New Trends In The Treatment Of Diverticular Disease

Abstract

SUMMARY D iverticular disease is an alteration of the colonic wall structure characterized by the presence of pockets called ‘diverticula’. These diverticula are characterized by herniation of the colonic mucosa and sub-mucosa through defects in the muscle layer at the weakest points in the colonic wall where blood vessels penetrate the wall of colon. Diverticula occur commonly in the sigmoid and descending colon which is a common place for increased pressure. However it can occur at any site throughout the gastrointestinal tract. By the age of 50 years old, approximately 50% of all people have diverticula, and nearly 70% of all people have diverticula by the age of 80 years old. There is no sex predominance, with males and females being equally affected. Most people with colonic diverticulosis remain asymptomatic, however about 20% of these patients will develop symptoms, which is called ‘diverticular disease’ (DD). 15 % of whom will ultimately develop complications. DD has a significant burden on westernized National Health Systems. The underlying pathological mechanisms cause the formation of colonic diverticula, these are likely to be the result of complex interactions among diet, colonic microbiota, genetic factors, colonic motility, microscopic inflammation and structure changes. All these factors have to be considered as potential targets of treatment. Major classification systems prompted the German Society for Gastroenterology and Digestive Diseases (DGVS) to propose a modified classification of diverticular disease, incorporating the best parts of other classification systems. Depicts the proposed classification, together with explanations of the different types of disease. The classification comprises various types of disease rather than stages because there is not necessarily a strong chronological order leading to chronic complications or diverticular bleeding. Asymptomatic uncomplicated diverticulosis typically is diagnosed incidentally and does not require further work-up. Consensus guidelines recommend a high-fiber diet in these patients to prevent symptomatic diverticular disease. Most people with colonic diverticulosis are unaware of this structural change. When symptoms do appear in a person over 40 years of age it is important to obtain medical advice and exclude more dangerous conditions such as cancer of the colon or rectum. Classically, diverticulitis is characterized by acute, constant abdominal pain most often occurring in the left lower quadrant. The site of pain varies depending on the site of the involved diverticulum. Fever and leukocytosis generally are present. Other commonly associated symptoms include nausea, vomiting, and constipation or diarrhea. Some patients may complain of dysuria and frequency, reflecting what has been called “sympathetic cystitis” induced by bladder irritation from the adjacent inflamed colon.