Conditions | Gastroenterology

Colorectal Conditions

Colorectal diseases refer to conditions impacting the colon or rectum, including colorectal cancer, colon polyps, colitis, and Crohn’s disease. These conditions can range from mild irritations to serious illnesses.

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Crohns Disease

Crohn’s disease is an autoimmune disease of the digestive tract. Your body’s immune system should protect your body from sicknesses. But in Crohn’s disease, your immune system attacks the digestive tract by mistake.

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Diverticulitis

Diverticulosis [dahy-ver-tik-yuh-LOH-sis] is a condition that impacts about half of people over age 60. It causes small pouches (diverticula) to bulge out through weak spots on the digestive tract — most often on the colon (large intestine). They can also form on the esophagus, stomach, and small intestine.

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Esophagitis

Eosinophilic [ee-uh-sin-uh-FIL-ik] esophagitis [ih-SOF-uh-JAHY-tis], or EE, is an allergic reaction that causes inflammation (swelling) in the esophagus. The esophagus is the tube going from your mouth to your stomach. The inflammation can make the esophagus become more narrow and stiff. This can make swallowing difficult and cause food to get caught in your esophagus.

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Gluten Intolerance

Gluten intolerance is a disorder similar to celiac disease that makes it difficult to eat gluten, a protein found in rye, wheat, and barley. The treatment for gluten intolerance is a gluten-free diet, which can make your symptoms better.

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Hepatitis

Hepatitis is a disease that irritates the liver and causes it to swell.

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Hernias

A hiatal hernia is a condition in which the top of the stomach bulges through an opening in the diaphragm called the hiatus. The diaphragm is the large muscle that helps you breathe. The diaphragm separates the stomach from the chest. A hiatal hernia moves up into the chest and can cause pain and other symptoms.

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Irritable Bowel Syndrome

Normally, a healthy colon keeps its contents moving through it with a regular rhythm. With IBS, the rhythm of your colon speeds up, causing diarrhea, or slows down, causing constipation.

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Liver Disease

The liver is the largest organ in your body. It performs many important functions, but can be damaged by many different conditions, such as hepatitis, hemochromatosis, and fatty liver disease.

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Pancreatitis

Pancreatitis is a condition in which the pancreas is irritated or inflamed (swollen).

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Peritonitis

Peritonitis [PEH-ree-TUHN-eye-TIS] is an inflamed peritoneum, the part of your body that surrounds your organs. It is usually caused by an infection. Peritonitis is treated with antibiotics and often needs surgery to help heal the injury that let the infection in.

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Rectal Prolapse

Rectal prolapse is when the lowest part of the large intestine, called the rectum [REK-tum] slips out of the anus. It can make it difficult to hold in your bowel movements.

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A hypothesis: is diverticulitis a type of inflammatory bowel disease?

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. 2006 Aug;40 Suppl 3:S121-5.

doi: 10.1097/01.mcg.0000225502.29498.ba.

Martin H Floch 
¹

Affiliations

Affiliation

• ¹ Section of Digestive Disease, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.

• PMID:

  16885694

• DOI:

  10.1097/01.mcg.0000225502.29498.ba

Martin H Floch.

J Clin Gastroenterol.

2006 Aug.

. 2006 Aug;40 Suppl 3:S121-5.

doi: 10.1097/01.mcg.0000225502. 29498.ba.

Author

Martin H Floch 
¹

Affiliation

• ¹ Section of Digestive Disease, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.

• PMID:

  16885694

• DOI:

  10.1097/01.mcg.0000225502.29498.ba

Abstract

It is accepted by epidemiologists that diverticula formation in the colon is related to a deficiency in dietary fiber intake, but the cause of acute diverticulitis remains unknown. A hypothesis is presented that acknowledges from the literature that fiber deficiency is also related to an altered intestinal microecology with a change in the bacterial flora. It is hypothesized that the change in the flora with a decrease in their influence on the immune process permits a low-grade chronic inflammation in the mucosa, which is the first step in developing an acute infection of diverticula or diverticulitis. There is some evidence that the low-grade chronic inflammation is present in subjects with diverticula, which is the forerunner of acute diverticulitis. This hypothesis is strengthened by early reports that anti-inflammatory mucosal agents such as mesalamine and immune process regulators such as probiotics may improve diverticulitis.

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Diverticular disease – treatment in St.

Petersburg. Diverticular disease of the colon

Diverticular disease is a chronic disease that occurs due to the formation of a sac-like protrusion (diverticulum) in the intestinal wall, and, as a result, a congestive process and the development of inflammation.

Sometimes there is a single diverticulum, but, as a rule, most often people have multiple protrusions in one of the sections of the intestine.

Diverticula are divided into “true” and “false”, as well as “congenital” and “acquired”.

