What are the main differences between diverticular disease and intestinal polyps. How do these conditions affect the digestive system. What are the symptoms, causes, and treatments for each condition. How are diverticulosis and colon polyps related to overall gut health.

Understanding Diverticulosis: Causes, Symptoms, and Prevalence

Diverticulosis is a common digestive condition characterized by small pouches or pockets that form in the wall of the digestive tract, most often in the colon. These pouches, called diverticula, occur when the inner layer of the digestive tract pushes through weak spots in the outer layer.

Who is most likely to develop diverticulosis? The condition affects:

• 50% of people over 60 years of age
• Nearly everyone by age 80
• Rarely individuals under 40 years old

Interestingly, diverticulosis is less common in certain parts of the world, such as Asia and Africa, where diets are typically higher in fiber.

What causes diverticulosis?

The exact cause of diverticulosis isn’t fully understood, but several factors may contribute:

• Low-fiber diet
• Constipation
• Increased pressure within the digestive tract
• Straining during bowel movements

The combination of pressure and straining over many years is believed to lead to the formation of diverticula.

Symptoms of Diverticulosis

Is diverticulosis always symptomatic? Most people with diverticulosis are unaware they have the condition because it usually does not cause symptoms. However, when symptoms do occur, they may include:

• Abdominal pain, typically in the lower left side
• Bloating
• Changes in bowel habits

Colon Polyps: Types, Risk Factors, and Detection

Colon polyps are small growths that develop on the inner lining of the colon or rectum. They are quite common, affecting 15% to 20% of the UK population. While most polyps are benign, some can develop into cancer if left untreated.

Types of Colon Polyps

There are several types of colon polyps:

• Sessile polyps: Tiny raised areas or bulges
• Pedunculated polyps: Resemble a grape on a stalk
• Clustered polyps: Many tiny bumps grouped together

Polyps can vary in size, typically ranging from less than 1cm to several centimeters.

Risk Factors for Colon Polyps

What factors increase the likelihood of developing colon polyps? Several risk factors have been identified:

• Age: More common in people over 60
• Family history: Genetic predisposition to polyps or colon cancer
• Lifestyle factors: Diet low in fiber, high in fat, smoking, obesity
• Certain medical conditions: Such as inflammatory bowel disease

Detecting Colon Polyps

How are colon polyps typically discovered? Many polyps are found incidentally during routine screenings or other bowel investigations. Common detection methods include:

• Colonoscopy
• Sigmoidoscopy
• CT colonography
• Stool-based tests

Regular screenings are crucial for early detection and prevention of potential complications.

Symptoms and Complications: When to Seek Medical Attention

While both diverticulosis and colon polyps can be asymptomatic, there are instances when symptoms may arise, indicating the need for medical attention.

Diverticulitis: A Complication of Diverticulosis

Diverticulitis occurs when diverticula become inflamed or infected. Symptoms may include:

• Severe abdominal pain, usually on the left side
• Fever and chills
• Nausea and vomiting
• Changes in bowel habits

Can diverticulitis be serious? Yes, if left untreated, diverticulitis can lead to complications such as abscesses, perforations, or fistulas.

Symptoms of Larger Colon Polyps

While most polyps are asymptomatic, larger ones may cause:

• Rectal bleeding
• Change in stool color
• Change in bowel habits
• Abdominal pain

When should you consult a doctor about potential polyp symptoms? Any persistent changes in bowel habits or rectal bleeding should be evaluated by a healthcare professional.

Treatment Options: Managing Diverticular Disease and Colon Polyps

The approach to treating diverticular disease and colon polyps varies based on the severity and specific condition.

Treating Diverticulosis and Diverticulitis

How is diverticulosis managed? For uncomplicated diverticulosis, treatment usually involves:

• Increasing dietary fiber intake
• Staying well-hydrated
• Regular exercise

For acute diverticulitis, treatment may include:

• Antibiotics
• Temporary liquid diet
• Pain management
• In severe cases, hospitalization or surgery

Removing Colon Polyps

What is the primary treatment for colon polyps? Most polyps are removed during a colonoscopy using techniques such as:

• Snaring: Using a wire loop to cut off the polyp
• Cauterization: Burning off the polyp

In rare cases involving large or potentially cancerous polyps, surgical removal of part of the colon may be necessary.

