLC, is developing live biotherapeutics called Blautix, that alter the gut microbiome. What are biotherapeutics? Biotherapeutics refers to the engineering of bacteria, fungi, yeast or cells to treat disease or illness. Changes to the gut bacteria is often a feature of IBS and places people at risk of acquiring other illnesses seeing as a large portion of our immune system resides in our gut. Those living with IBS may have decreased bacteria or less diversity of bacteria in their gut which is necessary for a healthy digestive system. 4D Pharma is in the midst of clinical trials, but has so far found that individuals taking Blautix had greater symptom relief and more diverse gut bacteria compared to the placebo group. This is promising news and we look forward to see what the next round of clinical trials reveal.

Reducing Holiday Flare-ups with the Low FODMAP Diet

The holidays are a stressful period for most people, but especially so for those with IBS. Many of our social gatherings around the holiday season involve indulgent meals, eating in excess, and consuming alcohol, all of which can trigger symptoms. So what should you do?

Dr. Ayesha Akbar, a gastroenterologist, shares five tips to help keep your symptoms at bay and enjoy the holidays with your loved ones.

• Avoid trigger foods
• Limit foods and drinks associated with bloating, such as carbonated drinks
• Try not to eat too late into the evening
• Drink plenty of water, especially if consuming alcohol
• Listen to your body and stop eating once you feel full

What Do Your Symptoms Mean?

The Weekly Challenger asked gastroenterologist Robynne Chutkan about common digestive issues and how you should address them. Dr. Chutkan highlights major symptoms of Crohn’s disease, ulcerative colitis, lactose intolerance, celiac and SIBO. She recommends that mild cases of IBD can be improved by lifestyle changes like the Low FODMAP diet and stress reduction. For IBS, she suggests the Low FODMAP diet along with exercise. Hearing medical professionals endorse lifestyle changes for symptom management is definitely encouraging, as more people are looking for a holistic approach to dealing with their health.

Increase in Low FODMAP Diet Awareness

Nutrition Insight recently wrote a piece about the rise in awareness about IBS and the Low FODMAP diet. They spoke with industry insiders to learn what the upcoming year has in store for those following the Low FODMAP diet.

Tim Mottin, the Director of FODMAP Friendly, revealed that “up to 80 percent of [those with IBS] are undiagnosed”. Openly discussing digestive health decreases the stigma around living with IBS and motivates those with IBS to demand more products and services that cater to their needs.

The food industry has an important role to play not only in developing products, but educating the public. Registered dietitian Julie Thompson noted that the food industry could help with the public’s understanding of the Low FODMAP diet, especially since the word “diet” is associated with weight loss. Food companies will need to stress that the Low FODMAP diet isn’t a fad diet or weight loss plan, but a solution for digestive health issues.

Within the past , Low FODMAP products have increased by 35 percent in the United States. With this increase in product development and awareness there will likely be products that cater to people at various stages of the Low FODMAP diet.

Certification programs such as FODMAP Friendly and Monash Low FODMAP play a big role in identifying Low FODMAP foods for consumers. These programs assure consumers that they are buying gut friendly products that have been tested in a lab and follow strict guidelines. With the growing number of products entering the market it can be overwhelming trying to figure out what works for you. Looking for these seals of approval definitely makes grocery shopping a little easier for Low FODMAPers everywhere!

Low FODMAP Diet to Prevent Diverticulitis 

One of the most exciting developments in Low FODMAP research has been applications to other digestive health issues beyond IBS. Research published in the November issue of the World Journal of Gastrointestinal Pharmacology and Therapeutics investigates if the Low FODMAP diet could help with diverticulitis.

What is Diverticulitis?

Diverticulitis occurs when little pouches (diverticula) formed in the wall of the colon become inflamed. The inflamed pouches can cause pain or bowel obstruction. The causes of diverticulitis are unknown, but dietary changes are a component of symptom management. Doctors routinely recommend a high-fibre diet to decrease risk of diverticulitis. However, the evidence supporting this practice lacks strength. Scientists in Japan and the United States are hypothesizing that there might be a better approach.

Taken from: On Health

Low FODMAP Diet to Prevent Diverticulitis

Diverticulitis and IBS share similar symptoms including, abdominal pain, gas, and bloating. It is believed that excess intestinal pressure can increase the chances of pouches becoming inflamed. Yoshiharu Uno and Jennifer Velkinburg propose that the gas-reducing Low FODMAP diet may help prevent diverticulitis from developing. They believe that a high-fibre diet actually exacerbates symptoms in diverticulitis because of the increased gas that is produced from poorly digested carbohydrates. They propose that the increase in pressure caused by gas might contribute to the formation of these pouches. Uno and Velkinburg suggest that a Low FODMAP diet should be considered as a possible treatment option for those with diverticulitis.

Looking at previous research, they found that those with diverticulitis are more likely to be lactose intolerant. Lactose is one of the FODMAPs some people living with IBS have difficulty digesting. There was also a direct link between IBS and diverticulitis. Although they are different conditions, those with sudden onset of diverticulitis are more likely to develop IBS.

Hopefully the findings of this research will prompt further study on the link between diverticulitis, IBS and the Low FODMAP diet. It is likely that over the next few years we will see the Low FODMAP diet being used to prevent or treat other digestive disorders.

Written by Adi Hazlewood, News & Culture Editor

References 

1. Uno Y and van Velkinburgh JC. World Journal of Gastrointestinal Pharmacology and Therapeutics. 2016. Logical hypothesis: Low FODMAP diet to prevent diverticulitis.
2. Monash University. 2016. Getting enough calcium on the Low FODMAP diet.
3. Rosenbloom C. Washington Post. 2016. A diet that helps relieve irritable bowel suffers’ pain (finally).
4. Arbor G. 2016. 4D pharma PLC clinical update very encouraging for future clinical development.
5. Gardiner H. Nutrition Horizon. 2016. Special report: Low FODMAP: Exploring the latest free-from trend.
6. Lerche O. Daily Express. 2016. Irritable bowel syndrome: How to avoid IBS flare ups at Christmas

Irritable Bowel Syndrome and Diverticulitis | health tips – Ahuriri Pharmacy Napier

Today we are looking at two disorders of the gut, irritable bowel syndrome (IBS) and diverticular disease. Both are sadly more common than ever.

Irritable Bowel Syndrome: Symptoms of IBS range from pain in the gut, bloating, constipation and diarrhoea. This may be related to food, gut function and movement, stress and depression. The cause of IBS is not known but there is inflammation and/or infection in the gut, changes in serotonin levels and a family history in some patients with IBS.

While there is no cure for IBS, symptoms can be managed and the first thing to do is to look at diet and exercise. Keep a food and symptom diary to identify any foods that are causing flare-ups and avoid those foods. Food intolerances are different to allergies and often symptoms will be related to the amount of the foods that you eat. If you find you are intolerant to a particular food, you can limit or replace that food with something else in your diet.

Your food and symptom diary can also help you identify whether fermentable foods are contributing to your symptoms. Dr Shepherd has developed the low-FODMAP diet which improved symptoms of 70% of patients who stayed on it. Foods identified as being a problem in some people include apples, pears, asparagus, dairy, beans and chickpeas. Click here for more information. While the results are encouraging, there is no point avoiding foods unnecessarily so if no improvement in symptoms is noticed, simply re-introduce that food. Excluding gluten may help even when gluten sensitivity is not identified.

The way we eat can also improve symptoms. Don’t skip breakfast. The gut is ready to digest food well after the overnight fast. Chew your food thoroughly and slowly. Sit up straight when you eat. Lifestyle changes may also help. Moderate exercise has been shown to help symptoms, reduce stress and improve mood. Include leisurely walks, yoga or other relaxation techniques into your week. If depression is a factor, this should be treated by your doctor.

Some patients with IBS will find medications useful. Anti-diarrhoeal drugs, laxatives and antispasmodics can relieve symptoms. Since the gut flora appears to be abnormal in people with IBS, a probiotic can be used to restore and encourage healthy gut flora and regulate bowel movements. Lactobacillus plantarum in Ethical Nutrients IBS Support is specific for IBS control. Anti-inflammatories such as omega-3, curcumin (in Turmeric) and slippery elm bark may also be helpful to reduce inflammation.

