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Colonoscopy with clipping diverticular bleeding

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Colonoscopy with clipping for the diagnosis and treatment of diverticular bleeding

The latest issue of Clinical Gastroenterology & Hepatology investigates colonoscopy with clipping for the diagnosis and treatment of diverticular bleeding.

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Diverticular bleeding is the most common cause of acute severe lower gastrointestinal bleeding in Western countries.

Diagnostic and therapeutic approaches, including endoscopy, radiology, or surgery, have not been standardized.

Dr Tonya Kaltenbach and colleagues from California, USA investigated colonoscopy as a first-line modality to diagnose and manage patients with severe lower gastrointestinal bleeding.

The research team performed a retrospective study of data collected from 2 tertiary Veterans hospitals of 64 patients with acute severe diverticular bleeding, based on colonoscopy examination.

The team assessed primary hemostasis using endoscopic clipping for diverticular bleeding and described the bleeding stigmata.

38% of patients had diverticular stigmata of recent hemorrhage
Clinical Gastroenterology & Hepatology

The research team measured early and late rebleeding, blood transfusion requirements, hospital stay and complications.

Patients received 3 and 0.9 U of blood before and after colonoscopy, respectively.

The team found that 38% of patients had diverticular stigmata of recent hemorrhage, and 88% were treated successfully using endoscopic clips, without complication or early rebleeding.

The team noted that hospital stays averaged 6 days.

Endoscopic clipping provided primary hemostasis in 75% of patients with active diverticular bleeding.

During 35 months of follow-up, late recurrent diverticular bleeding occurred in 22% of the patients after a mean time period of 22 months.

The researchers found that 21% with stigmata of recent hemorrhage who received clip treatment had rebleeding at 43 months.

Rebleeding was self-limited in 57% of patients, was clipped in 29%, or was embolized in 14%.

Dr Kaltenbach's team concludes, "Colonoscopy can be a safe first-line diagnostic and therapeutic approach for patients with severe lower gastrointestinal bleeding."

"Endoscopic clipping provides hemostasis of active diverticular bleeding."

"Recurrent bleeding occurs in about 21% of patients who were treated with clips, at approximately 4 years, and most bleeding is self-limited or can be retreated by endoscopic clipping."

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Patients with colonic diverticular bleeding show high recurrence rates within a short period. Risk factors for recurrence have been identified as the use of NSAIDs or antiplatelet drugs and hypertension.
2012-02-20 23:27:20
vega
Diverticulosis is a digestive disorder caused by small pouch-like herniations located along your gastrointestinal tract wall, according to John Hopkins University. Exercise to improve diverticulosis that is done at least 30 minutes on five or more days weekly provides many benefits including keeping your colon healthy, slowing or preventing disorder progression, and reducing colon pressure while improving bowel regularity and digestion.

Read more: http://www.livestrong.com/article/470332-exercise-to-improve-diverticulosis/#ixzz1nfBb0ahi
2012-02-28 16:29:52
vega
As a diverticulum herniates, the penetrating vessel responsible for the wall weakness at that point becomes draped over the dome of the diverticulum, separated from the bowel lumen only by mucosa (picture 1) [14]. Over time, the vasa recta is exposed to injury along its luminal aspect, leading to eccentric intimal thickening and thinning of the media. These changes may result in segmental weakness of the artery, predisposing to rupture into the lumen. (See "Colonic diverticular bleeding".)

In western countries, 75 percent of diverticula occur on the left side of the colon and, when right-sided diverticula do occur, they are usually associated with left-sided diverticula [16]. However, the right colon is the source of diverticular bleeding in 50 to 90 percent of patients [6,14,17]. The anatomic relationship between diverticula and the vasa recta is similar in both the right and left colon, but right-sided diverticula have wider necks and domes. This could expose the vasa recta to injury over a greater length, which may explain the higher incidence of right-sided hemorrhage [14].

Diverticular bleeding may be massive and life-threatening since diverticula often form at the site of arterial vascular penetration. The bleeding is usually painless except for mild crampy abdominal discomfort due to colonic spasm from intraluminal blood. Diverticular bleeding is self-limited in over 70 to 80 percent of cases. However, the rebleeding rate approaches 25 percent after the initial bleeding episode in those who do not undergo surgery [18].

Risk factors for diverticular bleeding include a lack of dietary fiber, aspirin and nonsteroidal antiinflammatory drug (NSAID) use, advanced age, and constipation [19-22]. Aspirin and NSAIDs may increase the risk of LGIB by a variety of mechanisms, including local erosive topical damage and platelet dysfunction [23].
2012-03-09 23:10:03
vega
Diverticulosis: Causes and prevention
We don't know for sure what causes diverticulosis. It's likely that several processes are involved. Excess pressure caused by abnormal contraction and spasms in the colon probably plays a part, possibly compounded by aging, which weakens muscles in the colon wall. A low-fiber diet is also thought to contribute. Diverticular disease is rare in areas of the world such as rural Africa and Asia, where diets are high in roughage, including high-fiber grains. Other possible risk factors are obesity, lack of physical activity, and high consumption of red meat and fats. Scientists are also considering the potential role of low-grade chronic inflammation and connective tissue defects (perhaps inherited).
2012-03-09 23:22:17
vega
What to do. You can't get rid of diverticulosis, but you can do things that may reduce the chance that it will progress to diverticulitis and other complications. Chief among them is eating a high-fiber diet. It hasn't been proved that fiber prevents diverticulitis, but evidence suggests that people who eat more fiber are less likely to develop the problem. Fiber absorbs water as it passes through the intestine, producing bulky stools that move through more quickly, reducing the likelihood of constipation and the resulting pressure in the colon. When fiber is inadequate, stools are small and hard, and the colon must contract with greater force to expel them, putting extra pressure on the colon walls.

A high-fiber diet should include a mix of whole grains, nuts, seeds, fruits, legumes (such as dried beans), and vegetables. (See "Fiber content of various foods.") At one time, people with diverticular disease were told to avoid popcorn, nuts, and seeds because of concern that these foods might become trapped in diverticula and trigger diverticulitis. However, this idea has been disproved.
2012-03-09 23:24:09
vega
For people who can't or don't consume enough fiber in foods, supplements are available, including psyllium (Fiberall, Konsyl, Metamucil, others), methylcellulose (Citrucel, generic), and calcium polycarbophil (FiberCon). It's important to take these supplements with adequate water — usually at least 8 ounces, preferably more, with each dose.

How much fiber? Women should aim for 25 grams of fiber per day (21 grams if you're over age 50). Added fiber can have unpleasant side effects, such as bloating or gas. To minimize this problem, increase your daily intake gradually, by about 5 grams per week, until you reach your goal. And be sure to drink plenty of fluids.

Regular exercise, especially aerobic exercise, can also help. It speeds the movement of food through the colon, reducing the risk of constipation and the formation of hard, dry stools. Both fiber (which is filling) and exercise help combat obesity, which has been linked in several reports to the development of diverticulitis and diverticular bleeding.


Diverticular bleeding. The most common symptom is painless rectal bleeding that causes bright red or maroon bowel movements. This bleeding is usually mild and stops with bed rest. More massive bleeding is a medical emergency that calls for expert hospital care with blood transfusions and intravenous fluids. It also requires intensive efforts — using such techniques as colonoscopy or angiography — to locate the site of bleeding and stop it. If neither approach works, surgery may be needed.
2012-03-09 23:25:41
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