Diverticulitis and diverticulosis: what they are and what is the difference
Diverticulosis and diverticulitis: causes and risk factors
Complications of diverticulitis
Diverticulosis and diverticulitis: diagnosis
Diverticulosis is often diagnosed by chance during a colonoscopy for the prevention of colorectal cancer or during a CT abdomen , which allows the evaluation of all abdominal organs and the detection of abnormalities of the small intestine and colon.
In the case of diverticular bleeding, a colonoscopy may be indicated to look for the source of the bleeding and exclude a malignoma. In the event that colonoscopy cannot be performed, interventional radiology techniques are used.
In case of clinical suspicion of diverticulitis, a blood test for general inflammatory parameters is useful. Imaging is important. The method of choice if diverticulitis of the descending colon / sigma is suspected is ultrasound . In this case the direct detection of inflamed diverticula with a thickening of the intestinal wall greater than 5 mm is often effective. Furthermore, it is possible to detect free fluid in the abdomen as a sign of an inflammatory reaction.
In heavily overweight patients, CT is often more effective than ultrasound. The patient is given the contrast medium orally, anal and intravenously to determine the exact position of the diverticulitis.
Due to the high risk of perforation, a colonoscopy should be avoided in urgency and should only be performed after the end of inflammation to rule out complications such as stenosis or malignant tumors.
Cure: the right diet
There is no possibility of therapy for the regression of diverticula . It is advisable to reduce the consumption of fatty foods and red meats to prevent the appearance and slow down the progression of diverticulosis .
The evidence, especially regarding the recommendation to follow a diet rich in fiber , is not clear. The fibers seem important in counteracting chronic constipation (as well as taking plenty of fluids and making regular meals), so to prevent diverticulosis and avert the risk that it develops in diverticulitis, but if taken in large quantities when diverticula are already present they can cause discomfort . There is no evidence to show that avoiding taking food with seeds or nuts leads to a benefit. It is therefore possible to eat foods such as tomatoes and kiwi, without removing the seeds.
These recommendations apply especially in the case of diverticulosis with “silent” symptoms, or almost, but they also apply to cases of uncomplicated acute diverticulitis: in this case the diet will vary from patient to patient, based on the intensity of the acute attack and to the foods that cause the most symptoms (for example, too many fibers can irritate the colon even more, so they are often excluded from the diet). Each patient should then individually discuss their dietary plan with the gastroenterologist based on their own discomfort.
In the case of complicated diverticulitis , strict fasting is recommended instead .
The most effective drugs for the treatment of diverticulitis
In the case of diverticulosis without symptoms, it is not necessary to take drugs . Instead it is important to follow a diet rich in fiber to prevent the appearance of disorders.
In the case of diverticulosis with vaghi symptoms (swelling, abdominal discomfort, sometimes true pain) it is useful to follow a diet rich in fiber, to be associated with probiotics and anti-inflammatories (eg Mesalazine), in some cases with antibiotics.
The use of antibiotics in case of diverticular disease with symptoms or after one or more acute episodes will have to be personalized , usually with effective intestinal drugs (eg Rifaximin) administered in cycles, followed by probiotics to restore the blood balance of bacterial flora.
The complicated diverticulitis is treated in hospital : is scheduled fasting, associated with administration of liquid for vein.
The diverticulitis uncomplicated can also be managed at home: in case of acute attack without fact, complications are not required hospitalization and antibiotic use, but you can discuss home treatment, except in elderly patients with major diseases or .
Along with probiotics, which are eventually prescribed in combination with antibiotic cycles to restore the bacterial flora, there are natural remedies that can be taken, on the advice of the herbalist, to alleviate the symptoms of diverticulitis. The herbalist , recommends 3 of them.
Vaccinium Vitis Idaea (cranberry) bud-derived . The glycerine macerate has an anti-inflammatory, antispastic action and relaxes the intestinal muscles. Indicated in irritable bowel syndrome, meteorism, dysbiosis, diverticulitis. How to use: 50 drops in a little water 2 times a day before the main meals for 2 months.
Mallow flowers and leaves . Mallow has emollient and calming properties, especially to relieve inflammation of intestinal mucosa. The flowers and in particular the leaves of the mallow are rich in mucilage able to ignite the colon and gently purify the intestine. How to use: bring about 200 ml of water to the boil, add a spoonful of mallow, prolonging boiling for a few moments. Turn off and leave to infuse for 15/20 minutes (stirring occasionally), strain and drink 1 to 3 cups a day, preferably between meals.
Lemon balm leaves in herbal tea . Lemon balm leaves contain essential oil, mucilage, useful tannins against painful spasms and help eliminate gas accumulations in the digestive tract. How to use: bring about 200 ml of water to the boil, pour a tablespoon full of lemon balm, turn off and leave to infuse (stirring occasionally). Strain and drink 1 to 3 cups a day.
When is surgery necessary and what does it consist of?
Surgery is usually only necessary in case of complications, such as perforation, stenosis, fistulae . It almost always intervenes in an emergency condition and almost never in prophylaxis. The intervention consists of a resection of the colonic tract involved with anastomosis (which consists in attacking the two stumps). Often for small abscesses without perforation, drainage and antibiotics are enough.
How to prevent diverticulosis and diverticulitis
As mentioned above, nutrition plays an essential role in preventing the onset and progression of diverticulosis. It is important, in particular, to reduce the consumption of fatty foods and red meats .
Even following a diet rich in fiber helps to combat constipation and thus prevent diverticulosis, as well as always ensuring the right hydration , either by drinking at least 1.5 / 2 liters of water a day, or by bringing food to the table. If diverticulosis is already present, the fibers are still important for preventing constipation and the development of diverticulitis. But be careful, in some cases too many fibers can also cause the opposite effect and give symptoms.
Regarding diverticulitis , recent studies have identified a direct link between consumption of red meat and the incidence of the disease , so it is advisable to limit the intake of meat, especially if you are at risk.
An abundant consumption of fruit and vegetables helps to reduce the risk of diverticulitis.
It is also important to have an active life to combat overweight and obesity, risk factors for the appearance of diverticolos : it is useful to practice sport consistently or, if this is not possible, to try to stay active, taking a brisk half-hour walk every day or using the stairs instead of the elevator.
Article written in collaboration with specialist medical personnel