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Thursday 21 November 2024

Peer Reviewed

Gastroenterology clinic

Managing patients with diverticulosis

Bruce Stewart

Recent articles on:
Diverticulosis and diverticulitis

The ins and outs of diverticular disease

Diverticular disease: picking the facts out of the pockets

Managing patients with diverticulosis

A man with rectal bleeding who wishes to avoid colonoscopy

Looking at colonic diverticular disease

Recent articles on:
Digestive diseases

Dysphagia – an updated guide to investigation

Anal disorders – haemorrhoids, abscesses and fissures

Coeliac disease – optimising long-term management

Irritable bowel syndrome: an update on diagnosis and management

Is heartburn always reflux? An update on gastro-oesophageal reflux

Abstract

While asymptomatic diverticular disease requires no specific treatment, acute diverticulitis should be managed with bowel rest and antibiotics, plus further investigation if symptoms do not resolve within 48 hours. Emergency surgery is sometimes necessary.

Key Points

Remember

Diverticulosis is a common condition in the Western world, affecting most people over 50 years of age. The vast majority of patients will have no significant clinical sequelae and the diagnosis may only be made incidentally during investigations for other colonic pathology.
The aetiology is presumed to relate to a refined diet with inadequate fibre intake leading to segmental colonic spasm, with high intraluminal pressure between constricted segments allowing mucosal herniation through the muscular wall of the bowel (Figure). The herniation usually occurs along the line of feeding vessels, which represent the site of maximal weakness, and there is usually associated muscle wall hypertrophy due to the heightened muscular activity.