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Diverticulitis

Diverticulitis is something that is mentioned quite often in the discussions of common medical issues.  Many times it is people confusing diverticulitis with diverticulosis.  A quick review:

  • A diverticula is a general name for an out-pouching of a hollow structure within the body.  It is most commonly used to discuss out-pouchings related to the colon.

                                        

  • Diverticulosis is just the presence of diverticula in the walls of the digestive tract, AKA the colon.  Diverticulosis is incredibly common, with most people having it by the age of 75 and just seen incidentally when they get a colonoscopy.

  • Diverticulitis is inflammation of one or more of these diverticula

I want to talk just a little bit about diverticulitis because there are a few major confusing things about it.

In general, for most people, diverticulitis presents as a left lower abdominal pain that goes on for several days.  There is usually some nausea associated with it, sometimes constipation, sometimes diarrhea, sometimes fever and sometimes some blood in the stool.

Misconception 1
It runs in my family 

There is not a known genetic component to diverticulitis, or diverticulosis for that matter, outside of some rare genetic syndromes.  What actually happens is it is such a common condition, becoming more common over time, that you can certainly see cases of diverticulitis in multiple generations of a family just by chance.  The main risk factors that we know of that contribute to diverticulitis are in the diet, specifically one that is low in fiber and high in fats and red meats, as well as physical inactivity and obesity, all of which are becoming much more common in today's society.

Misconception 2
Never eat popcorn or nuts if you've had diverticulitis

This used to be common advice because logically if you had a small out-pouching in the colon, you were worried about it getting blocked up with a small hard object.  But over time as we have done research on this, they looked at something like 50,000 cases of diverticulitis and never found any time where that actually happened.  Furthermore, because things like popcorn and nuts and seeds are higher in fiber and healthy fats, eating more of these actually reduce the risk of diverticulitis

Misconception 3
If you get it once, it will just keep getting worse

Again, previously the thinking had been that after a bout of diverticulitis, future ones would be worse and so there was a movement to perform earlier surgery to remove the part of the colon that had been affected.  Over time, we have seen that not only is this not true, but some research suggests that future episodes of diverticulitis are less severe than the initial and certainly not generally worsening over time.  There are exceptions to this rule of course, but these days we are becoming much more conservative in how we treat diverticulitis.  

In some instances, there has been more of a push to not use antibiotics for uncomplicated cases as research has shown they do not help.  About 15% of people will get a complicated case of diverticulitis where they can have issues with worsening infection like an abscess, but otherwise people do just fine.  You have somewhere between a 20-50% chance of having a recurrence, but by and large surgery is generally reserved for people who get multiple repeated severe bouts of diverticulitis.

Misconception 4
Doctors can usually tell when you have it

So this is the reason I got the inspiration to write this post–a recent study showed that about 50% of the time when a doctor thinks you have diverticulitis, we are wrong.  The gold standard for diagnosing diverticulitis is now a CT scan of the abdomen which can show most cases of diverticulitis because it can actually see inflammation happening in and around the diverticula.  This is important because if we are saying that people should be treated for diverticulitis with antibiotics, that is 50% of people who are getting exposed to unnecessary antibiotics which has a significant downstream effect, causing side effects and other infections and promoting antibiotic resistance.  I think practice has been shifting when possible over time to say that for an initial bout of diverticulitis, a CT scan should be performed before anything else is done.

Do not Pass Go
(or follow up colonoscopy)

One final note is that basically everybody who gets diverticulitis should have a colonoscopy, usually about 6-8 weeks later once the inflammation dies down.  The reasoning behind this is that in some cases, diverticulitis can be an initial sign of underlying colon cancer.  Research has found that this is more true for people who are older or who have complicated cases and is generally considered to be the standard of care.

For more information, or even just a prettier rehash of the above, here is some more information on diverticulitis

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