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Diverticulitis

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Diverticulitis is a gastrointestinal disease involving the large intestine. It occurs when small, abnormal pouches called diverticula become inflamed or infected. Having these pouches without any active inflammation is a separate condition known as diverticulosis. While many people live with diverticulosis without any issues, diverticulitis can cause significant medical problems. It is currently the most frequent anatomic disease of the colon.

Diverticulitis
Diverticulitis

The mechanism of diverticulitis involves a bacterial infection within these pouches. Scientists believe the process may start due to changes inside the colon. For example, high pressures from abnormally vigorous contractions may play a role. In the colon, right-sided diverticula are considered micro-hernias of the mucosa and submucosa. These occur where blood vessels penetrate the muscular layer. In contrast, left-sided diverticula are called pseudodiverticula because the herniation does not pass through all layers of the colon. When bacteria infect these areas, inflammation occurs.

Diverticulitis, very low mag
Diverticulitis, very low mag

Doctors classify the severity of the disease into different stages. Uncomplicated diverticulitis is localized inflammation without an abscess or perforation. Complicated diverticulitis includes more serious issues like an abscess or a fistula. A fistula is an abnormal connection between the colon and an adjacent organ. One widely used system is the German Classification. Stage 0 is asymptomatic diverticulosis. Stage 1a is uncomplicated diverticulitis. Stage 2b involves an abscess larger than one centimeter. Stage 3c describes relapsing diverticulitis that includes complications.

Diagnosis often relies on medical imaging to see the internal structure of the gut. A computed tomography scan, or CT scan, is the mainstay for diagnosing the condition.

Sigmadivertikulitis in der Computertomographie - coronar
Sigmadivertikulitis in der Computertomographie - coronar

CT scans can reveal localized thickening of the colon wall. They also show if inflammation has extended into the surrounding fat. Ultrasound is another tool used for preliminary investigation. It can show a thickened bowel wall or an obstructive fecalith. Doctors also look for elevated C-reactive protein and high white blood cell counts in blood tests. During the acute phase, doctors avoid using a colonoscopy because of the risk of perforation.

There is a wide range of symptoms depending on the individual. Most people experience a sudden onset of lower abdominal pain. In North America and Europe, this pain is usually on the left lower side in the sigmoid colon. In Asia, the pain is typically on the right side in the ascending colon. Other symptoms include fever, nausea, diarrhea, or constipation. Blood in the stool or fever can suggest a complication. About 5% of people experience a variant called smoldering diverticulitis. This involves frequent relapsing symptoms without progression to major complications.

Research has identified several risk factors and patterns related to the disease. Genetics play a major role, with one review estimating that 50% of the risk is attributable to genetic factors. Other risks include obesity, smoking, and physical inactivity. Diet is a complex topic in medical research. A 2017 analysis found that diets high in red meat, refined grains, and high-fat dairy were linked to increased risk. Conversely, diets high in fruits, vegetables, and whole grains were associated with a decreased risk. Interestingly, there is no evidence that avoiding nuts and seeds prevents inflammation. In fact, some studies suggest nuts and corn might help adult males avoid diverticulitis.

Significant statistics highlight the global impact of this disease. Diverticulitis is very common in the Western world, where about 35% of people have diverticulosis. In rural Africa, however, it affects less than 1%. The disease also becomes much more frequent as people age. It affects only about 5% of people under age 40, but rises to 50% for those over 60. The economic impact is also large. In 2013, the costs associated with diverticular disease were approximately US$2.4 billion in the United States. In Europe, the disease resulted in about 13,000 deaths in 2003.

Diverticulitis
Diverticulitis
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File:Gross pathology of diverticulitis with diverticular abscesses.jpg
Gross pathology of diverticulitis with...
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Diverticulitis.png
File:Sigmadivertikulitis in der Computertomographie - coronar.jpg
Sigmadivertikulitis in der...
File:Diverticulitis, very low mag.jpg
Diverticulitis, very low mag.jpg
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