gastrointestinal disorders
Colonic Diverticulosis
Symptoms and Signs of Colonic Diverticulosis
Most (80%) patients with diverticulosis are asymptomatic or have only intermittent constipation. About 20% become symptomatic with pain or bleeding when inflammatory or hemorrhagic complications develop. Patients with diverticulosis sometimes develop nonspecific gastrointestinal (GI) symptoms, including abdominal pain, bloating, constipation, diarrhea, and passage of mucus from the rectum. This constellation is sometimes referred to as Symptomatic Uncomplicated Diverticular Disease (SUDD) . However, some specialists believe these symptoms are due to another disorder (eg, Complications of colonic diverticular disease are more common among people who smoke, are obese, have HIV infection, or use NSAIDs or are undergoing cancer chemotherapy. Complications occur in 15 to 20% of patients and include Colonic Diverticulitis None Diverticular bleeding Segmental Colitis Associated With Diverticulosis (SCAD) None Colonic Diverticulitis is painful inflammation of a diverticulum. It may be uncomplicated or complicated. Diverticular bleeding occurs in 10 to 15% of patients with diverticulosis. Segmental Colitis Associated With Diverticulosis (SCAD) refers to manifestations of colitis (eg, hematochezia, abdominal pain, diarrhea) that develop in a few (1%) patients with diverticulosis. The degree to which the diverticulosis is causal is unclear. Diverticular bleeding is the most common cause (up to 50%) of brisk Overview of Gastrointestinal Bleeding in adults. A study showed that the cumulative incidence of lower GI bleeding from diverticulosis was about 2% at 5 years and 10% at 10 years ( The pathophysiology of diverticular bleeding is unknown, but several mechanisms are hypothesized, including Local trauma from impacted feces in a diverticulum that can erode the adjacent vessel Enlargement of the diverticulum that can stretch (and ultimately tear) the vessel NSAIDs have been reported to increase the risk of hemorrhage. Although most diverticula are in the distal (left) colon, half of diverticular bleeding occurs from diverticula in the proximal (right) colon. Patients with pancolonic diverticulosis have a higher incidence of bleeding. Diverticular bleeding manifests as painless hematochezia. Because the bleeding vessel is an arteriole, the amount of blood loss is usually moderate to severe. Fresh blood or maroon-colored stool is the typical manifestation; rarely, right-sided diverticular bleeding can manifest as melena. Diverticular bleeding usually occurs without concomitant diverticulitis. The majority (75%) of episodes of bleeding cease spontaneously. The remainder require Treatment of diverticular bleeding , typically endoscopic (see also the American College of Gastroenterology's Patients who have had a diverticular bleeding episode have an increased risk of rebleeding. After a second episode of diverticular bleeding, the risk of rebleeding is 50%. 1.Niikura R, Nagata N, Shimbo T, et al: Natural history of bleeding risk in colonic diverticulosis patients: A long-term colonoscopy-based cohort study.Aliment Pharmacol Ther41(9):888–894, 2015. doi: 10.1111/apt.13148 