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Chapter II/4: Clinical Aspects of Diverticulosis
Hagymási Krisztina
II/4.1: Introduction
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Diverticulosis of the colon is an acquired disease of the large intestine, the protrusion of mucosal and submucosal layers through the muscular layer. It develops at the weakest place of the colonic wall, usually in the entrance site of the supplying vessels . It is a pseudo-diverticulum as it does not contain all layers of the intestinal wall. The left half of the colon, in 95% the sigmoid, is affected the most frequently . The rectum is intact. In Asia more characteristically the right half of the colon is affected (70%). The number of the diverticula (from a few to even several hundreds) and their size (usually 5 to 10 mm, but also several centimeters) are varying.
The process of its development has not been fully elucidated, effects of several factors are presumed to contribute to it. It is probably generated in genetically susceptible individuals by environmental factors (obesity, reduced physical activity, dietary factors including food poor in fibers, consumption of read meats, increased intake of fat), structural anomalies of the intestinal wall (congenital or acquired structural anomalies of collagen, accumulation of elastic fibers), changes of motility (prolonged contraction of longitudinal musculature, shortening of the bowel, segmental tonic, rhythmic contractions, thickening of the muscles of the intestinal wall, shortening of the taeniae: myochosis), as well as by the increase of intraluminal pressure. No etiologic role of smoking, alcohol or coffee consumption has been established.
Diverticulosis affecting the right half of the colon may be due primarily to disorders of connective tissue . The newer hypotheses are focusing on inflammation and the changes of motility and microflora. The complaints are most likely due to inflammation even in the absence of an obvious diverticulitis. Mild chronic colitis may cause disorders of sensory and motor functions. A diet poor in fibers deteriorates the nutrition of the intestinal wall and makes it more vulnerable due to alterations in the microflora, the number and composition of intestinal bacteria, and their overgrowth. Non-steroidal anti-inflammatory drugs and platelet aggregation inhibitors play a role in the appearance of complications.
The chapter structure
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II/4.1: Introduction
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II/4.2: Epidemiology
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II/4.3: Course
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II/4.4: Symptomatology
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II/4.6: Therapy
References
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Banai J.: Diverticulosis. In: A belgyógyászat alapjai (Szerk.: Tulassay Zs.), Medicina, 2011, Budapest, 894-896.
Nagy F.: Diverticulumbetegség. In: Gasztroenterológia (Szerk.: Lonovics J., Nemesánszky E., Simon L., Tulassay Zs., Wittmann T.), Medicina, 2011, Budapest, 404-409.
Gasztroenterológiai Útmutató (Szerk.: Tulassay Zs.), Klinikai Irányelvek Kézikönyve, Medition Kiadó, 2007, Budapest, 131-134.
Lakatos L., Lakatos P. L.. A diverticularis betegség és kezelése. Orv. Hetil., 2012, 6, 205-213.
Klarenbeek, B. R., de Korte, N., van der Peet, D.L. et al.: Review of current classifications for diverticular disease and a translation into clinical practice. Int. J. Colorectal. Dis., 2012, 27, 207–214.
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