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  • Writer's pictureBrian Dooreck MD

Diverticulitis—Here are the Answers

Updated: Jul 27, 2023


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What is diverticulosis?


Many people have small pouches in their colon (large intestine) that bulge outward, creating a diverticulum. This condition is also known as "diverticulosis." The condition becomes more common with age, and about 10 percent of Americans over 40 have diverticulosis. Nearly half of people over age 60 have diverticulosis.


About 10 percent of Americans over the age of 40 have diverticulosis. The condition becomes more common with age.

About half of people over age 60 have diverticulosis.

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What is diverticulitis?


When these pouches become infected or inflamed, it is called "diverticulitis," as anything that ends in "-itis" means inflammatory diseases. This condition happens in 10 to 25 percent of people with diverticulosis.


When the pouches (diverticulosis) become infected or inflamed it is called diverticulitis.

This condition happens in 10 to 25 percent of people with diverticulosis.

What does diverticulitis feel like?


Patients have described the symptoms of diverticulitis as "dull" and, other times, "intense" pain. It can even be a "debilitating" type of pain with an unpredictable clinical pattern.




How common is diverticulitis?


The condition accounts for millions of clinic visits and hundreds of thousands of hospital admissions annually.


Most (~90%) of all diverticulitis is "uncomplicated," meaning no abscess, perforation, need for drainage, or surgery.


The majority (~90%) of all diverticulitis is "uncomplicated."

What causes diverticulitis?


It is poorly understood what causes diverticulitis. It was once thought that diverticulitis was due to a "polymicrobial" (many types of bacteria) infection in a diverticular "micro-perforation." This is now questioned.


What are the risk factors for diverticulitis?


  • Age

  • Sex

  • Lifestyle

  • Diet

  • Physical activity level

  • Smoking

  • Nonsteroidal anti-inflammatory drugs (NSAIDs like ibuprofen)


Make healthy food choices, be more active, eat a better diet, and keep your body mass index (BMI) where it should be.

What about age and sex as a risk for diverticulitis?


  • Before 50 years old, men are at greater risk than women for diverticulitis.

  • After 60 years old, women are at greater risk than men for diverticulitis.


What lifestyle is a risk for diverticulitis?


Poor dietary choices (read: options) and a sedentary lifestyle, with a lack of physical inactivity, increase your risk for diverticulitis.


Another risk factors are a smoking history.


Regularly using nonsteroidal anti-inflammatory drugs, such as ibuprofen, has been associated with diverticulitis.


Is diverticulitis hereditary?


It is reported that roughly 50% of the risk is hereditary.


Is diverticulitis cancer, or am I at risk for cancer from it?


The accuracy of the clinical diagnosis is only 50% based on a medical history and physical exam.


Thus CT scan images of the abdomen are important as they have a 96% sensitivity and 95% specificity for diagnosing diverticulitis.


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The American Gastroenterological Association guidelines on diverticulitis recommend colonoscopy six to eight weeks after diagnosis.


Guidelines from the American Gastroenterological Association on diverticulitis recommend colonoscopy six to eight weeks after diagnosis

Why do I need a colonoscopy six to eight weeks after the diagnosis of diverticulitis?


Because one of 100 patients presumed to have diverticulitis on CT has a malignancy (colon cancer).


⛔️ One of 100 patients presumed to have diverticulitis on CT, in fact, have a malignancy (colon cancer).

Can it develop into "complicated" diverticulitis?


Remember, most (~90%) of all diverticulitis is "uncomplicated,"—meaning there is no abscess, perforation, need for drainage, or surgery.


  • Only 2% of patients with "uncomplicated" diverticulitis will develop an abscess greater than 5 cm and a perforation.

  • Typically this would occur within the first six months. Again, this is only ~2% of the cases of "uncomplicated" diverticulitis.


Will I still have pain from diverticulitis?


Possibly. It is reported that ~40% of patients report "ongoing abdominal discomfort" one year after the "uncomplicated" diverticulitis episode.


~40% of patients report "ongoing abdominal discomfort" at one year after the episode of "uncomplicated" diverticulitis.

Sometimes you will need to repeat the CT scan, get labs, and have a repeat colonoscopy in certain instances.


Why do I still have pain from diverticulitis?


Diverticulosis without diverticulitis is what is usually found after successful treatment. You should focus on diet, lifestyle, and avoiding constipation.


In this setting, pain is usually due to "visceral sensitivity." This is common and knowna phenomenon similar to Irritable bowel syndrome (IBS). Read more about this in my other posts.



Is my diverticulitis going to recur?


The risk for a recurrence is 20% within five years of the first episode of an "attack."


The risk for a recurrence is 20% within five years of the first episode of an "attack."

~40% of patients report "ongoing abdominal discomfort" one year after the "uncomplicated" diverticulitis episode. Thus diverticulitis can then be considered a chronic disease.


Am I at risk for "complicated" diverticulitis?


"Complicated" cases (abscess, perforation, need for drainage, or surgery) of diverticulitis usually present as the first episode.


The risk of "complicated" diverticulitis "decreases" with each recurrent episode.


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How will I be treated?


Infection is believed to be a component of diverticulitis. Thus, the standard treatment for years has been and remains antibiotics.


Newer studies question whether antibiotics expedite or "speed up" the recovery from acute diverticulitis.


Guidelines for managing acute diverticulitis (Gastroenterology 2015;149[7]:1944-1949) support using antibiotics selectively rather than routinely in patients with uncomplicated acute diverticulitis.


Although more commonly used, acute uncomplicated diverticulitis warrants antibiotic treatment per guidelines only for "severe symptoms, comorbidities, and immunosuppression."


Will I need surgery?


Elective surgery can be considered for patients with recurrent episodes of uncomplicated diverticulitis.


Traditionally, counting episodes of recurrent attacks as the determining factor for surgery is changing. Surgery is indicated for immunosuppressed patients and those at increased risk for complicated diseases.


Personally


I eat a high-fiber, mostly plant-based 🌱 diet, no red meat, drink 4 liters of water a day, exercise, and am focused on keeping nutrition simple. I am sharing what works for me and what I routinely recommend to my patients.


"Balance. Portion control. Keep nutrition simple. Eat Smart. Eat Healthy. 🌱 🌾 🌿"

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