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Diverticulosis

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Diverticulosis

Diverticulosis is a condition in which the colon contains outpouchings (little sacks). Diverticula are present in a majority of people who reach the age of 50-60 years. The cause of colonic diverticula is not entirely known, but may be due to years of high pressure within the colon or a weakness in the wall of the colon. Diverticula are permanent, and no diet will cause them to disappear. The only way to rid a person of diverticula is to surgically remove the part of the colon that contains the diverticula. A person with diverticulosis typically has many diverticula scattered throughout the colon, but diverticula are most common in the sigmoid and descending colon.

Most people with diverticulosis have few or no symptoms. Diverticulosis is not a problem unless a diverticulum ruptures and an infection (abscess) results, a condition called diverticulitis. Diverticulitis causes abdominal pain, fever and tenderness usually in the left lower abdomen. Rarely, bleeding can occur from a diverticulum when a blood vessel inside the diverticulum is weakened by the infection and ruptures.

Bleeding from diverticulosis (diverticular bleeding) without the presence of diverticulitis is painless. Bleeding from diverticulosis is generally more severe and brisker than bleeding from anal fissures, hemorrhoids, and colon tumors. Diverticular bleeding is the most common cause of moderate to severe rectal bleeding that requires hospitalization and blood transfusions among the elderly population in the Western world.

When bleeding occurs in a diverticulum located in the sigmoid colon, the bleeding tends to be bright red. When bleeding occurs in a diverticulum located in the right ascending colon, the bleeding may also be bright red if the bleeding is brisk; However, the color is more likely to be dark red, maroon, or, sometimes, even black (melena).

Bleeding from diverticulosis is usually brief (it stops on its own). However, diverticular bleeding tends to recur. For example, a patient may experience several episodes of rectal bleeding from diverticula during the same hospitalization. Even after discharge from the hospital, approximately 25% of the patients who do not have the diverticula-containing part of their colon surgically removed will experience another episode of diverticular bleeding within 4-5 years.

Picture of diverticular disease (diverticulitis)

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there are some guidelines that can be followed to manage the condition. They are as follows:

1. Eat a high fiber diet, consisting of fresh fruits and vegetables, whole grain bread, cereals and bran.


2. Avoid foods containing indigestible roughage, such as celery and corn, and use bran to prevent constipation.


3. Avoid straining during bowel movements.


4. Establish a normal bowel routine. Try to have a bowel movement at approximately the same time every day and spend at least 10 minutes in the attempt.


5. Add bulk to stools by eating fruits and vegetables with a high fiber content, such as seedless grapes, fresh peaches, carrots and lettuce.


6. Avoid extremely hot or cold foods and fluids (which cause gas).


7. Avoid alcohol (which irritates the bowel).


8. Lose weight if you are overweight.


9. Exercise moderately.


10. Use natural laxatives (only when needed).


11. Drink at least three (3) to five (5) glasses of water or other liquid per day.


12. Do not smoke (it irritates the gastric mucosa).
2012-02-09 22:11:21
1232123
If bleeding stigmata, such as a protuberant vessel or pigmented spots, associated with a diverticulum are visualized during colonoscopy, therapy can be applied directly to this area. A small, retrospective study of endoscopic therapy in 10 patients found no rebleeding episodes using a combination of epinephrine injection and electrocautery therapy.12,25 Endoscopically placed clips (endoclips), fibrin sealant, and band ligation were shown to be effective in controlling diverticular bleeding in three small case series.26–28 If colonoscopy is not available or if it fails to reveal or control the bleeding source, further intervention is required. A tagged red blood cell scan is typically performed with attempts to localize the bleeding source and assist with targeted therapy by arteriography or surgery.