Prevention Strategies: Reducing Risk of Diverticular Disease and Colon Polyps

While some risk factors for these conditions are beyond our control, there are several preventive measures that can be taken to reduce the likelihood of developing diverticular disease or colon polyps.

Dietary Modifications

How can diet help prevent these conditions? A diet rich in fiber is believed to be beneficial for both conditions:

• Increase intake of fruits, vegetables, and whole grains
• Aim for 25-30 grams of fiber daily
• Stay well-hydrated to help fiber work effectively

Lifestyle Changes

What lifestyle modifications can reduce risk?

• Maintain a healthy weight
• Exercise regularly
• Quit smoking
• Limit alcohol consumption

Regular Screenings

How often should one undergo screenings? Guidelines vary based on individual risk factors, but generally:

• Begin colon cancer screenings at age 45 for average-risk individuals
• Follow up colonoscopies every 3-5 years if polyps are found
• More frequent screenings may be recommended for high-risk individuals

The Gut Microbiome: Its Role in Diverticular Disease and Colon Health

Recent research has highlighted the importance of the gut microbiome in overall digestive health, including its potential role in diverticular disease and colon polyp formation.

The Gut Microbiome and Diverticular Disease

How does the gut microbiome influence diverticular disease? Emerging evidence suggests that:

• Alterations in gut bacteria may contribute to inflammation in diverticular disease
• Certain probiotics might help manage symptoms and prevent complications
• A diverse microbiome may protect against diverticulitis

Microbiome and Colon Polyps

What is the relationship between gut bacteria and colon polyps? Research indicates:

• Certain bacterial strains may promote polyp formation
• A balanced microbiome might help prevent polyp development
• Probiotics could potentially play a role in polyp prevention

While more research is needed, maintaining a healthy gut microbiome through diet and lifestyle choices may contribute to overall colon health.

Long-term Outlook: Living with Diverticular Disease or a History of Colon Polyps

Understanding the long-term implications of these conditions is crucial for ongoing management and prevention of complications.

Prognosis for Diverticular Disease

What is the long-term outlook for individuals with diverticular disease? For most people:

• Diverticulosis remains asymptomatic
• About 20% of those with diverticulosis will develop diverticulitis
• Recurrence of diverticulitis is common, occurring in about 1 in 5 patients

Proper management and lifestyle changes can significantly reduce the risk of complications.

Follow-up Care for Colon Polyps

Why is ongoing surveillance important after polyp removal? Regular follow-up is crucial because:

• New polyps can develop over time
• The risk of colon cancer may be elevated in individuals with a history of polyps
• Early detection of new polyps or potential cancer is key to successful treatment

The frequency of follow-up colonoscopies will depend on the number, size, and type of polyps found during previous examinations.

Quality of Life Considerations

How do these conditions impact daily life? While both diverticular disease and a history of colon polyps can be managed effectively, they may require:

• Dietary modifications
• Regular medical check-ups
• Increased awareness of digestive symptoms

With proper care and lifestyle adjustments, most individuals can maintain a high quality of life and reduce their risk of complications.

In conclusion, while diverticular disease and colon polyps are distinct conditions, they share some common risk factors and preventive strategies. Understanding these conditions, their symptoms, and management options is crucial for maintaining optimal digestive health. Regular screenings, a healthy diet rich in fiber, and lifestyle modifications can go a long way in preventing and managing these common digestive issues. As research continues to evolve, particularly in areas such as the gut microbiome’s role in digestive health, we may see new strategies emerge for prevention and treatment of these conditions.

Bowel polyps | NHS inform

Bowel polyps are small growths on the inner lining of the colon (large bowel) or rectum. They are common, affecting 15% to 20% of the UK population, and don’t usually cause symptoms.

Polyps are usually less than 1cm in size, although they can grow up to several centimetres. There are various forms:

• some are a tiny raised area or bulge, known as a sessile polyp
• some look like a grape on a stalk, known as a pedunculated polyp
• some take the form of many tiny bumps clustered together

Bowel polyps are not usually cancerous, although if they’re discovered they’ll need to be removed, as some will eventually turn into cancer if left untreated.