Holistic Nutritionist Alison Cowell will be in-store on Wednesday 5^th June offering health and nutrition assessments and/or food intolerance tests at a special rate for anyone mentioning this column. To book your appointment, phone her on 844 0587 and visit her website for more information.

Diverticular Disease: The word “diverticulum” means “cave” in Latin and diverticular disease is where the lining of the colon bulges to cause small pockets (or caves). This is very common in New Zealand, especially as we get older, affecting nearly half of Kiwis over 60 years. 15-20% of people with diverticular disease develop diverticulitis where the pockets become inflamed and cause pain, bleeding, fever, nausea and constipation. If there is strong pain and a high fever, the person should go to hospital immediately as a pocket may have burst.

The pockets in the bowel lining are thought to be caused by intermittent increases of pressure in the bowel over a long period of time. This can run in families which suggest genetic factors are involved and a diet which is low in fibre can aggravate the condition. Fibre can be found in fresh fruits, vegetables and whole grains and is important to keep stools soft and bulky so they pass easily through the colon. If the stool becomes hard, the muscles in the colon strain to move it causing pressure which can lead to parts of the colon wall to pop out into pockets. If there is no inflammation, increasing the fibre in the diet (20-35g/day) may be all that is required to improve diverticular disease and prevent episodes of diverticulitis. It is advisable to increase fibre gradually in the diet to avoid wind and abdominal pain. Drink at least eight glasses of fluids through the day too.

If diverticulitis occurs, your doctor will advise you about your diet while the area heals and may prescribe an antibiotic to prevent or treat infection. Many of the symptoms described for both these disorders are the same as other bowel conditions. If you have been experiencing them for some time or if you have noticed weight loss, anaemia or bleeding, you should speak to your doctor.

Irritable bowel syndrome (IBS) – Better Health Channel

Around one in five Australians experiences the unpleasant symptoms of irritable bowel syndrome (IBS) at some time. These include abdominal pain, mucus in the stools, and alternating diarrhoea and constipation. Other terms for irritable bowel syndrome include ‘spastic colon’ and ‘irritable colon’. It seems that people with IBS have sensitive bowels that are easily ‘upset’. More women than men are prone to IBS, and symptoms tend to first occur in early adulthood.

The cause is unknown, but environmental factors such as changes of routine, emotional stress, infection and diet can trigger an attack. Research has shown that the neurotransmitter serotonin may be important in the symptoms of IBS, by altering the function of nerve cells in the bowel and causing changes in pain sensation and bowel function.

Irritable bowel syndrome doesn’t cause lasting damage and doesn’t contribute to the development of serious bowel conditions, such as cancer or colitis.

Symptoms of IBS

Some of the more common signs of irritable bowel syndrome include:

• abdominal pain or cramping that is often relieved by passing wind or faeces
• alternating diarrhoea and constipation
• a sensation that the bowels are not fully emptied after passing a motion
• abdominal bloating
• mucus present in the stools
• nausea.

None of these symptoms are exclusive to IBS. It is unusual for IBS to produce these symptoms, for the first time, after the age of 40.

Main IBS categories

Irritable bowel syndrome can be subdivided into three major categories:

• Constipation-predominant – the person tends to alternate constipation with normal stools. Symptoms of abdominal cramping or aching are commonly triggered by eating.
• Diarrhoea-predominant – the person tends to experience diarrhoea first thing in the morning or after eating. The need to go to the toilet is typically urgent and cannot be delayed. Incontinence may be a problem.
• Alternating constipation and diarrhoea.

Causes of IBS

The underlying cause of irritable bowel syndrome is still unknown, but certain factors have been found to ‘trigger’ attacks in susceptible individuals. These include:

• Infection – an episode of gastroenteritis will often result in persistent bowel symptoms, long after the offending bacteria or virus has been eliminated. The cause of this is unknown, but may involve changes to nerve function in the bowel or changes in the normal bacterial population of the bowel. Up to 25 per cent of IBS may be due to this problem.
• Food intolerance – impaired absorption of the sugar lactose (found in dairy and many processed foods) is the most common dietary trigger for IBS. Other sugars believed to trigger IBS are fructose (present in many syrups) and sorbitol.
• General diet – low-fibre diets can exacerbate the constipation of constipation-predominant IBS. Some people find spicy or sugary foods cause problems. However, many experts are sceptical about the role of general diet, once specific food intolerances have been eliminated.
• Emotional stress – strong emotions, such as anxiety or stress, can affect the nerves of the bowel in susceptible people.
• Medication – certain types (such as antibiotics, antacids and painkillers) can lead to constipation or diarrhoea.

Diagnosis of IBS

If you suspect you have irritable bowel syndrome, it is important to seek medical advice to make sure your symptoms aren’t caused by any other illness, such as diverticulitis, inflammatory bowel disease or polyps. Coeliac disease (an immune intolerance to gluten, present in wheat and other grains) may produce many of the same symptoms as IBS. Lactose intolerance may produce bloating, cramps and diarrhoea.

Diagnosis methods include:

• full medical check-up
• blood tests, including blood tests for coeliac disease
• stool tests
• investigation of the bowel lining by inserting a small tube (sigmoidoscopy)
• investigation of the bowel under sedation (colonoscopy) or barium enema, if necessary.

Treatment for IBS

IBS cannot be cured with medication or special diets. The primary preventative measure is to identify and avoid individual triggers. Treatment options may include:

• a modest increase in dietary fibre, together with plenty of clear fluids
• reducing or eliminating common gas-producing foods, such as beans and cabbage
• reducing or eliminating dairy foods, if lactose intolerance is a trigger
• antidiarrhoea medication, such as imodium or lomotil – these can be an essential part of management in those with diarrhoea-predominant IBS
• pain-relieving medication – opiates such as codeine can provide effective pain relief. One of their most common side effects, constipation, may also relieve the diarrhoea of diarrhoea-predominant IBS
• treatments to treat constipation
• antispasmodic drugs, which may ease cramping – examples include mebeverine, belladonna, hyoscine and peppermint oil capsules
• tricyclic antidepressants – these can be effective in treating the pain of IBS, but are best prescribed for a trial period with monitoring of symptoms. Use of these does not mean that IBS is caused by depression
• stress management, if stress seems to be triggering the attacks
• establishing eating routines and avoiding sudden changes of routine.

A a group of carbohydrates called FODMAP is now believed to contribute strongly to symptoms of IBS in many people. A low-FODMAP diet can be tried in these instances. This diet can be commenced with the supervision of a dietician experienced in management of IBS.

Specific treatments for IBS are not approved for use

A small number of medications have been developed to treat IBS and have been shown to be effective in selected groups in clinical trials. These work on the interaction between serotonin and nerve cells of the colon. They include alosetron, cilansetron and tegaserod. Safety concerns with these three medications has led to their withdrawal from the market, or restricted use only, and none are presently licensed in Australia.

Find an experienced health professional

People with IBS can become frustrated and feel their symptoms are not treated seriously. These frustrations, along with sometimes inappropriate therapy, can often make the symptoms worse. Finding a therapist with experience in the successful treatment of IBS is important.

Where to get help

• Your doctor
• Irritable Bowel Information and Support Association Tel.(07) 3372 2091
• Dietitians Association of Australia Tel. 1800 812 942

90,000 Treatment of acute intestinal diverticulitis in Germany

Siegbert Rossol, gastroenterologist, specialist in internal medicine

Since 2006 he has been the chief physician of the Nordwest Medical Clinic.

More about the specialist →

Diverticulitis is an inflammation of the protrusions of the mucous membrane of the colon ( diverticulum ). In diverticulosis, they often do not cause complaints and go unnoticed.The pathology under consideration, on the contrary, is accompanied by strong complaints:

• for pain in the left abdomen;
• temperature;
• digestive problems.

