Only 4% of Diverticulosis Cases Worsen into More Serious Condition

Diverticulosis
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If you have been diagnosed with diverticulosis, you may worry that you are automatically destined to develop a worsening of the disease (known as diverticulitis). But researchers have found that only a few actually do.

Over 15 years, UCLA researchers followed over 2,200 patients from the Veterans Affairs Health System that had confirmed cases of diverticulosis, which are pouches in the lining of the colon commonly detected during colonoscopy. Of those, only 4.3% developed diverticulitis, using a very liberal definition of the condition. Only 1% actually developed a CT-scan confirmed case of the disease.

Those identified at a younger age were more likely to progress into diverticulitis than those diagnosed at an older age. However, the risk is still much lower than was previously thought.

The study will help inform patients with diverticulosis and their physicians about the risks of developing acute diverticulitis, said study senior author Dr. Brennan Spiegel, an associate professor of medicine at the David Geffen School of Medicine at UCLA. The study appears in the December edition of the journal Clinical Gastroenterology and Hepatology.

Diverticular disease accounts for more than 300,000 hospital admissions per year in the United States and health care costs for the condition annually are around $2.4 billion.

As people age, most will develop diverticulosis. More than half of people over 60 and two-thirds of those over 70 have the condition. Pressure within the colon causes bulging pockets of tissue (sacs or pouches) that push out from the colon walls. These can occur anywhere in the colon but are most often found near the end of the left colon, known as the sigmoid colon.

However, most patients with diverticulosis have few or no symptoms. The most common symptoms include abdominal pain, constipation and diarrhea. Occasionally, bleeding can occur.

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Treatment of diverticulosis can include a high fiber diet (to improve transit time within the colon which reduces pressure) and anti-spasmodic drugs such as Librax, Bentyl, Donnatal, and Levsin.

When a diverticulum ruptures and infection sets in, diverticulosis has progressed into a more serious condition known as diverticulitis. Symptoms include abdominal pain (especially on the left side), abdominal tenderness, colon obstruction, and fever. This is treated with antibiotics, or in more severe cases, surgery.

“With an aging population and greater use of colonoscopy for colorectal cancer screening, more and more people are going to be told they have diverticulosis,” Spiegel said. “If providers had more accurate information regarding the risk of diverticulosis complications, they then could make better decisions about the timing of interventions such as surgery.”

How can you prevent diverticular disease? Once formed, diverticula are permanent but you can reduce the risk of developing them in the first place by increasing fiber in the diet. Fiber keeps stools soft and bulky, which makes them easier to pass. Your goal should be to consume at 30-35 grams of fiber per day.
• Trade refined grains for whole grains such as bran, whole wheat, rye and oats.
• Switch out your white rice for brown. Or try quinoa or kaniwa.
• Add beans and lentils to your meals. Include them in casseroles, soups or salads.
• Eat plenty of fresh fruits and vegetables, especially those with edible skins.
• Remember to drink plenty of water when increasing fiber intake. Aim for at least 8 eight-ounce cups per day.

If you have diverticulosis, your doctor may tell you to restrict foods that may become trapped in the diverticula, such as nuts, seeds, corn or popcorn. However, there really is no scientific data to support this, so eat these foods as tolerated.

Should you develop diverticulitis, your doctor will then ask you to restrict your intake of fiber. The goal is to now reduce the amount of residue present in the colon to allow it to rest and heal. For the first few days, you may need to be restricted to a clear liquid diet, consisting only of broth, apple juice, plain gelatin, and tea or coffee without cream.

A low-fiber diet includes foods such as canned or cooked fruits without seeds or skin, canned or cooked soft vegetables, white breads and pastas, and low-fiber cereals. You should feel better within two to three days of beginning these diets.

Reference:
Peery AF, Sandler RS. Diverticular Disease: Reconsidering Conventional Wisdom. Clinical Gastroenterology and Hepatology, Volume 11, Issue 12 , Pages 1532-1537, December 2013

Additional Resources:
National Institutes of Health
Stanford Hospital and Clinics: High Fiber Diet for Diverticulosis
Mayo Clinic: Diverticulitis Diet

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