121 - Diverticular Disease of the Colon

Abstract

Colonic diverticulosis is common in the Western world and increasing in incidence. Elevated intracolonic pressures, possibly caused by a dietary fiber deficiency, contributes, but there are undoubtedly other etiologic factors. The majority of patients with diverticulosis are asymptomatic, and other than education and a recommendation for a healthy higher fiber diet, no interventions are otherwise needed. Patients with symptoms suggestive of diverticular disease but without overt inflammation have been termed as having Symptomatic Uncomplicated Diverticular Disease and have clinical outcomes similar to patients with IBS. Possible (but data unsupported) interventions might include fiber, probiotics, non-absorbable antibiotics, or mesalamine. Acute diverticulitis occurs in a small subset of patients with diverticulosis and antibiotics are often given, although not obligate in all uncomplicated cases. Recurrent diverticulitis is less common than previously thought, and previous recommendations to consider elective surgical resection after 2 attacks have evolved to a more individualized approach. One of the more common complications of diverticulitis is abscess formation, generally identified on CT scan and often treated with percutaneous drainage. Fistulas are generally treated surgically, as are the uncommon free perforation. Segmental colitis associated with diverticulosis (SCAD) is an increasingly diagnosed entity that remains poorly understood but may respond to mesalamine treatment and is generally self-limited. Finally, diverticulosis is the most common cause of lower gastrointestinal bleeding. NSAID use is the major remediable risk factor and colonoscopy can assist in diagnosis and sometimes treatment.