There are two forms of the disease:

• Uncomplicated diverticulitis
  The diverticulum and the surrounding colon mucosa become inflamed. There are no signs of accumulation of pus ( abscess ) or widespread inflammation.
• Complicated diverticulitis
  An abscess forms and widespread inflammation occurs.Often accompanied by perforation of the intestinal wall ( intestinal perforation ). This inflammation can lead to intestinal obstruction or peritonitis.

On average, about 80% of cases of diverticulitis are uncomplicated and about 20% have complications.

Even after successful treatment in Germany, re-acute inflammation may subsequently occur. After complicated cases, the risk of recurrent exacerbation of diverticulitis is much higher. Previously, antibiotics were generally used in the treatment of this disease, and surgical treatment was recommended for recurrent infections.Today, doctors are trying to refrain from operations. Pain relievers from the group of non-steroidal anti-inflammatory drugs, such as ibuprofen or diclofenac, should not be taken for diverticulitis, as they increase the risk of bowel perforation.

Diagnosis of the disease in Germany, the study by the doctor of the obvious signs of acute diverticulitis and the symptoms voiced by the patient, helps to choose an effective method of therapy, the features of which depend on the degree of complication of the developing pathology.

Treatment of uncomplicated form

In 95 out of 100 cases of uncomplicated diverticulitis, the inflammation resolves within one week. In the five remaining cases, complaints persist, which requires further treatment. As a rule, there is no need for surgery.

• Antibiotics
  If there are no complications from taking antibiotics, you can refuse if the performed ultrasound or computed tomography confirms the absence of an abscess. Medicines do not reduce the risk of complications.Studies have shown that intestinal abscesses or perforation can occur regardless of whether the patient is taking these drugs or not. As a rule, antibiotics are prescribed in this case when the risk of complications is high, for example, with chronic kidney disease, a weak immune system, high blood pressure or allergies.
• Medical supervision
  Especially in the first days of the disease, regular medical supervision is very important in order to identify possible complications in a timely manner.Blood infection indicators are monitored. Serious complications with this form of diverticulitis are rare, but not excluded. Complaints of increased abdominal pain, fever, tension of the abdominal wall or nausea may be signals that indicate the onset of an exacerbation. In this case, immediate medical attention is required.
• Nutrition
  Many doctors recommend eating a normal diet based on food tolerance. Others recommend adhering to a strict diet: in the early days, only soups and cereals with a lot of liquid.In fact, the question of special nutrition for uncomplicated diverticulitis has not been deeply studied.

Treatment of complicated forms

In 80 out of 100 cases, complicated diverticulitis is cured with antibiotics within a few weeks. Surgical treatment is performed in about 20 cases.

• Antibiotics
  Complicated diverticulitis requires hospital treatment. In order to stop the spread of the inflammatory process, it is important to take antibiotics.
• Food
  The need for only liquid food depends on the findings of the examinations and the patient’s complaints. Most often, in the first days, a drinking diet is prescribed for diverticulitis : it is recommended to drink only water, teas and eat soups, after which gradually restore nutrition. If it is impossible to drink a lot, the liquid is injected using infusion.
• Drainage
  In 15 out of 100 cases, a purulent abscess develops. If necessary, pus can be removed with a thin catheter ( drain ) through the abdominal wall.
• Operation to remove diverticulitis
  If complaints persist for several days, the risk of serious complications increases. In this case, an operation is recommended. If bowel perforation has already occurred or peritonitis has begun, surgery is required immediately. If widespread inflammation has disappeared with antibiotics, bowel surgery is still recommended to prevent recurrence of the disease. Studies show that in this form of diverticulitis, after successful antibiotic treatment, in every second case within a year, a relapse occurs, often with serious complications.Patients with weakened immune systems or chronic kidney disease are at high risk.

Cost of diverticulitis treatment in Germany

In case of an exacerbation of the disease, immediate assistance, fast, high-quality diagnosis and treatment is required, which allows to cope with inflammation in the shortest possible time and prevent the development of serious complications. All this you will receive in the clinic “Nordwest”, where experienced doctors will conduct a professional examination and determine how to treat diverticulitis : whether antibiotics can be dispensed with or surgical intervention is required.The cost of treatment depends on the method of therapy and the severity of the pathology.

90,000 DIVERTICULAR DISEASE OF THE COLOR. SOLVED AND UNRESOLVED ISSUES | Ardatskaya

1. Butorova L.I. Diverticular disease of the colon: clinical forms, diagnosis and treatment: a guide for doctors. Moscow: 4TE Art, 2011.48 p.

2.Painter NS, Burkitt DP. Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol 1975,4: 3-21.

3. Etzioni DA, Mack TM, Beart RW et al. Diverticulitis in the United States: 1998-2005. Changing patterns of disease and treatment. Ann Surg 2009,249 (2): 210-7.

4. Shelygin Yu.A., Achkasov S.I., Blagodarny L.A.et al. Clinical guidelines for the diagnosis and treatment of adult patients with diverticular colon disease. M., 2013, 22 p.

5. Humes DJ. Changing Epidemiology: Does It Increase Our Understanding? Dig Dis, 2012, 30: 6-11.

6. Pittet O, Kotzampassakis N, Schmidt S et al. Recurrent left colonic episodes: more severe than the initial diverticulitis? World J Surg, 2009 Mar, 33 (3): 547-552.

7. Shelygin Yu.A., Blagodarny L.A. Handbook of Coloproctology. M .: Publishing house “Litterra”, 2012, 608 p.

8. Shelygin Yu.A., Achkasov S.I., Moskalev A.I. Classification of diverticular disease. Coloproctology, 2014, 4 (50): 5-14.

9. Ivashkin V.T., Shelygin Yu.A., Achkasov S.I. and other Recommendations of the Russian Gastroenterological Association and the Association of Coloproctologists of Russia for the diagnosis and treatment of adult patients with diverticular disease of the colon. RZhGGK, 2016, 1: 65-80.

10. Hinchey E. J., Schaal P. G. H., Richards G. K. Treatment of perforated diverticular disease of the colon. Adv Surg, 1978, 12: 85-109.

11.Hansen O, Stock W. Prophylaktische operation bei der divertikelkrankheit des kolons – stufenkonzept durch exakte stadieinteilung. Langenbecks Arch Chir (Suppl. II) 1999: 1257-60.

12. Tursi A. Diverticular disease: A therapeutic overview. World J Gastrointest Pharmacol Ther, 2010 Feb 6, 1 (1): 27-35.

13. Pfützer RH, Kruis W. Management of diverticular disease.Nat Rev Gastroenterol Hepatol 2015 Nov 12 (11): 629-38.

14. Murphy T, Hunt RH, Fried M, Krabshuis JH. Practical guide of the World Organization of Gastroenterology (WOG-OMGE). Diverticular disease. 2001.

15.http: //akr-congress2016.ru/upload/files/astrakhan-2016-resolution.pdf.

16.Vorobiev G.I. Fundamentals of Coloproctology. M., 2006.432 p.

17. Tursi A, Papa A, & Danese S. Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Aliment Pharmacol Ther, 2015, 42: 664-684.

18. Cuomo R, Barbara G, Pace F, Annese V, Bassotti G, Binda GA, Casetti T, Colecchia A, Festi D, Fiocca R, Laghi A, Maconi G, Nascimbeni R, Scarpignato C, Villanacci V and Annibale B …Italian consensus conference for colonic diverticulosis and diver-ticular disease. United European Gastroenterology Journal, 2014, 2 (5): 413-442.

19. Marzo et al. Dig. Liv. Dis, 2010, 42S: S61-s192.

20.http: //www.fda.gov/NewsEvents/Newsroom/ PressAnnouncements / ucm448328.

21.Mullen KD et al. Rifaximin is Safe and Well Tolerated for Long-term Maintenance of Remission From Overt hepatic Encephalopathy. Clinical Gastroenterology and Hepatology, 2014, 12.