Some people just develop one polyp, while others may have a few. They tend to occur in people over the age of 60.

How are they caused?

Bowel polyps are caused by an abnormal production of cells. The lining of the bowel constantly renews itself, and a faulty gene can cause the cells in the bowel lining to grow more quickly.

There may be a family tendency towards developing bowel polyps or bowel cancer.

What are the symptoms?

Most people with polyps won’t be aware of them as they produce no symptoms and are often discovered by accident.

However, some larger polyps can cause:

• a small amount of rectal bleeding (blood in your stool)
• mucus to be produced when you open your bowels
• diarrhoea or constipation
• abdominal pain

How are they discovered?

Bowel polyps are usually found as a result of a bowel investigation for another reason, such as a sigmoidoscopy (examination of the last part of the bowel) or during screening for bowel cancer.

If polyps are found, a colonoscopy or CT colonography is needed to view the whole of the large bowel and remove any polyps.

How are they treated?

There are several methods for treating polyps, but the most common procedure involves snaring the polyp during a colonoscopy. Snaring is like cutting the polyp off with cheese wire and is painless.

Both of the above methods involve passing a flexible instrument called a colonoscope through your bottom and up into your bowel. The colonoscope has a wire with an electric current to either cauterise (burn off) or snare the polyp.

In rare cases, polyps may need to be treated by surgically removing part of the bowel. This is usually only done when the polyp has some cell changes or is particularly large.

After the polyp or polyps have been removed, they are sent to specialists in a laboratory, who will inform your consultant if:

• the polyp has been completely removed
• there is any risk of it regrowing
• there is any cancerous change in the polyp

If there is a cancerous change in the polyp, you may need further treatment (depending on the degree and extent of change). Your specialist will be able to advise you on this.

Outlook

Some people will need further colonoscopies because polyps can recur. Polyps can sometimes run in families. This is uncommon, but means you’ll need colonoscopy checks at regular intervals.

You might be asked to have repeat examinations at intervals of around 3 to 5 years to catch any further polyps that may develop and potentially turn into bowel cancer.

ASGE | Understanding Diverticulosis

What is diverticulosis?

Diverticulosis is a condition in which there are small pouches or pockets in the wall or lining of any portion of the digestive tract. These pockets occur when the inner layer of the digestive tract pushes through weak spots in the outer layer. A single pouch is called a diverticulum. The pouches associated with diverticulosis are most often located in the lower part of the large intestine (the colon). Some people may have only several small pouches on the left side of the colon, while others may have involvement in most of the colon.

Who gets diverticulosis?

Diverticulosis is a common condition in the United States that affects half of all people over 60 years of age and nearly everyone by the age of 80. As a person gets older, the pouches in the digestive tract become more prominent. Diverticulosis is unusual in people under 40 years of age. In addition, it is uncommon in certain parts of the world, such as Asia and Africa.

What causes diverticulosis?

Because diverticulosis is uncommon in regions of the world where diets are high in fiber and rich in grains, fruits and vegetables, most doctors believe this condition is due in part to a diet low in fiber. A low-fiber diet leads to constipation, which increases pressure within the digestive tract with straining during bowel movements. The combination of pressure and straining over many years likely leads to diverticulosis.

What are the symptoms of diverticulosis?

Most people who have diverticulosis are unaware that they have the condition because it usually does not cause symptoms. It is possible that some people with diverticulosis experience bloating, abdominal cramps, or constipation due to difficulty in stool passage through the affected region of the colon.

How is the diagnosis of diverticulosis made?

Because most people do not have symptoms, diverticulosis is often found incidentally during evaluation for another condition or during a screening exam for polyps. Gastroenterologists can directly visualize the diverticula (more than one pouch, or diverticulum) in the colon during a procedure that uses a small camera attached to a lighted, flexible tube inserted through the rectum. One of these procedures is a sigmoidoscopy, which uses a short tube to examine only the rectum and lower part of the colon. A colonoscopy uses a longer tube to examine the entire colon. Diverticulosis can also be seen by other imaging tests, for example, computed tomography (CT) scan or barium x-rays.

What is the treatment for diverticulosis?

