Diverticulitis

Diverticulitis

Diverticulitis is a condition when pouches form in the wall of the large bowel and undergoes inflammatory processes. ^[1] Most patients are elderly although it can occur in younger people. The most common complaint is abdominal pain usually localized in the left lower area. ^[2]

Diverticulum and diverticulitis

The colon or large intestine is a lengthy structure that executes several functions including storage and elimination of waste products from digestive actions of the gut. ^[3] Pressure on this anatomic structure may cause small tissue pockets or pouches to be pushed out from the wall. Such pouch is medically called diverticulum or diverticula when in plural form. When an infection takes place, the condition is called diverticulitis. ^[3]

Epidemiology

A large percentage of patients in the United States have ages greater than 60. Affected individuals also are commonly from the Western countries. The condition is relatively rare in Asia and Africa. ^[3]

Causes

Age is a key risk factor in the development of diverticulum. Some suggests that a diet with low fiber may predispose an individual to it. Since fiber is low, the colon performs a more difficult task to thrust the stool forward. Raised pressure may lead to out pocketing on the wall. When fecal materials get ensnared in the sacs or pouches, bacterial growth is favored ultimately resulting to inflammation and infection. ^[1][3]

Signs and Symptoms

The most common presentation is an abdominal pain felt at the left lower region. Other symptoms include fever, chills, bloating, bowel changes (diarrhea or constipation), nausea, vomiting and loss of appetite. ^[1]     

Diagnosis

Medical history is important to be taken. Physical examination may reveal localized abdominal tenderness, palpable mass, reduced or absent bowel sounds and distended abdomen. Laboratory tests may be helpful especially when in doubt. The tests that may be done are complete blood count, electrolyte assay, liver enzyme levels, urinalysis, cultures, pregnancy test (women of childbearing age) and CT scan. ^[2]

Treatment

Clear liquid diet is recommended for patients with mild condition. Antibiotics are often given. Some patients may need to be hospitalized such as those who have systemic signs of infection, with low immune status and patients who do not respond to medications given on an outpatient basis. Surgery may be indicated in some cases. ^[2]

References:

1.      http://www.webmd.com/digestive-disorders/tc/diverticulitis-topic-overview

2.      http://emedicine.medscape.com/article/173388-overview

3.      http://www.medicinenet.com/diverticulosis/article.htm

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Psyllium (Isphagula, Plantago Psyllium) [1, 2, 3, 4, 5, 6, 7]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Strongly in favor (Clinical trials have shown that Psyllium is effective in treating diverticulitis)

Grade of Evidence: High quality of evidence

Coarse Bran [8, 9]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor (Some studies show that coarse bran may be helpful to those with diverticulitis)

Grade of Evidence: Low level of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-psyllium.html

3. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601104.html

4. http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cmed&part=A17913

5. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/psyllium

6. http://www.mayoclinic.com/health/cholesterol-lowering-supplements/CL00013/METHOD=print

7. http://www.ageless.co.za/herb-psyllium.htm

8. http://www.researchgate.net/publication/22396818_Comparison_of_bran_Ispaghula_and_lactulose_on_colon_function_in_diverticular_disease

9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625022/

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