gastrointestinal disorders
Colonic Diverticulosis
Treatment of Colonic Diverticulosis
No treatment for asymptomatic diverticulosis Management of specific symptoms Diverticular bleeding treated as a lower GI bleed Asymptomatic diverticulosisrequires no treatment or dietary changes. There is no association between consumption of nuts, seeds, corn, or popcorn and diverticulitis, diverticular hemorrhage, or uncomplicated diverticulosis, and avoidance of these foods is no longer recommended. NSAIDs and opioid analgesics may increase the risk of diverticular perforation and bleeding, therefore these drugs should be used only with appropriate caution and after extensive discussion with the patient about the risks. Fordiverticulosis with nonspecific GI symptoms,treatment is aimed at reducing spasm of a segment of colon. A high-fiber diet is often recommended and may be supplemented bypsylliumseed preparations or bran together with adequate fluid intake. However, the role of fiber in the treatment of diverticulosis is limited. In general, data are inadequate to confirm beneficial effects of fiber. Bulk-forming laxatives should be considered for people with constipation (see also2019 guidelines for diagnosis and management of diverticular diseasefrom the National Institute for Health and Care Excellence). Antispasmodics (eg, belladonna) are not of benefit and may cause adverse effects. Low-fiber diets are not helpful. Surgery is unwarranted for uncomplicated disease except for giant diverticula. There is no association between consumption of nuts, seeds, corn, or popcorn and diverticulitis, diverticular hemorrhage, or uncomplicated diverticulosis, and avoidance of these foods is no longer recommended. Diverticular bleeding stops spontaneously in 75% of patients. Initial management is as for Treatment . Treatment of diverticular bleeding is often given during the diagnostic procedure. However, several reports have shown that during the colonoscopy stigmata of recent hemorrhage (active bleeding, adherent clot, and visible vessel) are identified in only 8 to 15% of patients ( Angiography can help with diagnosis of the source of bleeding and treatment of ongoing bleeding. During angiography, a number of techniques can be used to control the bleeding, particularly embolization and, less often,vasopressininjection. Embolization is successful about 80% of the time. Angiographic complications of bowel ischemia or infarction are less common (< 5%) with current super-selective catheterization techniques. Surgery is rarely needed but is recommended for patients who have had multiple or persistent episodes of diverticular bleeding refractory to therapy or who have hemodynamic instability despite aggressive resuscitation. identifiable bleeding diverticulum may require a subtotal colectomy. [Patients with diverticular bleeding who have an unclear localization of the bleeding site have a mortality rate of 43% after colonic surgery, whereas patients who have a defined localization of the bleeding site have a mortality rate of 7% after surgery ( Treatment references ). 1.Gobinet-Suguro M, Nagata N, Kobayashi K, et al: Treatment strategies for reducing early and late recurrence of colonic diverticular bleeding based on stigmata of recent hemorrhage: A large multicenter study.Gastrointest Endosc95(6):1210–1222.e12, 2022. doi: 10.1016/j.gie.2021.12.023 2.Schultz JK, Azhar N, Binda GA, et al: European Society of Coloproctology: Guidelines for the management of diverticular disease of the colon.Colorectal Dis22 (supplement 2):S5–S28, 2020. doi: 10.1111/codi.15140 