Once diverticula form, they do not disappear by themselves. Fortunately, most patients with diverticulosis do not have symptoms, and therefore do not need treatment. When diverticulosis is accompanied by abdominal pain, bloating or constipation, your doctor may recommend a high-fiber diet to help make stools softer and easier to pass. While it is recommended that we consume 20 to 35 grams of fiber daily, most people only get about half that amount. The easiest way to increase fiber intake is to eat more fruits, vegetables or grains. Apples, pears, broccoli, carrots, squash, baked beans, kidney beans, and lima beans are a few examples of high-fiber foods. As an alternative, your doctor may recommend a supplemental fiber product such as psyllium, methylcellulose or polycarbophil. These products come in various forms including pills, powders, and wafers. Supplemental fiber products help to bulk up and soften stool, which makes bowel movements easier to pass. Your doctor may also prescribe medications to help relax spasms in the colon that cause abdominal cramping or discomfort.

Are there complications from diverticulosis?

Diverticulosis may lead to several complications including inflammation, infection, bleeding or intestinal blockage. Fortunately, diverticulosis does not lead to cancer.

Diverticulitis occurs when the pouches become infected or inflamed. This condition usually produces localized abdominal pain, tenderness to touch and fever. A person with diverticulitis may also experience nausea, vomiting, shaking, chills or constipation.

Your doctor may order a CT scan to confirm a diagnosis of diverticulitis. Minor cases of infection are usually treated with oral antibiotics and do not require admission to the hospital. If left untreated, diverticulitis may lead to a collection of pus (called an abscess) outside the colon wall or a generalized infection in the lining of the abdominal cavity, a condition referred to as peritonitis. Usually a CT scan is required to diagnose an abscess, and treatment usually requires a hospital stay, antibiotics administered through a vein and possibly drainage of the abscess.

Repeated attacks of diverticulitis may require surgery to remove the affected portion of the colon. Bleeding in the colon may occur from a diverticulum and is called diverticular bleeding. This is the most common cause of major colonic bleeding in patients over 40 years old and is usually noticed as passage of red or maroon blood through the rectum.

Most diverticular bleeding stops on its own; however, if it does not, a colonoscopy may be required for evaluation. If bleeding is severe or persists, a hospital stay is usually required to administer intravenous fluids or possibly blood transfusions. In addition, a colonoscopy may be required to determine the cause of bleeding and to treat the bleeding. Occasionally, surgery or other procedures may be necessary to stop bleeding that cannot be stopped by other methods. Intestinal blockage may occur in the colon from repeated attacks of diverticulitis. In this case, surgery may be necessary to remove the involved area of the colon.

Important Reminder:
This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

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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 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 occurs 3 times less often 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 reveals 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 likely to occur 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 intestinal bleeding, conservative treatment (hemostatic therapy) is most often prescribed or endoscopic hemorrhage 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 is usually 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.

Diverticular disease (diverticulosis) of the colon

What is diverticular disease (diverticulosis) of the colon?

Diverticula (lat. diverticulum – literally “branch”, “road to the side”) are sac-like protrusions of all layers of the colon wall or only the mucous membrane and submucosal layer through a defect in the muscular layer.

Figure 1. Cross section of the colon. Diverticulum

Colon diverticulosis is a condition in which there is at least one diverticulum in the colon.

Figure 2. Diverticulosis of the left departments of the colon of the colon

diverticular disease – a disease characterized by clinical manifestations of the inflammatory process and its possible complications – abscesses, perforation of diverticuls, the formation of fistulas, peritonitis, as well as bleeding.

What is the anatomy of the large intestine?

To better understand the pathogenesis of diverticular disease, consider the anatomy of the colon. The large intestine is a hollow muscular organ – a “tube” located in the abdominal cavity in the shape of a “horseshoe”, and is the final section of the gastrointestinal tract, where the formation and evacuation of feces occurs. It consists of the following sections: appendix, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.

The wall of the large intestine consists of four layers: mucous, submucosal, muscular and serous.