Intra-arterial vasopressin infusion during arteriography is successful in identifying bleeding in 72 percent of patients and controlling bleeding in 90 percent of patients. However, it is complicated by a 50 percent rebleeding rate and is seldom used in practice.29 Selective arteriography with therapeutic embolization is effective (76 to 100 percent of patients had controlled hemorrhage) and safe (less than 20 percent of patients experienced ischemia following embolization).
2012-02-09 22:18:26
1232123
Prognosis and Follow-up

Although most diverticular bleeding is self-limited and resolves spontaneously,8,34 blood loss is massive and rapid in 9 to 19 percent of patients.29,36 Patients at high risk of adverse outcomes include those with comorbid diseases, poor nutrition, or preexisting liver disease.1 Following the resolution of diverticular hemorrhage and the initial colonoscopy, surveillance colonoscopy is not recommended unless it is performed for other indications, such as colorectal cancer screening. The use of aspirin and nonsteroidal anti-inflammatory drugs is associated with an increased risk of diverticular bleeding (odds ratio = 1.9 to 18.4).37 To prevent progression of diverticular disease, patients should increase their dietary fiber intake or begin fiber supplementation (32 g per day), and increase their level of physical activity.38–40 Obesity (body mass index greater than or equal to 30 kg per m2) is a significant risk factor for diverticular bleeding (relative risk = 2.0).41 Avoidance of certain nuts, corn, or popcorn to prevent complications is no longer recommended in patients with diverticular disease.42
2012-02-09 22:19:48
1232123
To prevent diverticular disease or reduce the complications from it, maintain good bowel habits. Have regular bowel movements and avoid constipation and straining. Eating appropriate amounts of the right types of fiber and drinking plenty of water and exercising regularly will help keep your bowels regulated.

The American Dietetic Association recommends 20 to 35 grams of fiber a day. Every person, regardless of the presence of diverticula, should try to consume this much fiber every day. Fiber is the indigestible part of plant foods. High-fiber foods include whole grain breads, cereals and crackers; berries; fruit; vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, squash and beans; brown rice; bran products; and cooked dried peas and beans, among other foods.

Drinking eight 8-ounce glasses of water a day, monitoring changes in bowel movements (from constipation to diarrhea) and getting enough rest and sleep, are other ways to prevent diverticular disease.
2012-02-09 23:11:23
vega
Treatment

The good news is that people who have diverticulosis do not need treatment. Since ithe disease does not display any illness it is always a good prevention and treatment to adopt a high-fiber diet daily. On a more general note, laxatives should not be considered to treat diverticulosis as well as enemas should also be avoided.

Prevention

Always practice a good bowel hygiene daily to prevent diverticular disease and/or reduce the complications from it. This totally eliminates constipation and straining. Eating appropriate amounts fiber-rich foods are important to sustain good health and proper bowel movement. Drinking plenty of water and exercising regularly are also important.

The American Dietetic Association recommends 20 to 35 grams of fiber rich foods a day. Regardless of the condition of diverticula a person should try to eat this much fiber every day. Fiber is the indigestible part of plant foods. High-fiber foods would include whole grain breads, cereals; berries; fruit; vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, squash and beans; brown rice; bran products; and cooked dried peas and beans, among other foods.

A high-fiber diet eliminates constipation and provides a number of other health benefits such as lowering the blood pressure, reducing blood cholesterol, improving your blood sugar and reducing your risk of developing certain intestinal disorders.

Drinking eight 8-ounce glasses of water a day improves motility in the intestines and with this effect it changes in bowel movements to a more fit condition.
2012-02-11 15:33:36
vega
VIII.Course
A.Bleeding spontaneously ceases in 75%, recurs in 38%
B.Recurrence is 9% at one year and 25% at 4 years
IX.Prognosis: Comorbidities that increase complication risk
A.Hypertension
B.Diabetes Mellitus
C.Chronic Obstructive Pulmonary Disease (COPD)
D.Chronic Kidney Disease
E.Coronary Artery Disease
X.Prevention
A.Avoid Aspirin and NSAIDs
B.Increase Dietary Fiber
C.Weight loss in Obesity with goal Body Mass Index <30 kg/m2
2012-02-11 15:53:18
1232123
To prevent progression of diverticular disease, patients should increase their dietary fiber intake or begin fiber supplementation (32 g per day), and increase their level of physical activity.38–40 Obesity (body mass index greater than or equal to 30 kg per m2) is a significant risk factor for diverticular bleeding (relative risk = 2.0).41 Avoidance of certain nuts, corn, or popcorn to prevent complications is no longer recommended in patients with diverticular disease.42
2014-09-23 21:03:07
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