Diverticular disease

​Diverticula are saccular adhesions of the lining of the intestine. The size and number of colonic diverticula varies from patient to patient. They are quite common in older patients (>40 years of age) and are the result of intra-abdominal pressure disturbances within the bowel. They are more common in patients with bowel motility disorders and in cases of constipation. They are most common in the colon and particularly in the left colon but can affect any part of the digestive tract.

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Symptoms

Diverticula are not always associated with symptoms but their presence may be responsible for symptoms of stool disorders and functional bowel disorders. They are often associated with abdominal pain, bloating and flatulence and diarrhoea. Around 20% of patients may develop complications such as bleeding from the rectum, inflammation of the diverticula (diverticulitis) or even perforation of the bowel

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Diagnosis

​Because most people with diverticulosis have no symptoms, they are usually discovered incidentally either during colonoscopy or during imaging tests such as CT scans or barium enema. Colonoscopy is quite useful to exclude other bowel diseases that may present with similar symptoms. Colonoscopy should be avoided in the acute phase of diverticulitis because there is a risk of complications (perforation). CT scanning is mainly used to evaluate complications such as abscesses and localised peritonitis but also therapeutically to absorb abscesses by guided biopsy in order to avoid surgery.

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Addressing

People who have diverticulosis without symptoms or complications do not necessarily need treatment. However, it is extremely important that they adopt a diet rich in fibre to avoid constipation which can make the disease worse. In patients with stool disorders and irritable bowel symptoms, probiotics are often used to reduce symptoms.

In cases of inflammation of the diverticula of the colon, antibiotics are used, while in severe cases, hospitalization of the patient may be required for intravenous administration of antibiotics and supportive treatment. In complicated conditions such as recurrent diverticulitis, narrowing of the lumen of the bowel, presence of fistulas , bleeding from diverticula or in cases of perforation, surgical treatment with resection of the affected part of the affected part of the colon may be necessary.