• True diverticula are most often congenital – due to a direct violation of the structure of the intestine. One of the features of a true diverticulum is that the walls of the diverticulum have all the layers characteristic of the intestine. True diverticula, for example, include Meckel’s diverticulum: a protrusion of the wall of the small intestine at the confluence of an unclosed embryonic vitelline duct into it as an anomaly of development.
• False diverticula are acquired and represent a bulging of the intestinal mucosa outward through thinned places in its muscular layer.

As a rule, acquired diverticula are multiple and rarely occur in a single number.
Diverticulosis is a change in the intestinal wall with the presence of multiple diverticula in it without inflammatory processes occurring in them and not manifesting themselves clinically.
If an inflammatory process develops in the diverticulum, they speak of diverticulitis and, as a result, the development of diverticular disease.

Incidence of diverticular disease

Of all the diseases of the colon, intestinal damage by diverticula is one of the most common in the modern world. The frequency of diverticular disease reaches an average of 20% in European countries; moreover, in older age groups of the population (60–80 years), the frequency increases, reaching 40–50%, and among patients over the age of 80, the incidence reaches 60–65%. In our country, diverticula of the large intestine are found in approximately 17-28% of gastroenterological patients. The frequency of the disease in men and women is approximately the same.

Classification of diverticular disease

• Uncomplicated. This form is detected incidentally during X-ray or endoscopic examination of the intestine. In blood tests, as a rule, no changes are found. An examination must be carried out to assess the prevalence of intestinal damage, predict the course of the disease and choose a method for preventing complications or treatment.
• Complicated with acute inflammatory process (diverticulitis, diverticular infiltrate, diverticulum perforation, abscess, peritonitis), chronic inflammatory process, and bleeding. The chronic process includes situations when the inflammation cannot be eliminated within 6 weeks, or it occurs again. In severe cases, an infiltrate, narrowing of the intestine, or a fistula from a destroyed diverticulum may form.

Causes of diverticula

The occurrence of this disease does not have any specific cause. It is due to a combination of many factors. There is an opinion about the predisposition of some people to this disease due to congenital underdevelopment of the muscular layer of the intestinal wall. As a result, they develop diverticula with age or under the influence of any factors.

Congenital predisposition plays a role in people with hereditary connective tissue dysplasia syndromes (Marfan, Ehlers-Danlos syndromes, when there is a deficiency of collagen in the human body), a combination of diverticular disease of the large intestine with diseases associated with a decrease in elasticity and strength of the connective tissue (hernias) is also common. , varicose disease, visceroptosis, polycystic).
However, congenital inferiority of tissues is not the only reason for the occurrence of pathological changes in the intestinal wall.

The high incidence of diverticular disease in the elderly is associated with a gradual decrease in the tone of the colon wall as the body ages. Diverticular disease is a chronic disease that occurs due to the formation of a sac-like protrusion (diverticulum) in the intestinal wall, and, as a result of a congestive process, the development of inflammation in them. The muscular layer of the colon becomes thicker and less elastic. The supporting connective tissue loses its elasticity, and the intestinal wall becomes less extensible. Therefore, diverticula in people of the older age group appear more often than in young people.

It is also known that diverticula occur significantly more often with a decrease in plant fibers and fiber in the diet. Therefore, in vegetarians, diverticular disease is 3 times less common than in people who limit the intake of vegetables and fruits. Foods low in fiber poorly stimulate intestinal motility, slow down the movement of contents through the large intestine, which increases the absorption of water and, as a result, constipation develops. The retention of feces in the intestines, combined with a violation of the normal intestinal microflora, leads to inflammation and the progression of diverticular disease. This can also explain the more frequent occurrence of diverticula in the sigmoid colon (constipation in this case plays the role of a resolving factor).

The clinical picture in about two out of three cases is not accompanied by any complaints (asymptomatic diverticulosis), the pathology is detected by chance during endoscopic or X-ray studies. Most often, the first signs of diverticular disease are pain and functional disorders in the form of constipation or diarrhea. There are complaints of regularly recurring pain in the abdomen, more often in the left iliac region or lower sections, disappearing after defecation. Pains of varying intensity can exist for a long time – from several weeks to months. Increased pain is sometimes accompanied by fever, signs of intoxication may appear (dry mouth, nausea, tachycardia). Also, bloating and profuse gas separation, various dyspeptic disorders are often noted, which is sometimes hidden under the guise of irritable bowel syndrome.

Complications of diverticular disease of the colon

• Diverticulitis. This is an acute inflammation that occurs in diverticula in a quarter of patients with diverticulosis. Signs of the development of inflammation can be the appearance of pain and tension in the muscles of the anterior abdominal wall, fever, chills, bloating, stool disorders in the form of diarrhea or constipation.