22. Antonio Colecchia et al. Efficacy of long term cyclic administration of the poorly absorbed antibiotic Rifaximin in symptomatic, uncomplicated colonic diverticular disease. World J Gastroenterology, 2007 Janyary 14, 13 (2): 264-269.

23. Bianchi M., et al. Meta-analysis: longterm therapy with rifaximinin the management of uncomplicated diverticular disease. Aliment Pharmacol Ther 2011; 33: 902-910.

24. Colecchia A, Vestito A, Pasqui F, et al. Efficacy of long term cyclic administration of the poorly absorbed antibiotic Rifaximin in symptomatic, uncomplicated colonic diverticular disease.World Journal of Gastroenterology: WJG. 2007; 13 (2): 264-269. doi: 10.3748 / wjg.v13.i2.264.

25. Brandimarte G., Tursi A., Rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease. Med Sci Monit. 2004; 10 (5): PI70-73.

26. Ridgway PF, Latif A, Shabbir J et al.Rando mized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis. Colorectal Dis, 2008,11: 941-6.

27. Chabok A, Pahlman L, Hjern F et al. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg, 2012, 30. doi: 10.1002 / bjs.8688.

28. Hjern F, Josephson T, Altman D et al.Conservative treatment of acute diverticulitis: are antibiotics always mandatory? Scand J Gastroenterol, 2007, 42 (1): 41-7.

29. Trespi E, Colla C, Panizza P, Polino MG, Venturini A, Bottani G, et al. Therapeutic and prophylactic role of mesalazine (5-ASA) in symptomatic diverticular disease of the colon: 4-year follow-up results. Minerva Gastroenterol Dietol 1999,45: 245-52.

30.Tursi A, Brandimarte G, Daffinà R. Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon. Dig Liver Dis, 2002, 34: 510-515.

31. Lanas A. et al. One year intermittent rifaximin plus fiber supplementation vs. fiber supplementation alone to prevent diverticulitis recurrence: A proof-of-concept study. Digestive and Liver Disease, 45, 2: 104-109.

32. Gatta L, Vakil N, Vaira D, et al. Efficacy of 5-ASA in the treatment of colonic diverticular disease. J Clin Gastroenterol., 2010 Feb, 44 (2): 113-9.

33. O. N. Minushkin, M. A. Kruchinina, N. V. Polunina, T. V. Stebletsova. Diverticular disease of the colon: diagnosis and observation in a polyclinic. Kremlin medicine.Clinical Bulletin, 2013, 3: 90-95.

34. Minushkin O. N., Kruchinina M. A. Prevention of recurrence of diverticulitis in a polyclinic. Diary of the Kazan Medical School. Scientific and practical journal, 2013, 1: 110.

35. Minushkin O. N., Kruchinina M. A. Diverticular disease of the colon: outpatient follow-up. Coloproctology.Scientific and practical medical journal, 2014, 3 (49): 94.

90,000 symptoms, treatment of pathology and prognosis in adults

Diverticulosis of the large intestine (syn. Diverticular disease of the colon, diverticulosis of the colon) is a disease against which the formation of pathological hernia-like or bag-like protrusions occurs. It is noteworthy that the risks of developing the disease increase with age.An exception is the congenital form, which develops in children and young people.

Pathology is always of a secondary nature, often develops against the background of gastroenterological pathologies. The influence of vascular disorders and muscle weakness is not excluded.

Symptoms of the disease are nonspecific, which complicates the diagnosis process. The main external manifestations are considered to be pain syndrome, flatulence and disorder of the act of defecation. However, diverticulosis is often asymptomatic.

Diagnostics requires an integrated approach, from palpation of the anterior abdominal wall to endoscopic instrumental examinations.Laboratory tests are of secondary importance.

Diverticulosis can be treated using conservative methods, for example, taking medication, adhering to a sparing diet, physiotherapy and exercise therapy. The indication for medical intervention is the development of complications.

In the international classifier of diseases of the tenth revision, diverticulosis has its own meaning: the ICD-10 code is K57.3.

Diverticulosis of the large intestine develops several times more often than the defeat of the small intestine.It is believed that the incidence rate is high – every tenth person lives with such a diagnosis.

Various predisposing factors contribute to the appearance of primary and secondary diverticula (saccular neoplasms).

Causes of congenital diverticulosis:

• Congenital weakness of the connective tissue of the large intestine;
• motor impairment;
• inappropriate nutrition of a woman during the period of bearing a child;
• degenerative intestinal lesions;
• anomalies of intrauterine development of the gastrointestinal tract.

As for the acquired form, in most situations the provocateurs of diverticulosis are as follows:

• chronic intestinal obstruction;
• unhealthy diet – eating a lot of fatty and spicy foods, pickles and smoked meats, strong coffee and carbonated drinks;
• lack of fiber – against this background, during the course of treatment, the doctor prescribed a diet for diverticulosis;
• long-term addiction to bad habits, especially to alcoholic beverages;
• excessively high body weight;
• prolonged refusal to eat followed by overeating;
• atherosclerosis;
• ischemic heart disease;
• Any conditions leading to an increase in intra-intestinal pressure.

The main risk group is made up of elderly people, since the formation of diverticulums can be caused by the natural aging process of the human body, when the muscles of the internal organs lose their tone.

The frequency of diagnosing the problem will increase with age. Prevalence by age group:

• children – the disease develops extremely rarely, only due to congenital abnormalities;

90,017 persons under 40 years of age – 10% of cases;

90,017 people from 40 to 50 years old – defects in the colon are detected in every third person;

90,017 over 60 years old – 50% of situations;

90,017 over 70 years old – 80%.

Diverticulum in the large intestine

In addition to the existence of congenital and acquired forms, diverticulosis is divided according to the location of the pathological process:

• distal colon – approximately 20%;
• transverse colon or sigmoid colon – 50%;
• right sections of the large intestine – 10%

90,017 left sections of the large intestine – 30%.

Depending on the clinical picture, the following variants of the pathology are noted:

• asymptomatic – occurs most often, in 80%;
• with characteristic features;
• complicated – the most common complication of colon diverticulosis is diverticulitis (inflammatory lesion of diverticulums).

Specialists in the field of gastroenterology distinguish the following types of problems:

1. True diverticular disease. It is congenital in nature. There is an involvement in the pathological process of all layers of the large intestine (muscle, mucous and submucosal).
2. False diverticular disease. Considered acquired. Only the mucous membrane changes structurally.

In almost all situations, colon diverticulosis occurs without any clinical manifestations, as a result of which a person may not know that he is sick until the end of his life.

In other cases, the pathology acts as a diagnostic surprise – it is detected during a preventive examination or during instrumental examinations for other disorders. Such a diagnosis is made by only 20% of patients from the total number of cases.

Regardless of the cause of the formation, diverticulosis has the following symptoms:

• recurrent aching abdominal pain;
• increase in the size of the anterior abdominal wall;
• flatulence;
• stool disorder – there is an alternation of constipation and diarrhea, less often – the predominance of one of the signs;
• heaviness and discomfort in the lower abdomen;
• decreased appetite or complete aversion to food;
• false desires or, conversely, painful bowel movements;
• feeling of fullness in the intestines;
• the appearance of pathological impurities in the feces – blood and mucus;
• fast saturation.

The formation of complications will not go unnoticed for a person, since the above symptoms will be supplemented with the following signs:

• increase in the intensity of the severity of pain
• fever;
• weakness and fatigue;
• decrease in working capacity;
• tension of the abdominal muscles;
• nausea and vomiting;

90,017 headaches and dizziness;

• weight loss;
• pallor of the skin;
• The appearance of a painful lump, which is localized in the left lower abdomen, is easily detected during self-palpation.

Similar clinical manifestations are typical for every patient, regardless of age and gender.

A gastroenterologist is engaged in the implementation of diagnostics and the development of a scheme for treating the disease. Pathology does not have specific symptoms, therefore, in order to make a correct diagnosis, the clinician must study the results of a wide range of laboratory and instrumental examinations and draw a conclusion regarding the cause of the disease.

