Diverticulitis

5 mins read

Introduction
Diverticulitis refers to the formation of small pouches in the wall of the digestive tract (diverticulosis) and their rupture. These pouches, also called as diverticula, are formed due to bulging in the inner layer of the digestive tract. Rupturing of these diverticula leads to infection within the digestive tract.

It is a common digestive disorder, which is often quite painful. Diverticula are formed when the feces are not passed properly and are trapped inside these pouches.

Epidemiology
The disorder is more prominent in elderly populations as compared to children and young adults. Depending upon the region affected, diverticulitis is broadly classified as left- and right-sided diverticulitis. Right-sided diverticulitis is more common in Asia and West Africa, whereas left-sided diverticulitis is prevalent in regions of Europe, America, and South America.

Causes
Diverticulitis develops due to the formation of bulge in the inner lining of the digestive tract. However, the cause is yet not established. Various studies have demonstrated the role of physiological factors and diet in the development of the disorder.

Physiological Factors
Straining on the digestive tract affects bowel movement, which results in the development of diverticula.

With age, the inner lining of the tract narrows, whereas the outer layer thickens. This affects the motion of bowel and induces the development of diverticula.

Diet
Low-fiber diet is one of the most important causes of diverticulitis. These diets are ‘hard’ and result in the formation of ‘hard stool’. The passage of this stool becomes difficult and eventually the feces get deposited in the inner bulges.

Symptoms Of Diverticulitis
In comparison to diverticulosis, symptoms associated with diverticulitis are more severe, and often require specified treatment regimens.

Some of the common symptoms are:

  • Intense abdominal pain, depending upon the side affected
  • Nausea and dizziness
  • Vomiting
  • Fever and occasional signs of respiratory infections
  • Severe constipation and/or diarrhea
  • Inflammation in the abdomen
  • Muscular cramps
  • Loss of appetite

Treatment Strategies In Diverticulitis
Treatment strategies vary depending upon the severity of the condition. In most of the patients with mild to moderate symptoms, oral medications are effective in alleviating the condition. However, in more severe conditions, medications along with surgical intervention is often recommended.

Medications
Various drugs are used that targets the primary symptoms associated with diverticulitis. These drugs provide relief from muscular cramps, severe abdominal pain, fever and/or chills, and bowel movement.

Some of the common drugs used are:

  • Metronidazole (Flagyl)
  • Doxycycline (Vibramycin)
  • Ciprofloxacin (Cipro)
  • Cephalexin (Keflex)

Surgery
Surgery is only recommended in severe cases and the associated complications. The procedure can be performed either by laparoscopic surgery or colectomy, depending upon the affected region. Surgery is often recommended in patients who do not respond to the drugs. Additionally, surgery is effective in treating patients with progressive diverticulitis (infection of the diverticula affecting other vital organs such as kidneys, urinary bladder, spleen).

Home Remedies
In addition to the aforementioned strategies, various home remedies are also quite effective in managing the symptoms of diverticulitis.

High-Fiber Diet: Incorporating green leafy vegetables, fruits, salad, bran, and citrus are effective in managing abdominal pain and constipation.

Hydration: Taking plenty of fluids is vital for bowel movement, preventing constipation, and progression of infection.

Well-Cooked Food: Overuse of raw food can intensify the condition. Moderately cooked food (including vegetables for salad) is often recommended.

Complications
Presence of pouches within the digestive tract is not fatal in most of the individuals. However, once the pouch (diverticula) ruptures, it results in spread of infection and other complications. Some of the common complications are:

  • Diverticula rupture leads to bleeding within and around the colon, thereby leading to the development of severe colonic infection
  • Development of fistula between vagina and colon (in females) and colon and urethra (in males)
  • Development of irritable bowel syndrome (IBS)
  • Infections such as urinary tract infection, colon infection, and digestive tract infection

Conclusion
Diverticulitis is a common digestive tract disorder, which is characterized by the formation and rupture of diverticula (pouches). These diverticula develop within the inner lining of the digestive tract. The condition is often quite painful and requires immediate diagnosis and treatment. Drugs, including metronidazole, metronidazole, ciprofloxacin, etc. and surgery are the most common treatment strategies in the management of diverticulitis. The condition is associated with various complications such as IBS, fistulas, colonic bleeding, etc.

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References
1. Lobo-Machín I, Delgado-Plasencia L, Hernández-González I, et al. Appendiceal diverticulitis and acute appendicitis: Differences and similarities. Rev Esp Enferm Dig. 2014 Aug;106(7):452–458.

2. Barton JS, Karmur AB, Preston JF, Sheppard BC. Familial jejuno-ileal diverticulitis: A case report and review of the literature. Int J Surg Case Rep. 2014 Nov 1;5(12):1038–1040.

3. Lohrmann C, Ghanem N, Pache G, et al. CT in acute perforated sigmoid diverticulitis. Eur J Radiol. 2005 Oct;56(1):78–83.

4. [No authors listed] Diverticulitis is less common than we thought. Harv Mens Health Watch. 2014 Mar;18(8):8.

5. Feingold D, Steele SR, Lee S, et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014 Mar;57(3):284–94.

6. Humes DJ, Spiller RC. Review article: The pathogenesis and management of acute colonic diverticulitis. Aliment Pharmacol Ther. 2014 Feb;39(4):359–70.

7. Tursi A. Preventing recurrent acute diverticulitis with pharmacological therapies. Ther Adv Chronic Dis. 2013 Nov;4(6):277–86.

8. Samdani T, Pieracci FM, Eachempati SR, et al. Colonic diverticulitis in chemotherapy patients: Should operative indications change? A retrospective cohort study. Int J Surg. 2014 Nov 7;12(12):1489–1494.

9. Hupfeld L, Burcharth J, Pommergaard HC, Rosenberg J. Treatment of acute purulent diverticulitis is still not clarified. Ugeskr Laeger. 2014 Mar 10;176(11B). pii: V09130568.

10. Scotti A, Santangelo M, Federico S, et al. Complicated diverticulitis in kidney transplanted patients: analysis of 717 cases. Transplant Proc. 2014 Sep;46(7):2247–50.

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