The mucosa of the large intestine is its inner membrane facing the lumen. It is a thin layer of cells – a cylindrical epithelium. The mucous membrane lies on its own plate, consisting of loose fibrous connective tissue, in which the glands, blood and lymphatic vessels are located. In the deepest layer of the mucous membrane, on the border with the submucosa, there is a muscular plate of the mucous membrane. The epithelium of the mucous membrane performs an integumentary function, is a link between the wall of the large intestine and its lumen – it ensures the absorption of water, the synthesis of B and K vitamins by intestinal bacteria, the formation of fecal masses and their preparation for evacuation, releasing the required amount of mucus.

The submucosa is the layer of the colon wall following the muscularis mucosa. The submucosa contains blood vessels that feed the intestinal wall and nerve plexuses that coordinate its contractions. Due to the submucosa, the mucosa can shift in relation to the next layers of the colon wall and form folds.

The muscle fibers of the intestinal wall are arranged both circularly and longitudinally. This layer acts as a framework, and also ensures the promotion of fecal masses due to contractions.

Outside, the large intestine is covered with a thin “film” – a serous membrane.

For a better understanding of the mechanism of diverticulum formation, one should also pay attention to the peculiarities of the blood supply to the colon wall.

The colon is nourished from the system of the superior and inferior mesenteric arteries, which originate from the aorta, the main vessel of our body. Their branches form a single marginal vessel that accompanies the large intestine throughout its entire length. Feeding branches depart from the marginal vessel, passing through the muscle layer and branching in the submucosa. With an increase in pressure inside the intestine, sections of the muscular layer through which the feeding vessels pass can serve as a “gateway” for the formation of diverticula.

How does diverticular disease manifest itself?

Uncomplicated diverticulosis is usually asymptomatic – you may not even notice the disease. Diverticula may be an incidental finding during a routine examination. In this situation, no special treatment is required. Recommendations include regular medical supervision, a diet high in fiber and low in refined carbohydrates, and regular physical activity and weight control.

The difficulty of timely detection of diverticular disease lies in the absence of specific symptoms. The clinical picture is presented mainly by cramping pains mainly on the left lower abdomen, increased gas formation, unstable stools with a tendency to constipation or with alternating constipation and diarrhea. Such complaints are mainly associated with dysmotility of the colon.

When they see a doctor, such patients are usually diagnosed with irritable bowel syndrome or dolichosigma, the patient is reassured, an abdominal ultrasound is recommended, and after light therapy, they are sent “home”.

However, in the event of such complaints, a colonoscopy is mandatory! The above symptoms can be manifestations not only of diverticular disease, but also of many other diseases of the colon, the timely detection of which can significantly improve the results of treatment.

Figure 3. Colonoscopy. Orifices of diverticula are visible

The clinical picture of diverticulitis is significantly different. Severe abdominal pain, bloating, lack of stool, may be accompanied by fever, nausea, and vomiting. Such complaints require urgent hospitalization in the coloproctology department, where patients receive antibacterial, anti-inflammatory therapy, and if this treatment is not effective, surgical intervention may be necessary.

The main cause of inflammation of a diverticulum – diverticulitis – is the ingress of dense fecal masses into it, unable to come back out. At this stage, inflammatory changes and the formation of an infiltrate (seal) of the surrounding tissues occur.

What causes diverticula?

Often at the doctor’s office, patients diagnosed with diverticular disease ask the question: “Why did this disease develop?” What are the causes of this disease? A large amount of information on the Internet does not always give a clear explanation. Let’s try to tell in more detail.

We believe that all the main causes of diverticular disease can be divided into two interrelated groups:

• Increased pressure in the intestinal lumen;
• Weakness of the intestinal wall.

Deficiency of vegetable fiber in the diet leads to a decrease in volume and an increase in the density of feces, which causes disturbances in the motor activity of the large intestine: it reacts even to slight irritation with chaotic contractions. Thus, short closed segments of the intestine with increased intraluminal pressure appear, which leads to bulging of the mucosa through the “weak” sections of the intestinal wall – the places where the blood vessels pass.

For a clear understanding of the formation of a diverticulum, we offer you an interesting comparison:

“The wall of the intestine is similar to the layered structure of a soccer ball – strong and hard skin on the outside, and a soft but elastic rubber chamber inside.

Now imagine that a hole, a hole, is formed in the outer hard shell of this ball. What will happen then? The high pressure inside the ball will push part of the soft and elastic inner rubber chamber outward: a pocket protruding outward is formed. This can be compared with a hernia on the abdomen – through a defect in the muscles, the contents “bulge out” outward.