• Diverticulum perforation. Against the background of the inflammatory process in the diverticulum, part of its wall may collapse, and the intestinal contents enter the abdominal cavity. At the same time, local or diffuse peritonitis develops. With perforation (rupture of the wall) of the diverticulum into the retroperitoneal tissue or the space between the sheets of the mesentery, infiltrates or abscesses appear.

• Bleeding. Occurs in approximately 25% of patients with diverticular disease. For many people, it may be the first and only manifestation of the disease. Usually bleeding is associated with ulceration of the wall of the diverticulum as a result of chronic inflammation. Also, in place of a fecal stone, a pressure sore may form with damage to the blood vessel. The intensity of bleeding can be different: from a slight admixture of blood in the feces (sometimes there is hidden bleeding, which is manifested by a gradual increase in anemia), to massive profuse bleeding, accompanied by collapse and even leading to death.

• Intestinal obstruction. The cause of intestinal obstruction may be an inflammatory process around the diverticulum or adhesions, leading to deformation of the intestine and disruption of the movement of stool along it. In rare cases, invagination (screwing) of a part of the intestine with a diverticulum or spasm of smooth muscles may occur.

• Intestinal fistulas. May occur when a diverticulum is perforated and an abscess ruptures into a nearby organ (the so-called “internal fistulas”). Men are more likely to develop fistulas with the bladder, women – with the vagina. With the formation of an entero-vesical fistula, air or an admixture of feces may appear in the urine.

Diagnosis of diverticular disease

• Irrigoscopy is an x-ray examination in which the colon lumen is filled with a contrast suspension and its condition is assessed during filling and after bowel emptying.
• Colonoscopy can detect the presence of multiple diverticula, signs of inflammation or intestinal bleeding, and may also be helpful in detecting associated lesions such as polyps and cancer.
• MSCT (multispiral computed tomography). Appropriate for the differential diagnosis of diverticulitis and tumor lesions of the colon.

Treatment

The main goal of treating diverticular disease is to normalize bowel function, prevent disease progression and complications, and relieve exacerbations.

Diet

Since diverticular disease is much more common in people who restrict their dietary intake of vegetables and fruits, all patients with diverticulosis should use foods high in vegetable fiber and pectin. Wheat bran is very useful (especially coarse bran), which significantly reduces the pressure inside the intestine and accelerates the speed of movement of the contents through the intestine.

Be sure to exclude all foods that cause increased gas formation (legumes, lentils, grapes, sauerkraut, butter and yeast dough, onions) and constipation (blueberries, rice). It is also advisable to exclude seeds, fruits with a large number of grains and excessively coarse fiber (persimmon, pineapple, turnip, radish, radish).

Drug treatment

• In an uncomplicated course, the disease does not require the use of drugs. The need to take medication arises depending on the clinical manifestations.
• Antispasmodics are used for abdominal pain.
• When dysbacteriosis is detected, drugs that help restore normal intestinal microflora.
• With persistent constipation, drugs are taken to enhance the motility of the stomach and intestines: lactulose preparations, vaseline or olive oil orally or in microclysters.
• In case of diverticulosis with clinical manifestations of inflammation, it is necessary to use the whole range of therapeutic measures: laxative diet, antispasmodics; drugs that regulate the motor function of the intestine, and drugs that normalize the composition of the bacterial flora of the intestine.

Surgical treatment

The need for surgical treatment for diverticular disease can arise both urgently and in a planned manner. This happens when complications occur that can threaten a person’s life (bleeding, perforation, peritonitis).
Planned surgical treatment is always aimed at eliminating the threat of such complications. The choice of the operation method in each specific case depends on the prevalence of the process, inflammatory changes in the diverticula, the condition of the intestinal wall and surrounding tissues, the presence of inflammation outside the intestinal lumen or peritonitis. It is important to take into account comorbidities often observed in the elderly. As a rule, resection (removal) of the affected part of the large intestine is performed in a planned manner with simultaneous imposition of an anastomosis.
Surgical treatment in our Clinic is performed laparoscopically, which allows patients to quickly return to active life. A planned operation is always performed during the period of remission, 2-3 months after the removal of an acute attack of the disease. Colon fistulas are an indication for planned surgical treatment, since it is not possible to achieve their self-healing, and chronic inflammation leads both to the development of rough scars that disrupt the passage of intestinal contents, and to the development of chronic intoxication and a decrease in immunity. With the formation of intestinal-vesical fistulas, there is a threat of developing an ascending urinary tract infection and kidney damage.