First of all, a specialist must independently carry out several diagnostic procedures:

• read the medical history – to search for the underlying disease;
• to collect and analyze a life history – information about the patient’s eating habits;
• deep probing and tapping of the entire surface of the anterior wall of the peritoneum;
• assessment of the general health and condition of the skin;
• measure temperature readings;
• to interrogate the person in detail.

Laboratory tests are also required, including:

• general analysis of urine and blood;
• blood biochemistry;
• coprogram;
• fecal occult blood test;
• bacterial culture of stool.

The following instrumental procedures will help to accurately diagnose the doctor:

• Ultrasound of the abdominal cavity;
• radiography using a contrast agent;
• colonoscopy;
• sigmoidoscopy;
• manometry;
• CT and MRI;
• endoscopic biopsy.

X-ray examination of the colon

Multiple diverticula of the large intestine must necessarily be differentiated from the following pathologies:

After confirming the diagnosis, clinicians make attempts to conservatively eliminate the pathology, which can be achieved by taking the following drugs:

• broad-spectrum antibiotics;
• antispasmodics and pain relievers;
• prokinetics and enzymes;

90,017 prebiotics and probiotics;

• antidiarrheal and other medicines that help relieve clinical signs;
• fortifying agents;
• vitamin and mineral complexes.

During treatment, it is extremely important to observe a sparing diet for colon diverticulosis. Diet therapy has the following rules:

• Complete rejection of the consumption of muffins and confectionery products, semi-finished products and offal, fried and spicy dishes, fatty meats and fish;
• minimizing the consumption of dairy products, sweets, strong tea and coffee, sweet carbonated drinks;
• frequent and fractional food intake;
• enrichment of the diet with fiber, which is found in vegetables, fruits and cereals;
• thorough chewing;
• food preparation by cooking, steaming, stewing and baking;
• control over the temperature regime of dishes.

Only a specialist – a gastroenterologist or a nutritionist can provide a complete list of prohibited and permitted ingredients and draw up an approximate menu.

Conservative therapy includes:

• therapeutic massage of the abdomen;
• exercise therapy – exercises are selected individually;
• unconventional methods – after the approval of the attending physician, you can use folk remedies.

Treatment of colon diverticulosis with surgery is performed only if conservative methods are ineffective or in case of complications.An operation is shown, implying complete or partial excision of the affected segment.

• Asymptomatic course, refusal of qualified assistance or an attempt to independently get rid of diverticulosis often provoke consequences.
• Major complications:
• To prevent the development of diverticulosis, it is enough to follow a few simple rules of prevention:

• life-long rejection of bad habits;
• healthy and balanced nutrition;
• weight control;
• timely detection and treatment of any disease that may lead to diverticulosis;
• regular preventive examinations in a medical institution.

A similar lesion of the large intestine has a favorable prognosis. The disease responds well to therapy and rarely leads to complications.

Intestinal diverticulosis (syn.

intestinal diverticula, diverticular disease) is considered a widespread pathology, against the background of which hernial neoplasms form in various parts of the large and small intestine.

Clinicians claim that every tenth person on Earth is diagnosed with such a diagnosis, but the final incidence rate is unknown due to the possible asymptomatic course of the anomaly.

… Diverticulosis of the sigmoid colon

Diverticulosis of the sigmoid colon (syn. Diverticular disease of the sigmoid colon, diverticular disease) is a disease characterized by the formation of hernia-like protrusions in the intestine. It is often diagnosed in people over 40 years of age. According to statistics, every 10 people on Earth suffer from pathology.

…

Diverticula of the esophagus is a pathological process characterized by deformation of the esophageal wall and protrusion of all its layers in the form of a sac towards the mediastinum.In the medical literature, esophageal diverticulum also has another name – esophageal diverticulum.

In gastroenterology, this localization of the saccular protrusion accounts for about forty percent of cases. Most often, pathology is diagnosed in males who have crossed the fifty-year milestone.

But it is also worth noting that usually such persons have one or more predisposing factors – stomach ulcer, cholecystitis and others.ICD 10 code – acquired type K22.5, esophageal diverticulum – Q39.6.

…

Achalasia of the cardia is a chronic disorder of the esophagus, which is characterized by a violation of the swallowing process. At this moment, relaxation of the lower sphincter is observed.

As a result of such a violation, food particles accumulate directly in the esophagus, which is why there is an expansion of the upper parts of this organ. This disorder is quite common.Almost equally affects both sexes.

In addition, cases of detection of the disease in children have been recorded. In the international classification of diseases – ICD 10, this pathology has its own code – K 22.0.

…

Distal esophagitis is a pathological condition characterized by the progression of the inflammatory process in the lower part of the esophageal tube (located closer to the stomach).

Such a disease can occur in both acute and chronic forms, and is often not the main, but a concomitant pathological condition.Acute or chronic distal esophagitis can develop in any person – neither age category nor gender plays a role.

Medical statistics are such that more often the pathology progresses in people of working age, as well as in the elderly.

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Intestinal diverticulosis – causes, symptoms, treatment and diet – Stomach pain

• Intestinal diverticulosis is a pathological condition of the intestinal wall, which is characterized by a protrusion in the form of a hernial sac (diverticulum) with impaired organ function.
• Such an ailment can be localized in any part of the gastrointestinal tract, most often diverticula are localized in the large and small intestine, less often they can affect the stomach and esophagus.
• There is a certain pattern for the formation of the disease: if the patient does not comply with the correct diet, work and rest, physical activity, then the risk of developing pathology increases.
• This is due to the fact that the normal motility of the gastrointestinal tract is disrupted, peristalsis becomes abnormal, the digestion process is disrupted.
• The patient feels bloating, increased gas production, frequent constipation – these phenomena lead to an increase in intra-abdominal pressure and stretching of the bowel loops.
• If the effects are of a long-term nature, this disease occurs.
• By its nature, the disease can be congenital or acquired:
• Formed against the background of underdevelopment of the muscular apparatus of the intestine itself, these are genetic diseases or anomalies of intrauterine development, congenital defects.
• Formed in older people in the course of exposure to the gastrointestinal tract of pathological factors.

Why diverticulosis is dangerous

The main danger is that it may not manifest itself for a long time, during this time, serious complications develop that are dangerous to the life and health of the patient.

The intestine is severely damaged and irritated, against the background of this complications are formed:

• Peritonitis is a diffuse inflammation of the peritoneum.

The inflammatory process goes beyond local manifestations and spreads to all layers of the abdomen. A serious complication requiring urgent medical care and hospitalization is treated only promptly.

• Inflammation of the intestinal diverticulum.

1. A stretched section of the intestine in the form of a diverticular sac can become inflamed, this happens when an infection joins the affected area, since many bacteria, beneficial and opportunistic, live in the intestine.
2. Normally, they do not cause inflammatory reactions, but serve as helpers for the normal process of digestion.
3. With diverticulosis, local immunity weakens, conditionally pathogenic flora becomes aggressive, and an inflammatory infiltrate is formed.
4. Accompanying inflammation of the diverticulum with severe abdominal pain, impaired bowel movement, an admixture of pus in the feces, an increase in body temperature.
5. To prevent peritonitis, urgent hospitalization is required, surgical treatment with antibiotic therapy.

• An abscess is a suppuration of a diverticulum.

Formed during a long course of the disease, manifested by pulsating acute abdominal pain, nausea, vomiting, diarrhea.

Body temperature jumps to high numbers, requires urgent care and surgical treatment.

• Phlegmon of the retroperitoneal space.

It develops against the background of an untreated abscess – this is a diffuse purulent process, characterized by febrile fever, unbearable abdominal pain, vomiting, severe intoxication.

The patient may fall into a state of shock, lose consciousness, and require surgical intervention. After the operation, he is observed in the intensive care unit.

• A serious complication, a person may die from it, accompanied by an admixture of blood in the feces, a drop in blood pressure, an increase in pulse, loss of consciousness, pallor of the skin with cold sweat, pain and gopovolemic shock.
• A person in this state needs resuscitation measures.
• It is expressed by impaired stool, constipation, bloating, pain, loss of consciousness, severe intoxication, urgent surgical intervention is required.
• To avoid such negative manifestations, it is necessary to diagnose and treat the disease in the early stages.
• Modern medicine has reached such a level that, with preventive examinations, it is able to reveal an ailment at the stage of formation, such an approach will facilitate treatment and prognosis.