Approximately the same thing happens with the colon with diverticulosis. If the pressure inside the intestinal lumen is large, and there are weak spots in the muscular layer, then the inner lining of the intestine tends outward through these holes, forming protrusions in the form of sacs. They are called diverticula.”

What tests should be performed if diverticular disease is suspected?

The first step in the diagnosis of diverticular disease without exacerbation is colonoscopy. With the help of a video camera inserted through the anus, more than a meter of the intestine is examined – the entire large intestine and the final section of the small intestine. Colonoscopy allows not only to see the presence of a diverticulum, but also to determine the size of its gate, the condition of the wall, and the exact localization. If other changes are found in the intestine, colonoscopy allows you to take a piece of tissue for examination – perform a biopsy with further histological examination in order to understand the microscopic structure of the changes. This study can be performed under light anesthesia, which allows you to completely save the patient from the discomfort associated with the procedure.

The “gold standard” for diagnosing diverticular disease is barium enema. This method allows you to determine the number of diverticula, their exact location, size and shape. The essence of the procedure is the introduction of a radiopaque preparation into the colon, after which a series of x-ray images are taken to assess the condition of the colon. In the presented photographs, the arrows indicate the orifices of the colonic diverticula. We marked with blue arrows multiple diverticula of the colon. This is what they look like on a CT scan.

Figure 4. Irrigoscopy. Diverticulosis of the colon

X-rays taken during irrigoscopy clearly show multiple diverticula of the colon. They look like sacs filled with radiopaque.

Equally important methods are ultrasound diagnostics and computed tomography. Due to its minimally invasiveness, ease of implementation, ultrasound diagnostics is very relevant at the stage of the initial examination. It allows you to see the presence of diverticula, identify indirect signs of their inflammation, such as infiltration, abscess, or suggest a generalized form – peritonitis.

In order to clarify the data obtained during the ultrasound examination, in case of doubt and to clarify the diagnosis, a spiral computed tomography is performed. Virtual computed tomography allows you to recreate a three-dimensional image of the colon, including the affected areas. Using this technique, you can accurately determine the boundaries of the infiltrate or abscess, other organs involved in the inflammatory process.

Figure 5. Virtual colonoscopy. Orifice of diverticulum

How to treat diverticular disease, diverticulosis and diverticulitis?

Medical treatment

When treated promptly, diverticulitis responds very well to medical treatment. Inflammatory changes are completely cured with the help of antibacterial and anti-inflammatory therapy.

In case of complications in patients, the treatment method should be selected as less traumatic and minimally invasive. The infiltrate can be completely cured with medication. The abscess can be punctured under ultrasound or CT guidance.

Surgical treatment

In case of peritonitis and the need for surgery in the early stages of the disease, intervention can be performed laparoscopically – through small punctures. Unfortunately, the development of fecal peritonitis usually requires a laparotomy – a “large incision” for thorough washing and examination of the abdominal cavity.

Surgical treatment of diverticular disease outside periods of exacerbation is especially important for active travelers, as well as patients living far from district centers. If an exacerbation of the disease occurs away from centers where you can get quality medical care, the consequences can be the most unpleasant. If there are three or more attacks of diverticulitis per year, the patient should contact the coloproctology department to determine the optimal treatment tactics outside the exacerbation period. If surgical treatment is necessary, the operation of choice in this case is the laparoscopic removal of the affected area of ​​the colon and the rectosigmoid junction as one of the causes of increased pressure in the intestinal lumen. Removal of the stoma (even temporarily) in this case is not required.

When is emergency surgery needed?

Urgent surgery is necessary if purulent inflammation spreads to the peritoneum, i.e. peritonitis, which is a life-threatening complication.

Is the intestine always exposed to the anterior abdominal wall during emergency surgery?

This issue is decided individually for each patient. Of course, the formation of a stoma is not shown in 100% of cases.

Benefits of minimally invasive surgery for diverticulosis and diverticulitis

The main advantages of minimally invasive operations are a satisfactory cosmetic effect (there are no large scars on the anterior abdominal wall) and a faster patient recovery after surgery.