HYANNIS – Add diverticulitis to the list of ailments that can affect you as you age. As such, the condition is on the rise in the U.S., as the population grows older.
Between 2003 and 2017, hospital admissions from the disease increased 21 percent. Annual costs to treat it are estimated between 2.2 and 2.6 billion dollars, making it the fifth most expensive gastrointestinal disease in terms of cost.
“This is a very common condition,” explained Falmouth gastroenterologist David Guo, MD, PhD, at Falmouth Specialty Care, “When we do colonoscopies we see that many people have diverticulosis. Based on the statistics, by the age of 60 about 60 percent of the people will have diverticulosis. When you get older it is even more prevalent.”
But younger people are now experiencing the condition at greater numbers, he said.
“This now seems to involve more of the younger population, an 88 percent increase in hospital admissions in 18-44 years old patients from 1998-2005, so I think that is another epidemic. We don’t see as many, but we certainly see more than before.”
The reason for the rise in diverticular diseases is the usual suspect – lifestyle. The western world has more diverticulosis and therefore has more diverticulitis, according to Dr. Guo.
“Diverticulosis is a condition that is basically lots of pouches on the colon wall and diverticulitis is when one of the pockets gets infected,” he said.
The Causes
The causes of diverticular diseases, according to Dr. Guo, include:
Not eating enough fiber
A high fat, high red meat diet
Not getting enough physical activity
Obesity
Several factors appear to be associated with diverticulitis or diverticular bleeding:
Smoking
Steroid medications
Nonsteroidal anti-inflammatory drugs
Opioids
Preventing the disease centers around controlling or eliminating these factors.
Interestingly, the thing that most people assume is the biggest risk – eating seeds and nuts – is actually not true.
“Studies actually showed the opposite, or at least it’s not associated with increased risk of diverticulitis or diverticulosis or diverticular bleeding. Some studies even show that you may slightly increase the risk of diverticulitis if you stop eating (seeds and nuts),” said Dr. Guo.
The Diagnosis
Diverticulitis can be tricky to diagnose, according the Dr. Guo. The most common symptom is abdominal pain, most often in the lower abdomen on the left side, although it can occur other places. Other symptoms include fever, chills and constipation.
With simple diverticulitis, most people go to their primary care doctor or, if they are in greater pain, they head to the Emergency Department. The treatment is a fairly simple round of antibiotics, Dr. Guo said. He usually only sees those patients if the diverticulitis recurs, which it is quite apt to do.
“The risk of recurrent diverticulitis is there,” he said. “The same with diverticular bleeding. So, if you have one episode, it can turn into two or three episodes.”
The question then becomes, should the patient undergo surgery to remove the affected section of the bowel? A systematic review of the studies on the disease shows the outcome for patients with uncomplicated diverticulitis who were treated conservatively with medicine was very similar to those who had surgery, Dr. Guo said. With that in mind, there is no significant reason to do surgery on the patients who had uncomplicated diverticulitis, even with recurrent diverticulitis, unless it failed medical treatment with dietary changes and antibiotics.
That advice changes drastically with complicated diverticulitis, he said. The following conditions often call for surgery:
Diverticulitis that causes a perforated bowel would require emergency surgery.
A bowel obstruction that does not resolve itself after a few days of dietary change and medication.
Abscesses that cannot be successfully drained.
Patients who develop a fistula.
Patients who develop peritonitis.
Patients who fail with antibiotic treatment.
“In surgery, typically we remove a section of their colon that is the most prevalent section,” he said. “The sigmoid colon is one of the hot spots that diverticulosis can be present. So, you just remove that section and it removes the chance that it will recur.”
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