Diverticulosis

 ICD9           = 562|
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 OMIM           = 223320 |
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 eMedicineSubj  = med |
 eMedicineTopic = 3102 |
 DiseasesDB     = 3871 |

}} Diverticulosis, otherwise known as "diverticular disease", is the condition of having diverticulain the colonwhich are outpocketings of the colonic mucosaand submucosa through weaknesses of musclelayers in the colon wall. These are more common in the sigmoid colon, which is a common place for increased pressure. This is uncommon before the age of 40 and increases in incidence after that age.

Epidemiology

About 10% of the US population over the age of 40 and half over the age of 60 has diverticulosis. This disease is common in the US, England, Australia, Canada, and is uncommon in Asiaand Africa. It is the most common cause for bleeding in US adults over the age of 40 years.

Causes

Diverticuli are thought to be caused by increased pressure within the lumenof the colon. Constipationis the most common cause of diverticulosis. Increased intra-colonic pressure secondary to the constipation leads to weaknesses in the colon walls giving way to diverticula. Other causes may include a colonic spasm which increases pressure, which may be due to dehydrationor low-fiber diets(merck manual online 2005); although this may also be due to constipation. Fibercauses stools to retain more water and become easier to pass (either soluble or insoluble fiber will do this). A diet without sufficient fiber makes the stoolssmall, requiring the bowel to squeeze harder to remove the smaller stool. Summarizing the risk factors from this and the introduction: low-fiber/high-fat diet, increasing age, constipating conditions, and connective tissuedisorders which may cause weakness in the colon wall (ex. Marfan syndrome).

Symptoms

Often this disorder has no symptoms. The most common is bleeding(variable amounts), bloating, abdominal pain/crampingafter meals or otherwise often in the left lower abdomen, and changes in bowel movements (diarrheaor constipation). Sometimes, symptoms include unspecific chronic discomfort in the lower left abdomen, with occasional acute episodes of sharper pain. The discomfort is sometimes described as a general feeling of pressure in the region, or pulling sensation. A tickling sensation may be felt as the small pockets fill and unfill; a feeling like gas may be moving in areas outside the colon. First-time bleeding from the rectumshould be followed up with a physician, especially if over age 40 because of the possibility of colon cancer. Symptoms of anemiamay present: fatigue, light-headedness, or shortness of breath.

Testing

Colonoscopyis the most used test for diagnosis. This is important for treatment and investigation of other diseases. Other tests include abdominal X-ray, barium enema, CT, or MRI.

Complications

Infection of a diverticulum can result in diverticulitis. This occurs in 10-25% of persons with diverticulosis (NIDDK website). Tears in the colon leading to bleeding or perforations may occur, intestinal obstruction may occur (constipation or diarrhea does not rule this possibility out), peritonitis, abscessformation, retroperitonealfibrosis, sepsis, and fistulaformation.

Infection of a diverticulum often occurs as a result of stool collecting in a diverticulum.

Treatment

Often no treatment is needed. Increases in hydration, increasing fiber content in the diet (the American Dietetic Associationrecommends 20-35 grams each day), or removing factors resulting in constipation help decrease the incidence of new diverticuli or possibly keep them from bursting or becoming inflammed (ADA website). Fiber supplementsmay aid if diet is inadequate. If the diverticuli are unusually large (greater than 1 inch), often infected (see diverticulitis), or exhibit uncontrollable bleeding, surgery can be performed to decrease relapse or other complications. The NIDDK says foods such as nuts, popcornhulls, sunflower seeds, pumpkin seeds, carawayseeds, and sesame seedsshould be avoided because they may irritate diverticuli. The seeds in tomatoes, zucchini, cucumbers, strawberries, raspberries, and poppy seeds, are not considered harmful by the NIDDK. Treatments, like some colon cleansers, that cause hard stools, constipation, and straining, are not recommended.

External links

• National Institude of Diabetes, Digestive and Kidney Diseases website NIH Publication No. 04?"1163 dated August 2004, no e-copyright
• Merck Manual online
• J. American Diet Assoc. 2002;102:993-1000

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This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Diverticulosis Wikipedia article Diverticulosis.