• Surgical removal of fistulas is a complex surgical intervention requiring the participation of highly qualified specialists. In our clinic, when planning such interventions, if necessary, related specialists (urologists, gynecologists, endoscopists) are involved. In case of intestinal bleeding, conservative treatment (hemostatic therapy) is most often prescribed or endoscopic hemostasis is performed. The operation is performed only when conservative methods of treatment are ineffective.
• Surgical treatment of diverticulum perforation. If the operation is urgent, a colostomy may be used to reduce the risk of postoperative complications. Reconstructive surgery with closure of the colostomy and restoration of intestinal continuity is performed after the inflammatory process subsides (after about 3 months).

Dispensary observation

Patients with diverticular disease should be regularly observed by a gastroenterologist or coloproctologist. Colonoscopy in the absence of complaints is performed at intervals of 1 time in 3 years.
If pain and other manifestations of the disease occur, the examination should be completed as soon as possible. With frequent periodic recurrences of diverticulitis, regular anti-relapse courses of treatment are indicated.

Forecast

The prognosis, as a rule, is favorable, if the disease is detected in a timely manner, the necessary preventive and therapeutic measures are started, provided that the patient complies with all the necessary recommendations.
However, if the need for prevention is ignored, diverticular disease can lead to the development of severe complications that threaten the life and health of the patient. Moreover, the disease is more common among older people who have a variety of concomitant diseases and lower body resistance.

Prevention

Among preventive measures, a varied and balanced diet is of primary importance. Due to the fact that a diet low in plant fibers predisposes to the formation of diverticula, in order to reduce the risk of developing the disease, it is necessary to include plant-based products in large quantities.
Since the timely detection of diverticula plays an important role, it is extremely important to undergo a preventive examination and regularly perform an endoscopic examination of the intestine.

symptoms, diagnosis, treatment of diverticulitis – Department of the State Hospital NCC No. 2 (CCH RAS)

Diverticula are areas of the intestine in which protrusion of tissues is observed. When inflammation of these areas occurs, intestinal diverticulitis begins. Inflammation is provoked by fecal masses that enter the diverticula and accumulate in them, irritating the walls and leading to the development of infection. Long-term malnutrition is considered the main cause of the onset of the disease. Adult patients usually suffer from diverticulitis – it develops in women and men over 60 years of age.

Causes of disease

The main factor that provokes the disease is malnutrition. This refers to the use of a large number of semi-finished products, low-quality food rich in fat and refined foods. Also, malnutrition includes reduced fiber intake. It is fiber in food that helps the proper movement of the masses through the intestines.

Localization of diverticulitis

The disease can affect different parts of the intestine:

• Diverticulitis of the small intestine – multiple protrusions of the mucosa through weak spots in the walls. In this zone, diverticula appear much less frequently than in the colon. The cause is believed to be a failure of peristalsis.
• Diverticulitis of the large intestine – masses up to two centimeters, often affecting elderly patients. The reason is malnutrition, the predominance of animal food over plant food.
• Sigmoid diverticulitis – a degenerative tissue disorder that appears as a result of a violation of peristalsis and vascular pathologies.

Symptoms of diverticulitis

When the disease begins, its symptoms in most cases are absent. Only when the disease passes into the chronic stage, there are signs by which it can be identified. Among the warning signs that indicate the presence of problems:

• Bloating, excessive flatulence.
• Traces of blood in the stool.
• Increased body temperature.
• Pain in the lower abdomen and back.
• Nausea, vomiting.
• Decreased appetite.
• Cold sweat.

Disease diagnosis

This serious complication requires immediate diagnosis, analysis of symptoms and treatment. The initial task of the doctor is to distinguish diverticulitis from stomach ulcers and irritable bowel syndrome. It all starts with questioning the patient, compiling a medical history, conducting an initial examination. Diagnostic methods that are used for suspected diverticulitis:

• Colonoscopy
• Sigmoidoscopy
• Irrigoscopy
• Computed tomography of the intestine
• X-ray of the intestines
• ultrasound
• Clinical analysis of urine and blood

Treatment of disease

There is a resolution of diverticulitis without special treatment due to the normalization of nutrition and diet. With a serious stage of the disease, how to treat it is determined individually and often in a hospital. In this case, the patient is given antibiotics and other supportive drugs. The operation is performed in order to separate the affected part of the intestine. Such a measure is required quite rarely:

• If the disease is severely advanced. There are fistulas, perforations, abscesses.
• When antibiotics do not help get rid of the problem.
• There is bleeding, peritonitis.

Risk of complications

Most of the complications of diverticulitis are associated with perforation, leakage of feces through the walls of the intestine:

• Abscess – removal of the affected part or puncture is required.
• Peritonitis is the spread of infection into the abdominal cavity. The operation is necessary to cleanse the abdominal cavity and remove part of the intestine.
• Intestinal obstruction – scarring resulting in partial or complete blockage of the lumen.