Causes of the disease

Doctors do not identify the exact and only cause of the disease, it is believed that the disease is caused by several factors in combination.If a patient has 3 or more reasons, then the risk of developing pathology increases significantly.

Eating harmful products: excessive amounts of fried, spicy, sour, salty, smoked fast food, sausages.

• Abuse of bad habits: alcoholism, smoking, use of prohibited chemicals.
• Low content of fiber in the diet, an excess of meat, bakery products.
• Dyspeptic disorders in the form of alternating constipation and diarrhea.
• Persistent constipation.
• Overweight, obesity, dyslipidemic syndrome.
• Excessive gassing.
• Physical inactivity or sedentary lifestyle.
• Sedentary work.
• Age is over 60 years old.
• Generalized atherosclerosis of arteries, including intestinal.
• Infectious and inflammatory bowel disease.

Can colonoscopy be done for diverticulosis

To correctly identify the disease, you must seek medical help from a specialist.The doctor will take an anamnesis, examine in detail all the patient’s complaints and proceed with the appointment of tests.

The following clinical and laboratory tests are recommended:

• Complete blood count – it will show inflammatory markers.
• General analysis of feces – will reflect the digestive function of the intestines.
• Ultrasound examination of the abdominal organs – will detect pathological protrusions.
• Contrast-enhanced OBP X-ray – will help assess the presence or absence of diverticula and the integrity of the intestinal loops.
• Colonoscopy

In order to examine the internal environment of the intestine and make an accurate diagnosis, a thin tube with a camera at the end is inserted into the anus and the intestines are examined from the inside.

Only a doctor can do this manipulation and is extremely careful not to damage the intestines.

• Computed tomography and magnetic resonance imaging are prescribed in unclear cases.

Symptoms, signs and treatment of illness in adults

In the early stages of development, diverticulosis may not show signs and symptoms for a long time, therefore it is classified as a dangerous intestinal pathology.

The disease can show itself at later stages or with complications, which significantly complicates and increases the duration of treatment.

How to suspect a disease

1. Main features:
2. The patient may feel pain in the abdomen, which is localized more often in the lower abdomen, in the left iliac region.
3. The pain is aching or twitching in nature, has a prolonged course, intensifies an hour after eating.
4. Is an early sign of the disease, at first the stool liquefies, becomes mushy, has a yellowish tinge, then changes to prolonged constipation.
5. This tendency tends to be repeated; impurities of blood, mucus, pus may join – this is an unfavorable sign.

• Lack of appetite.
• Nausea.

Not a common symptom, but may accompany pathology.

• Spontaneous urge to vomit.

Occur in later stages and with complications.

• Feeling of heaviness in the intestines.

Develops against the background of weakening of the muscular layer of the intestine and stretching of sections of its wall.

• Increased gas formation, bloating, flatulence.
• False urge to defecate (tenesmus)

It seems to the person that he wants to go to the toilet, but no feces are excreted. Tenesmus forms when the lower colon is damaged.

• Feeling that the bowels have not been emptied completely after using the toilet.

If at least one of the signs of similar symptoms occurs, an urgent need to consult a doctor to find out the cause and prescribe the correct treatment.

It is important to remember that the disease can disguise itself as other pathologies of the gastrointestinal tract or proceed in latent forms.

It is important for people at risk to undergo preventive medical examinations.

How and how to treat the disease

• Therapy of the disease consists in a combination of various methods, in the early stages they are treated conservatively without surgery.
• The patient is at first in the hospital in the surgical or gastroenterological department, he is prescribed the correct diet, adherence to the daily regimen and drug therapy.
• If the process is started to later stages, the digestive function is actively suffering, complications join, then they resort to surgical routes, perform laparoscopic or open operations.

Antibiotics for diverticulosis

Antibacterial drugs are the main ones in the treatment of diverticula, they relieve the inflammatory process, inhibit the growth and development of pathogenic microflora.

Antibiotics are prescribed from the first days of detection of diseases, the course, dosage and duration are stipulated by the doctor.They prevent the development of complications such as abscess, phlegmon, peritonitis.

Antibiotics are also prescribed in the recovery period after surgery. Most often, penicillin groups or cephalosporins of different generations are used.

Before prescribing, you need to make sure that the patient does not have allergic reactions to the drug and side effects, when they appear, the drug is canceled. Antibiotics are administered intravenously, intramuscularly or in tablet form.

What drugs are most often prescribed:

• Amoxiclav – penicillin series, broad spectrum of action.
• Metronidazole – a wide spectrum, plus the effect on the simplest intracellular organisms.
• Ceftriaxone, cefotaxime are third generation cephalosporins.
• Cefipim is a fourth generation injectable cephalosporin.
• Gentamicin – aminoglycosides.
• Meropinem – carbapinems, a reserve antibiotic.
• Vancomycin – in the presence of ulcerative colitis.

Combinations of drug groups are often used.

Medicines for diverticulosis

In addition to antibiotic therapy, other groups of drugs are also used for treatment; they are prescribed together to eliminate symptoms and restore the functions of the gastrointestinal tract.

• Non-steroidal anti-inflammatory drugs.

They are prescribed to relieve active inflammation, eliminate pain: Ketorol, Nimesil.

• Antispasmodics for the normalization of peristalsis: Drotaverin, papaverine, No-shpa, Duspatalin.
• Antiemetic prokinetics: Cerucal, Metoclopramide.
• Enzyme preparations help to improve digestion: Pancreatin, Creon.
• Laxatives for relief of prolonged constipation: Duphalac, Forlax.
• To reduce gassing: Espumisan.

All drugs are prescribed strictly on an individual basis by the attending physician.

Nutrition and diet for constipated diverticulosis

Good nutrition and diet is an important part of diverticulosis therapy. The diet should be complete, balanced, rich in nutrients, and should be eaten on schedule so that intestinal motility is in order.

You need to eat in small portions 5 times a day, finish eating 4 hours before bedtime and do not wear tight clothes. After eating, do not engage in physical activity, observe the regime of work and rest.

Must be included in the diet:

Cook them without milk, as dairy products increase bloating and gas formation. The most useful are buckwheat, pearl barley, oatmeal porridge.

Take them daily, doctors recommend eating bran for breakfast to improve intestinal motility.

Cook them without meat broth.

It is rich in nutrients, fatty acids, macro-and microelements, it is better to dress them in salads with fresh vegetables.If the patient is worried about severe constipation, you can drink a dessert spoon of oil in the morning.

Boiled chicken is rich in proteins, which are important in the recovery period.

Boiled fish is good for digestion.

• Fresh fruits and vegetables are useful for vitamin composition.
• Foods containing fiber: oatmeal, bran, crispbread, avocado, dried fruit, nuts.
• Slightly carbonated mineral waters, compotes, kefir.

What you can’t eat

What should be completely abandoned in case of illness:

• From everything fried, fatty, salty, spicy, sour.
• Completely exclude fast food, noodles and instant potatoes.
• White bread and flour and pasta are prohibited.
• We refrain from coffee, strong tea, alcohol, soda, concentrated juices.
• We exclude rice, semolina, chocolate, sausages and smoked products.
• We do not eat kebabs, fatty fish, meat, fried potatoes, pastries, cakes, rolls.

1. Weekly menu:
2. It is worth starting the week with meat-free and low-fat products, vegetable puree soups, cereals without milk, fresh fruits are well suited.
3. From vegetables, give preference to greens, for a side dish you can boiled potatoes with a summer salad, yogurt or fruit for an afternoon snack, and a couple of hours before bedtime – kefir with biscuit biscuits.
4. You can add meat products, cottage cheese or oatmeal for breakfast, then 50 grams of nuts, noodle soup or potato soup for lunch, buckwheat porridge with chicken meatballs.
5. Afternoon snack – tea with biscuit biscuits or croutons, dinner – boiled potatoes poured with olive oil with summer salad and chicken breast, 3 hours before bedtime – dried fruit compote or yogurt.

