Diverticulosis

By Peter Galvin, MD

Diverticulosis is a condition where outpouchings form in the intestinal wall, usually involving the left-side of the large intestine, or colon. Risk factors for diverticulosis include being older than 65 years, obesity (body mass index [BMI] of 30 or more), high blood pressure, type 2 diabetes, the use of certain medications (such as opioids, steroids, and non-steroidal anti-inflammatory drugs [NSAIDs]), connective tissue diseases (such as polycystic kidney disease, Marfan syndrome, and Ehlers-Danlos syndrome), and specific genetic variants. By age 60, nearly 60% of people have diverticulosis.

When these outpouchings become infected, it is called diverticulitis. About 1% to 4% of people with diverticulosis will develop diverticulitis in their lifetime. Acute diverticulitis affects about 180 per 100,000 people in the US every year, resulting in approximately 200,000 hospitalizations annually. Diverticulitis causes pain in the left lower area of the abdomen that begins gradually and worsens over time. About 30% of patients also experience nausea, vomiting, fever, or chills. In severe cases, patients may develop shock, with an elevated heart rate, low blood pressure, and cool or clammy extremities.

About 85% of those with acute diverticulitis have uncomplicated diverticulitis, which is inflammation of a single area of the colon. The remaining 15% of patients will have complicated diverticulitis, which includes one or more of the following: perforation of the colon, a collection of pus (abscess) in the abdomen, narrowing of the colon with possible obstruction, or an abnormal connection (fistula) between the colon and an adjacent organ such as the bladder, vagina, uterus, abdominal wall, or other parts of the small or large intestine.

The recommended test to diagnose diverticulitis is a computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast. Often, an abdominal ultrasound using a portable ultrasound machine in the ER may be used to diagnose acute diverticulitis. Patients with mild diverticulitis typically receive acetaminophen for pain and are placed on a clear liquid diet for several days after diagnosis. Oral antibiotics are usually prescribed for certain patients with mild disease, such as those who have fever, are older than 80 years, are pregnant, are immunosuppressed, or have a chronic medical condition such as cirrhosis, heart failure, chronic kidney disease, or poorly controlled diabetes. Those with complicated diverticulitis are usually hospitalized and may receive intravenous antibiotics, drainage of an abscess, or surgery to remove part of the colon.

Most patients with uncomplicated diverticulitis improve within a few days and have complete resolution of symptoms within one to two weeks. Repeat episodes of diverticulosis occur in 13% to 23% of those with uncomplicated disease and in up to 40% of those with complicated diverticulosis. Behaviors to lower the risk of diverticulosis include regular exercise and weight loss. It was once thought that avoiding nuts, seeds, and red meats helped prevent diverticulitis, but research has shown that there is no evidence linking those foods to diverticulitis.

For more information go to the website of the Americal Gastrointestinal Association at www.gastro.org

Please direct questions and comments to editor@rockawaytimes.com