Diverticular Disease in the Elderly

Abstract

There are few diseases whose incidence varies as greatly worldwide as that of diverticulosis. Its prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those ≧65 years of age. Of patients with diverticula, 80–85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15–20% of patients develop symptomatic diverticular disease. Traditional concepts regarding the causes of colonic diverticula include alterations in colonic wall resistance, disordered colonic motility and dietary fiber deficiency. Currently, inflammation has been proposed to play a role in diverticular disease. Goals of therapy in diverticular disease should include improvement of symptoms and prevention of recurrent attacks in symptomatic, uncomplicated diverticular disease, and prevention of the complications of disease such as diverticulitis. Diverticulitis is the most usual clinical complication of diverticular disease, affecting 10–25% of patients with diverticula. Most patients admitted with acute diverticulitis respond to conservative treatment, but 15–30% require surgery. Predictive factors for severe diverticulitis are sex, obesity, immunodeficiency and old age. Surgery for acute complications of diverticular disease of the sigmoid colon carries significant rates of morbidity and mortality, the latter of which occurs predominantly in cases of severe comorbidity. Postoperative mortality and morbidity are to a large extent driven by patient-related factors.

Risk factors for severity and recurrence of colonic diverticular bleeding

“…This was expected since transfusion needs, which is one of our criteria for severe bleeding, are determined mainly by low hemoglobin levels. Older age has been associated with the development of diverticulosis (6,9,(33)(34)(35)(36) and also with increased risk for LGIB (16) and CDB recurrence (26). As mentioned above, in the present study older age was also a predictive factor for severe CDB.…”

Review article: the current and evolving treatment of colonic diverticular disease

“…Colonic diverticulosis is characterized by the presence of sac-like protrusions (diverticula), which form when colonic mucosa and sub-mucosa herniate through defects in the muscle layer of the colon wall. 5,6 It is highly prevalent in western countries, but is rarely encountered in the developing world. 7,8 The risk of acquiring the disease increases uniformly with age, with approximately 40% of people aged over 60 years being affected in western countries.…”

“…The increased pressure on the colon wall causes it to herniate at its weakest points between the taenia coli at sites of arterial blood vessel (vasa recta) penetration. This leads to diverticula formation 5,6,[17][18][19] The most common site of diverticula formation in western patients is in the sigmoid colon, the site with the smallest lumen and the highest intraluminal pressure, 19 although other areas of the large intestine and even the entire colon can be affected. 20 The process through which diverticula become inflamed is thought to be similar to the mechanism that causes appendicitis, whereby the necks of diverticula become obstructed by inspissated food particles, with the subsequent irritation causing increased mucus production and allowing bacterial overgrowth, which ultimately leads to inflammation and potential perforation.…”

Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies

“…The prevalence of diverticulosis and subsequently diverticulitis is increasing in the last decades [1,2]. Diverticulosis increases with age; it is estimated less than 10% in those under the age of 40 and increases to 65-70% in those above 65 years of age [3][4][5].…”