Start breakfast with buckwheat porridge, wash it down with tea, eat bran, for lunch, puree soup with chicken cutlet, afternoon snack and dinner – grated applesauce. Before going to bed – compote or kefir with croutons.

Breakfast – cottage cheese with raisins and nuts, lunch – vegetable soup with chicken broth, side dish of potatoes with boiled fish, afternoon snack – 50 grams of nuts, apple and yogurt, dinner – buckwheat porridge with chicken roll.

• Friday – completely dedicated to the fruit diet.

We eat bran, bananas, nuts, apples, oatmeal, cereals.

For breakfast, porridge or cottage cheese with nuts, lunch – cream soup with a side dish of potatoes and fish. Afternoon snack – bran with yogurt or kefir, dinner – buckwheat porridge with chicken fillet and green salad, before going to bed – kefir or compote.

Do not forget about drinking plenty of fluids, we drink at least 1.5 liters of liquid a day.

How to treat a disease with folk remedies

Herbal infusions and decoctions are best suited for the treatment of intestinal diverticulosis:

Dried chamomile flowers are used, ready-made collection can be bought at the pharmacy.Two tablespoons of dry matter pour 300 ml of boiling water, leave for 30 minutes, cool, drink 50 ml 3-4 times a day.

Required ingredients: dried dill, rose hips, nettle leaves. The collection is prepared in equal proportions, 1 teaspoon of each plant, poured with two glasses of boiled hot water, leave for 2 hours, strain, drink as required.

Relieves inflammation, eliminates bloating, increased gas formation. Pour a teaspoon of fresh mint with a glass of hot water, about 90 degrees, leave for 30 minutes, drink 2-3 times a day.

Intestinal diverticulosis: symptoms, treatment, prognosis

Update: December 2018

Obvious symptoms in the majority of patients with colon diverticulosis (diverticular disease) are absent or identical with manifestations of other bowel diseases. But it has been found that the incidence of diverticulosis increases with age.

It is below 10% among people under 40 and about 50-60% over 80. On the European continent, diverticula are diagnosed in every 10th inhabitant before the age of 40, after 60 years – in every third, and from 75 years – every second inhabitant has .

Symptoms of intestinal diverticulosis are associated with the localization of the diverticulum. Among the population of Western countries, most often, in 90% of registered cases, they are found in the distal colon, of which 50-60% are in the sigmoid colon and only 10% are in the right parts of the large intestine. The localization of the diverticulum in the rectum was not found.

Main mechanisms of symptomatology

The prevailing frequency of sigmoid diverticulum and the corresponding symptoms are associated with anatomical and physiological features.The sigmoid colon has a smaller diameter and more curves than the rest of the large intestine.

It performs the function of a reservoir in which the formation, compaction and accumulation of feces occurs. By regulating their advancement into the rectum, it is segmented much more often than other departments.

All these reasons lead to increased pressure and stretching of the walls of the sigmoid colon.

Age-related changes in the connective tissue and muscle fibers of the transverse colon also contribute to the emergence of diverticulums.As a result, muscle tension and resistance to the movement of feces, intraintestinal pressure and protrusion of the mucous membrane through defects in the muscle layer of the intestinal wall increase more and more.

At the same time, pathological changes occur in the submucous nerve plexuses with dysfunction of baroreceptors, thickening of the circular and longitudinal layers of the muscular membrane of the intestine, a decrease in the extensibility and tone of its walls, the convergence of circular folds, as a result of which the intestine takes the form of an accordion.This in turn leads mainly to:

• compression of the vessels located in the intestinal wall;
• deterioration of blood microcirculation and the development of ischemia;
• atrophy of the muscle layer;
• bowel motility disorders;
• the formation of weak areas on which diverticula are formed.

Clinical manifestations of diverticulosis of the large intestine, sigmoid colon

All of the above changes cause intestinal dysfunction in general with the gradual development of symptoms of colon diverticulosis and its complications:

• Diverticulitis (inflammation of the diverticulum)
• Bleeding
• Perforation (perforation)
• Infiltration formation
• Internal or external fistulas (rare)
• Acute or chronic intestinal obstruction

The disease is mainly progressive in nature with clinical manifestations, the severity of which depends on the duration of the disease, complications of diverticular disease, localization of diverticulums, the presence of concomitant diseases, the patient’s age and compliance with recommendations regarding proper nutrition.

The most common clinical form is uncomplicated diverticulosis of the large intestine. It occurs in almost 80% of patients with this disease.

For many years it was believed that such forms of the disease proceed completely in the absence of symptoms.

But studies of recent years have shown that in 85% of patients, even single diverticula of the large intestine, not to mention diverticulosis, are accompanied by clinical manifestations of varying degrees of severity.

However, the symptoms are non-specific.Often, patients either do not seek medical help at all, or, if they do go to a doctor, they are diagnosed with dysbiosis, chronic colitis, large intestinal dyskinesia, etc.

The most frequent and main symptoms of uncomplicated colon diverticulosis:

• Intermittent recurrent pains of a spastic, paroxysmal or dull aching character in the left (most common), middle (below the navel) or lower abdomen. It is assumed that these pains occur as a result of increased pressure in the lumen of the intestine and impaired motility.
• The pain may go away on its own after a few hours, but it may get worse, especially after eating.
• The appearance of pain similar to an attack of appendicitis (in the lower right abdomen) is possible, even if the diverticula are not localized in the ascending regions (right), but in the sigmoid colon (left).
• Sometimes there is irradiation (spread) of pain: in the anus, lower back, sacrum, as well as in the groin or gluteal zone.
• Relief or complete disappearance of pain after passing gas or an act of defecation.

In addition to the main manifestations of large intestinal diverticulosis, there may be general symptoms characteristic of its dysfunction:

• constipation that is persistent;
• constipation followed by diarrhea;
• discharge of copious amounts of mucus;
• bloating and significant discharge of offensive gas;
• False urges (tenesmus) or repeated acts of defecation;
• A feeling of incomplete emptying after the act of defecation (often accompanied by the presence of diverticulums in the sigmoid colon).

On examination, the doctor notes bloating, pain on palpation (palpation) along the entire large intestine. These phenomena are most pronounced in the left sections, however, there is no protective reaction (tension) of the abdominal wall. The spasmodic part of the large intestine is also palpated, in which the diverticula are localized.

Some distinguishing features of diverticulosis of various parts of the transverse colon:

When complications such as diverticulitis, bleeding, perforation, etc. are added, the corresponding symptomatology occurs:

• with changes in clinical analyzes of blood, urine
• temperature onset
• blood in feces
• changes in the nature of the pain syndrome, etc.d.

Diagnostics using basic instrumental methods, such as irrigography (X-ray examination after filling the intestine with a contrast agent), endoscopy, colonoscopy, computed tomography, allows you to more accurately establish the presence, localization and condition of diverticula.

Treatment of uncomplicated diverticulosis

The main thing in the treatment of intestinal diverticulosis (uncomplicated form) is eating foods rich in dietary fiber.

According to the latest data, their use by asymptomatic patients helps to prevent its progression and complications.

There is a conflicting opinion of some researchers that the inclusion of these products in the diet even leads to regression of diverticula.

Dietary fiber, or dietary fiber, is a varied composition and structure of plant fibrous substances that are not digested or absorbed in the intestines.With a caloric intake of 2500 kcal, the daily physiological need for them is 30 g.

Most of the types of plant fiber contain indigestible polysaccharides, pectin, cellulose and hemicellulose, lignin, alginates.

Their main property is the binding of water in the intestinal lumen, which increases the volume of the chyme, reduces the pressure inside the intestine and promotes faster transport through the intestines and the removal of feces and toxins from the body.

