Diverticulitis—Here are the Answers

What is diverticulosis?

Many people have small pouches in their colon (large intestine) that bulge outward creating what is called a diverticulum. This condition is also known as "diverticulosis." The condition becomes more common with age and about 10 percent of Americans over the age of 40 have diverticulosis. Nearly half of people over age 60 have diverticulosis.

About 10 percent of Americans over the age of 40 have diverticulosis. The condition becomes more common with age.

About half of people over age 60 have diverticulosis.

What is diverticulitis?

When these pouches become infected or inflamed it is called "diverticulitis" as anything that ends in "-itis" means inflammatory diseases. This condition happens in 10 to 25 percent of people with diverticulosis.

When the pouches (diverticulosis) become infected or inflamed it is called diverticulitis.

This condition happens in 10 to 25 percent of people with diverticulosis.

What does diverticulitis feel like?

Patients have described the symptoms of diverticulitis as a "dull" and other times "intense" pain. It can even be a "debilitating" type of pain with an unpredictable clinical pattern.

When the pouches (diverticulosis) become infected or inflamed it is called diverticulitis.

How common is diverticulitis?

The condition accounts for millions of clinic visits and hundreds of thousands of hospital admissions every year.

The majority (~90%) of all diverticulitis is "uncomplicated"—which means there is no abscess, perforation, need for drainage or surgery.

The majority (~90%) of all diverticulitis is "uncomplicated."

What causes diverticulitis?

It is poorly understood what causes diverticulitis. It was once thought that diverticulitis was due to a "polymicrobial" (many types of bacteria) infection in a diverticular "micro-perforation." This is now questioned.

What are the risk factors for diverticulitis?

• Age

• Sex

• Lifestyle

• Diet

• Physical activity level

• Smoking

• Nonsteroidal anti-inflammatory drugs (NSAIDs like ibuprofen)

Make healthy food choices, be more active, eat a better diet, and keep your body mass index (BMI) where it should be.

What about age and sex as a risk for diverticulitis?

• Before the age of 50 years old, men are at greater risk than women for diverticulitis.

• After the age of 60 years old, women are at greater risk than men for diverticulitis.

What lifestyle as a risk for diverticulitis?

Poor dietary choices (read: choices) and a sedentary lifestyle, with a lack of physical inactivity, all increase your risk for diverticulitis.

Other risk factors are a smoking history

The regular use of nonsteroidal anti-inflammatory drugs, such as ibuprofen, has been associated with diverticulitis.

Is diverticulitis hereditary?

It is reported that roughly 50% of the risk is hereditary.

Is diverticulitis cancer or am I at risk for cancer from it?

The accuracy of the clinical diagnosis is only 50% based on a medical history and physical exam.

Thus CT scan images of the abdomen are important as they have a 96% sensitivity and 95% specificity for diagnosing diverticulitis.

Guidelines from the American Gastroenterological Association on diverticulitis recommend colonoscopy six to eight weeks after diagnosis.

Guidelines from the American Gastroenterological Association on diverticulitis recommend colonoscopy six to eight weeks after diagnosis

Why do I need a colonoscopy six to eight weeks after the diagnosis of diverticulitis?

Because one of 100 patients presumed to have diverticulitis on CT, in fact, has a malignancy (colon cancer).

One of 100 patients presumed to have diverticulitis on CT, in fact, have a malignancy (colon cancer).

Can it develop into "complicated" diverticulitis?

Remember, the majority (~90%) of all diverticulitis is "uncomplicated"—which means there is no abscess, perforation, need for drainage or surgery.

• Only 2% of patients with "uncomplicated" diverticulitis will develop an abscess greater than 5 cm and a perforation.

• Typically this would occur within the first six months. Again, this is only ~2% of the cases of "uncomplicated" diverticulitis.

Will I still have pain from diverticulitis?

Possibly. It is reported that ~40% of patients report "ongoing abdominal discomfort" at one year after the episode of "uncomplicated" diverticulitis.

~40% of patients report "ongoing abdominal discomfort" at one year after the episode of "uncomplicated" diverticulitis.

Sometimes you will need to repeat the CT scan, get labs, and in certain instances have a repeat colonoscopy.

Why do I still have pain from diverticulitis?

Diverticulosis without diverticulitis is what is usually found after successful treatment. You should focus on diet, lifestyle, and avoiding constipation.

Pain, in this setting, if usually due to "visceral sensitivity." This is a common, and known—a phenomenon that is similar to Irritable bowel syndrome (IBS). Read more about this in my other posts.

• Visceral hypersensitivity (VH) is a multifactorial process that may occur within the peripheral or central nervous systems and plays a principal role in the etiology of IBS symptoms. J Neurogastroenterol Motil. 2016 Oct; 22(4): 558–574.

Is my diverticulitis going to recur?

The risk for a recurrence is 20% within five years of the first episode of an "attack."

The risk for a recurrence is 20% within five years of the first episode of an "attack."

~40% of patients report "ongoing abdominal discomfort" at one year after the episode of "uncomplicated" diverticulitis, thus diverticulitis can then be considered a chronic disease.

Am I at risk for "complicated" diverticulitis?

"Complicated" cases (abscess, perforation, need for drainage, or surgery) of diverticulitis usually present as the first episode.

The risk of "complicated" diverticulitis "decreases" with each recurrent episode.

How will I be treated?

Infection is believed to be a component of diverticulitis. Thus, the standard treatment for years has been and remains antibiotics.

Newer studies question whether antibiotics actually expedite or "speed up" the recovery from acute diverticulitis.

Guidelines for the management of acute diverticulitis (Gastroenterology 2015;149[7]:1944-1949), support that antibiotics be used selectively, rather than routinely, in patients with uncomplicated acute diverticulitis.

Although more commonly used, acute uncomplicated diverticulitis warrants antibiotic treatment per guidelines only in the setting of "severe symptoms, comorbidities, and immunosuppression."

Will I need surgery?

Elective surgery can be considered for patients with recurrent episodes of uncomplicated diverticulitis.

Traditionally, counting episodes of recurrent attacks as the determining factor for surgery is changing. Surgery is indicated for those that are immunosuppressed, and those at increased risk for complicated disease.