Diverticular Disease

Question 1

What do I need to know about Diverticular Disease?

Answer 1

• To explore aetiological factors that are involved in the development of diverticular disease
• To examine the conditions of diverticulosis and diverticulitis, and associated malabsorption

Question 2

What is Diverticular Disease?

Answer 2

• Diverticula - small pouches in the large bowel wall
• Pouches formed when inner layers of large bowel push through weak areas in the more superficial muscle layers
• Most common in descending/sigmoid colon
• Normally asymptomatic but can turn into Diverticultis when there is inflammation and pain

Question 3

What are the signs and symptoms of Diverticular Disease? What are the potential complications?

Answer 3

Signs and symptoms
* Pain, usually lower left quadrant but right-sided in people of Asian descent
* Fever
* Abdominal tenderness
* Nausea and vomiting
* Constipation or, less commonly, diarrhoea

Complications :
* Abscess
* Stricture formation due to scarring
* Intestinal fistula, perforation, or obstruction
* Generalized peritonitis
* Sepsis

Question 4

What likely causes Diverticular Disease?

Answer 4

What contributes to the development of diverticula (the pounches)?
* Ageing
* Low-fibre, high-animal fat diet
* Obesity
* Smoking
* Sedentary lifestyle
* Medications – steroids, NSAIDS, Opioids

Think about how each of these factors affects the bowel wall – what mechanical effects and effects on tissues might there be?

Question 5

What is the pathophysiology of Diverticular Disease?

Answer 5

Pathophysiology usually of Diverticulitis
* Single muscle layer in large intestine presents more vulnerability to herniation than the double muscle layer of the small intestine
* Ageing leads to decreased elasticity of the colonic wall, more prone to damage
* Dietary impacts slow transit time and increase weight and retention of stool
* Increased pressure in bowel lumen, erosion, inflammation

Question 6

What are the key diagnostic tests for Diverticular Disease?

Answer 6

Diagnosis
* Case history
* Blood test (to rule out coeliac disease)
* Colonoscopy
* CT scan or CT colonography (virtual
* colonoscopy)

Question 7

What are the convential treatments for Diverticular Disease? How can herbs help?

Answer 7

Conventional treatment
Diverticulosis - the pounches have formed
* High fibre diet with increased fluid intake
* Painkillers (paracetamol)
* Bulk forming laxative
Diverticulitis - the pouches have caused inflammation
* Fluid diet followed by very low fibre during
* recovery
* Antibiotics
* Possible surgery for complications

Divertuculosis - Preventive herbs? – Gentle laxatives, demulcents
Diverticulitis - Healing herbs when inflammation strikes – Antiinflammatories, vulneraries

Question 8

What is a low FODMAP diet?

Answer 8

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are short-chain carbohydrates (sugars) that the small intestine absorbs poorly. Some people experience digestive distress after eating them.

Base your meals around low FODMAP foods such as:
Eggs and meat
Certain cheeses such as brie, Camembert, cheddar and feta NOT most cheese
Almond milk not cow milk; avoid dairy foods
Grains like rice, quinoa and oats NOT beans and pulses or wheat-based products such as cereal, bread and crackers
Vegetables like eggplant, potatoes, tomatoes, cucumbers and zucchini NOT ones like artichokes, asparagus, onions and garlic.
Fruits such as grapes, oranges, strawberries, blueberries and pineapple NOT apples, cherries, pears and peaches.