In addition, insoluble dietary fiber, covering about 6 – 9% of the body’s energy requirements, create a large additional surface in the colon, on which a large number of beneficial intestinal bacteria are located and fixed. Fibers are a nutrient medium for “friendly” bacteria, on which they quickly grow and multiply, which leads to the suppression of pathogenic flora.

Table of characteristics of the positive effect of dietary fiber on the human body:

It is becoming clear why dietary foods containing bran are effective nutrition for intestinal diverticulosis.Coarse wheat bran has the greatest ability to reduce intra-intestinal pressure and increase the volume of chyme.

They must be introduced into the diet gradually over 2 weeks to 1 month. The daily rate starts from 5-10 g to 20-30 g. For this purpose, the daily dose (2-4 tablespoons) of bran is poured with 1 glass of boiling water and kept for 30-40 minutes, after which the water must be drained.

Boiled bran can be added to vegetable dishes, fermented milk products, cereals, soups.

During the first month of such a diet, intestinal diverticulosis, which contains a large amount of plant dietary fiber, may develop or worsen abdominal pain. Therefore, it is recommended to take antispasmodic drugs, for example, no-shpy or mebeverin 20-30 minutes before meals in the morning and evening, 400 mg, meteospasmil, bukopan and others.

An effective source of dietary fiber is considered to be the preparations Mukofalk, Fiberlex, Ispagol, Solgar Psyllium, consisting of the shells of seeds of the oval plantain growing in the arid regions of the Mediterranean, Pakistan and India.In the shell of plantain seeds of this particular species, mucous components are contained in a high concentration, due to which the drug belongs to soft dietary fibers.

Mucofalk, unlike bran, has almost no side effects in the form of flatulence and spastic pain, but it has an anti-inflammatory effect and is significantly superior to wheat bran in terms of reducing intraintestinal pressure, effectively promotes the reproduction of lacto – and bifidobacteria.

Dietary fibers, which are part of “Mucofalk”, have the following physical and chemical characteristics:

• Slow down the processes of evacuation of food mass from the stomach
• Increase the viscosity of food masses in the small intestine
• Enhance the formation of mucus on the cells of the mucous membrane of the large intestine
• They bind and retain a volume of water that exceeds the mass of the fibers themselves, thereby reducing the tension of the intestinal walls, moisturizing the feces and ensuring their accelerated passage through the intestines
• Colloidal toxic elements of external and internal origin are collected and kept on their surface in a colloidal state
• Provide additional area for beneficial microbial associations and, undergoing enzymatic decomposition by microorganisms, become an energy resource for the latter
• Do not interfere with intestinal absorption of microelements and vitamins

It is recommended to include in the diet of patients with intestinal diverticulosis:

• bran or wholemeal bread
• crumbly cereals from wheat and buckwheat with vegetable oil
• vegetable casseroles
• vegetable soups with meat broth
• fermented milk products
• baked vegetables (if well tolerated)

It is desirable to exclude astringent and peristalsis-inhibiting foods from the diet.These include:

• finely ground fine flour bread
• pasta
• semolina and rice porridge
• jelly, coffee and strong brewed tea
• red wine, cocoa and chocolate

Dietary fiber is the main treatment and prevention of colon diverticulosis. In the absence of complicated forms of the disease, their constant use is recommended, with the exception of the summer and autumn seasons, due to the inclusion in the diet of a sufficient amount of fresh vegetables, fruits and herbs.

Drug treatment

In case of intestinal diverticulosis, treatment tactics are determined by the general state of health of the patient, the severity of the disease, and the presence of complications.

For asymptomatic diverticulosis

when the disease was diagnosed by chance (accidental finding), the patient was advised only to follow a diet, with an increase in the daily diet of fruits, vegetables, beans, cereals, the use of at least 2 liters of fluid per day (if there are no contraindications).According to the indications, it is possible to use probiotics (see the list of Linex analogues), enzyme preparations, medicines that reduce flatulence (causes).

In the presence of an uncomplicated inflammatory process

With the development of an inflammatory process, symptoms of intestinal diverticulosis, but without serious complications, outpatient treatment is possible. In addition to the diet described above with a maximum amount of fiber and a drinking regime, the following are prescribed:

• broad-spectrum antibiotics, preparations of 5-aminosalicylic acid, butyric acid
• enzymes to improve digestion
• stimulants of gastrointestinal motility, such as Domperidone (Motilium, Pasazhiks, Motilak), Metoclopromide, etc.
• antispasmodics – Noshpa, Drotaverin, Spazmol, Spazmonet
• laxatives – prebiotics (based on Lactulose – Normase, Romfalak, Portalak syrup, Duphalac, Lactulose Poly, Goodluck, Lactulose Stada, Livolyuk-PB).

If there is no improvement within 3 days of therapy, then the patient is shown hospitalization, with correction of treatment and determination of further tactics of therapy. Additional diagnostics are performed, infusion therapy is prescribed – glucose solution, saline solutions, the issue of surgical treatment is being resolved.

If the patient has had 2 attacks of diverticulosis, according to the latest clinical studies, it is advisable to carry out elective surgery.

Since repeated attacks are poorly amenable to drug treatment and, as a rule, result in intestinal perforation followed by peritonitis.

Moreover, surgical treatment is recommended for patients over 40 years of age even after 1 episode of diverticulitis.

Surgical treatment consists in removing (resecting) the part of the intestine that is affected by diverticula.The indications for surgery are the following complications:

• heavy bleeding
• progressive intestinal obstruction
• perforation of a diverticulum with the development of peritonitis or retroperitoneal phlegmon
• opening of an abscess when external or internal intestinal fistulas develop

In each specific clinical case, the volume of the operation is determined individually, sometimes during emergency surgery, the intestine is removed in an unnatural way onto the abdominal wall.

Timely treatment of the patient to a gastroenterologist and coloproctologist, adequate therapy and planned surgical treatment (especially after an attack) improve the prognosis.

In 80% of cases, diverticulosis proceeds without complications, with complications the risk of recurrence in the future is 25%.

Valentina Selezneva, therapist

Colon diverticulosis: symptoms, causes, treatment and diet

Many people, when faced with the concept of “intestinal diverticulosis”, do not even know about the meaning of this disease.Diverticular disease is a pathological process accompanied by the formation of diverticulums on the surface of the intestine – hernia-like protrusions no more than 2 cm in size.

Colon diverticulosis occurs due to the weakening of connective tissue at any age. Most often, the disease is diagnosed in the elderly. The pronounced symptomatology of the disease is mainly not observed or is similar to the manifestations of other pathological conditions. Symptoms and treatment of intestinal diverticulosis in adults depends on the location and stage of development of the diverticulum.

Main mechanisms of symptomatology

The prevailing frequency of sigmoid diverticulum and the corresponding symptoms are associated with anatomical and physiological features. The sigmoid colon has a smaller diameter and more curves than the rest of the large intestine.

It performs the function of a reservoir in which the formation, compaction and accumulation of feces occurs. By regulating their advancement into the rectum, it is segmented much more often than other departments.

All these reasons lead to increased pressure and stretching of the walls of the sigmoid colon.

Age-related changes in the connective tissue and muscle fibers of the transverse colon also contribute to the emergence of diverticulums. As a result, muscle tension and resistance to the movement of feces, intraintestinal pressure and protrusion of the mucous membrane through defects in the muscle layer of the intestinal wall increase more and more.

At the same time, pathological changes occur in the submucous nerve plexuses with dysfunction of baroreceptors, thickening of the circular and longitudinal layers of the muscular membrane of the intestine, a decrease in the extensibility and tone of its walls, the convergence of circular folds, as a result of which the intestine takes the form of an accordion.This in turn leads mainly to:

• compression of the vessels located in the intestinal wall;
• deterioration of blood microcirculation and the development of ischemia;
• atrophy of the muscle layer;
• bowel motility disorders;
• the formation of weak areas on which diverticula are formed.

Expert commentary

It is believed that diverticulosis is a consequence of malnutrition. Due to a lack of fiber, prolonged constipation occurs, leading to stretching of the walls of the intestinal tract.Any chronic inflammatory process leads to morphological changes in the muscle frame.