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The inhabitants of the poor regions of Africa and Asia have not even heard of diverticula. This is a typical ailment of societies in highly developed countries, resulting from the low content of fiber in the diet. So let’s find out how it is treated, and even better – how to prevent it.
Diverticula are nothing more than a bulging of the wall of an organ that has light. They resemble pockets and appear as single or multiple lesions. In the case of a large number of them, we are talking about diverticulosis. They are found in every part of the digestive tract. They most often appear in the large intestine, especially in the sigmoid colon (90%) and the descending colon, less often in the rectum or proximal parts of the intestine. In about 7% of people, diverticula affect the entire colon. Their diameter usually does not exceed 1 cm.
Regardless of their location, diverticula can be divided into congenital and acquired. The former, which are elevations of the intestinal wall layers, are rare and of little importance. They are usually single cecal diverticula. Acquired diverticula are much more common. These are small pockets of a hernia of the mucosa and submucosa. Their walls are thinner and do not contain a muscular layer, hence their name – pseudodiverticula or pseudo-diverticula.
With whom and why?
They appear most often around the age of 50, and their frequency increases with age. Over the years, their number and size may also increase. It is estimated that diverticula concern about 1/3 of inhabitants of developed countries, who are over 60 years of age.
Interestingly, they are practically not found in poor regions of Africa or Asia, where the diet is based on plant-based foods. Hence the belief that the factor contributing to their formation is insufficient fiber content in food. This causes constipation, colon cramps, an overgrowth of the muscular layer in the colon, and an increase in pressure in the lumen of the intestine. This, in turn, pushes the intestinal mucosa and submucosa outwards at the points of least resistance.
The decrease in the elasticity of the walls of the colon, especially the sigmoid colon, which progresses with age, also plays a significant role in the development of diverticula.
Diverticular disease
The presence of diverticula is not a disease. Most often (70-80%) they do not cause ailments and are detected accidentally during imaging examinations of the large intestine. This asymptomatic presence of a large number of diverticula is referred to as colonic diverticulosis.
In others, diverticula may be accompanied by pain, usually in the lower left abdomen, flatulence, constipation, or constipation, alternating with diarrhea. There are also symptoms that suggest intestinal obstruction, such as a temporary arrest of bowel movements and an inability to pass gas. So when there are also complaints, we are talking about diverticular disease of the colon.
Multiple complications
The most common complication of diverticulosis is acute diverticulitis (10-25%). It starts in a single diverticulum and spreads rapidly along the colon to form a colonic abscess. The incidence of this complication increases with age. When the thin wall of an inflamed diverticulum (perforation) breaks, the contents of the intestine pours into the peritoneal cavity through the hole and causes it to become inflamed. Fortunately, it is usually limited and has the character of localized peritonitis. The symptoms of this complication include soreness in the left lower abdomen, a palpable lump or muscle stiffness in the abdominal wall. There may also be general symptoms such as fever, malaise, an increase in the number of white blood cells or an increase in ESR. Treatment for several days includes bed rest, a strict diet, and the use of oral or parenteral antibiotics depending on the patient’s condition.
Some of the less common complications of diverticulosis require emergency surgery. These include perforation with diffuse peritonitis, intra-abdominal abscess or mechanical intestinal obstruction. Sometimes it is also operated due to recurrent diverticulitis or obstruction. It is then that most often the changed part of the intestine is excised and the continuity of the gastrointestinal tract is restored. A novelty is the possibility of removing a part of the colon by laparoscopic technique, which is less strenuous than classic surgery.
Another complication is diverticular haemorrhage, presenting with sudden rectal bleeding, low blood pressure, increased heart rate, or fainting. In most patients, it stops spontaneously. However, some people with persistent or recurrent bleeding require surgery.
A rare complication is the development of abnormal connections (fistulas) between the colon and adjacent organs, such as loops in the small intestine, bladder or vagina. They also require surgery.
Fiber is essential
Uncomplicated diverticular disease does not require hospital treatment. In its treatment, it is recommended to increase the consumption of dietary fiber. The recommended amount (approx. 30 g / day) is contained in approx. 0,5 kg of vegetables and fruit. Its rich source is also wheat bran (3-4 tablespoons equals 15-20 g of fiber). In diverticular disease of the colon, it is recommended initially to eat 1-2 tablespoons of bran a day, then increase the dose by 2 tablespoons every week, reaching about 6 tablespoons a day. However, it is only after a few weeks that a marked reduction in abdominal pain and normalization of bowel movements can be expected.
In some patients, sudden increases in fiber may lead to a temporary increase in gas and gas. It should also be remembered that the chronic use of bran reduces the absorption of, e.g. iron and magnesium, the serum levels of which should be checked periodically. In diverticular disease, the improvement can also bring diastolic drugs and drugs regulating the motility of the gastrointestinal tract.
In the prevention of colonic diverticulosis, the main role is played by the prevention of constipation, i.e. a diet rich in fiber, drinking the right amount of fluids, regular physical activity and fighting overweight and obesity.
Text: Dorota Ksiądzyna, MD, PhD
Source: Let’s live longer
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