Changes in the World of Diverticulitis

Diverticulosis: Brief Overview

Diverticulosis is the outpouching of the inner mucosa in the GI tract. Most are found in the large colon, specifically the sigmoid area. For more detailed information on diverticulosis, see the following article: Taking the Mystery Out of "Tics" (Diverticulosis)

Diverticulosis isn't a problem unless it becomes infected or causes bleeding.

Diverticulosis is very prevalent, especially in the United States. In fact, 50% of the population over 50 are diagnosed with it¹. Of that 50%, diverticulitis is thought to develop in what is guessed as 10 to 25 %¹. When it comes to diverticulosis and its watershed of possibilities, statistics are only estimates. Not many absolute facts are known about diverticulosis or diverticulitis. 

Diverticulitis: Overview

When diverticulosis becomes inflamed, that is called diverticulitis. Fecal material that becomes caught in the diverticulum causes inflammation².  This can lead to an obstruction, an abscess, a fistula, or even perforation in complicated diverticulitis². When a patient is diagnosed with symptomatic diverticulitis, the doctor must decide if they need to be hospitalized.  The decision to hospitalize a patient with diverticulitis is based on their comorbidities². The physician would also assess their pain level and if they are able to drink fluids and eat². If the patient isn't able to eat or drink enough, or their pain level is high, then they will need in-patient medical care to recover.

Classifications

• Chronic recurrent diverticulitis
• Segmental colitis concurrent with diverticulosis (SCAD)
• Symptomatic uncomplicated diverticular disease (SUDD)

SCAD is considered to be benign and does not always involve the diverticulum². It is defined as being segmental in the sigmoid area, causing rectal bleeding, diarrhea, and abdominal pain². SUDD presents with chronic abdominal pain without acute symptoms, It is very similar to irritable bowel in its disease process and presentation². 

Patients that take NSAIDs or aspirin have an increased chance of developing bleeding in the GI tract. They are finding that it also increases their chance of diverticulitis². Therefore, doctors caution patients after a bout of diverticulitis to avoid NSAIDs, but not therapeutic aspirin². 

Treatment

In the past, diverticulitis has been blamed on infection, but they are now realizing that it can also be inflammation. Antibiotics have generally been used to treat diverticulitis, but studies are showing that they haven't helped in uncomplicated diverticulitis. However, they did help with complicated diverticulosis². In fact, for uncomplicated acute diverticulitis, recovery was not longer without antibiotics².  They have found that many patients do not benefit from antibiotics and that the body heals itself in about the same amount of time. Below is a list of medications that have been used in the treatment of diverticular disease that has not been shown to lessen its recurrence:

1. Mesalamine
2. Rifaximin
3. Probiotics

Patients who are physically very active reduce their chances of developing diverticulitis². Treatment is becoming more individually focused and holistic. 

Another treatment that has historically been used is surgery after the second episode of diverticulitis². They are finding that medical treatment works in reducing the recurrence rate, and surgery is not considered now until the fourth episode of diverticulitis².  A colonoscopy is recommended after the patient has healed to make sure that there isn't other pathology that needs to be addressed. 

Trends

New studies have shed some light on how diverticular disease can be treated. Previously, several theories on preventing diverticulitis have included increased fiber in the diet. Also, it is thought that constipation could cause diverticular disease. However, these approaches have been challenged and are no longer the gold standard¹. As mentioned above, exercise is now thought to help. Also, now there is research to show that genetics may have a linking factor¹. Diverticular disease is still mysterious to the GI world, but as more studies are done, better treatment will be a result. 

Conclusion

In the world of medicine, things are always changing and improving. And as this happens, treatment for diverticular disease becomes more individualized. With the reduction in the use of antibiotics and surgery, the patient is not at risk for complications as a result of them. It also reduces costs to the patient and to the healthcare system in general. There has been an increase in young patients and in obese patients, which may speak to a larger problem. The common mantra is that a healthy diet and exercise go a long way to protecting us from many disease processes. We know this to be helpful, and as nurses, we are an example and educators at the same time. 

Have you seen any alternative treatments for diverticular disease?

How successful were they?

References

¹ Everything you need to know about diverticulitis: Causes

² Diverticular Disease: An Update on Pathogenesis and Management