Colonic Diverticular Disease: Pathophysiology and Clinical Picture

Abstract

Colonic diverticulosis is the most frequent structural abnormality of the large bowel, although it was a rarity before the 20th century. Lifestyle changes in westernized societies with reduced fiber diet are supposed to be the main cause for its high prevalence nowadays. In African countries, where staple diet is rich in fiber, diverticulosis remains very infrequent. Prevalence increases with ageing too. A fiber-deficient diet and subsequent reduction in bowel content volume would lead to increased intraluminal pressures and colonic segmentation, thus promoting diverticula formation. Animal and human studies have shown increased intracolonic pressures in patients with diverticulosis. Alterations in colonic muscle properties, collagen metabolism and in the interactions of the extracellular matrix components may play a role in remodelling the gut wall in diverticular disease. At least one fourth of patients with diverticulosis will develop symptoms, sometimes overlapping with irritable bowel syndrome, but 10–25% will suffer diverticulitis and 3–5% diverticular bleeding. Conservative medical management is usually sufficient in the first episode of diverticulitis, but surgical treatment is generally advocated in recurrences. Diverticular bleeding is a major cause of lower digestive haemorrhage, but generally self-limited. With the application of therapeutic endoscopic and angiographic methods, emergency surgery can often be avoided.

Severe Hypokalaemia, Hypertension, and Intestinal Perforation in Ectopic Adrenocorticotropic Hormone Syndrome

“…However, most of the diverticulosis cases remain asymptomatic lifelong; symptoms and findings appear only in 10%-25% of the cases [8]. Although diverticulitis regresses with medical treatment in many cases, it may cause abscess, obstruction, perforation or internal fistulization in some patients [7,8].…”

“…To the best of our knowledge, this is the first published case of lower intestinal perforation as a clinical symptom of EAS. Stress, metastasis of malignancy, excessive secretion of gastrointestinal fluid, diverticulitis, and gastrointestinal tumours may lead to intestinal perforation in patients with diverticulosis [8]. On the other hand, corticosteroid excess may prone to collagen damage and easy injury [9,10].…”

Medical treatment of colonic diverticular disease: are we sure the aim is right?

“…In fact, the symptoms taken into consideration in this study are similar to those seen in the irritable bowel syndrome, likely to overlap DD (at least in a certain percentage of patients) in this setting [11], as also shown by motility studies [12]. On the other hand, there is evidence from large patient cohorts that DD patients exhibit different and more specific abdominal pain patterns [13], and that only abdominal pain lasting for more than 24 h discriminates patients with DD from those with an irritable bowel syndrome (G.Bassotti, R.Cuomo, B.Annibale, unpublished data).…”

Probiotics in diverticular disease: not ready for prime time?

“…The diverticular disease of the colon is a common condition in the Western world, especially in elderly people, with a prevalence of about 65% in subjects aged over 65 years [1,2].…”

“…While the majority of patients with colonic diverticulosis remains asymptomatic, in up to 20% of cases recurrent episodes of abdominal pain with or without frank inflammation (diverticulitis) will develop [1,2]. One of the possible mechanisms of diverticular inflammation is represented by overgrowth or alteration of the enteric flora, which provides the rationale for the use of a non-absorbable antibacterial agent such as rifaximin [3,4] in addition to dietary fiber supplementation and/or mesalamine administration [4].…”