The diverticula of the colon

The diverticula of the colon diverticula when we talk about in general is normally used to indicate the saccular protrusions that develop against the wall of a hollow organ. They can occur in various locations (pharynx, esophagus, duodenum, jejunum, ileum, bladder, …), but occur primarily dependent on the large intestine, namely and especially of the sigmoid colon.

It ‘s good diverticulosis easy to distinguish from the outset rather than being designated as diverticular disease. The first form, which is also the most frequent, is characterized by the presence of diverticula in the colon, as we said, which, however, have never given clinical manifestations have been highlighted significant and occasionally. However, when using the term diverticular disease is to indicate clinically active diverticulosis of the colon that is highlighted with a different set of symptoms, as discussed later in detail.

The diverticula of the colon

Diverticulosis of the colon, therefore, we intend to briefly deal with, both in its simple form in that complicated, is rather seldom below forty years ago and its prevalence is statistically more significant in the later decades of age, until to arrive at a rate that exceeds 30% in Western populations. Diverticulosis seems to have a slight predominance in females for reasons that are not yet known.

Wanting to deal in popularizing this note, acquired diverticula of the colon (those are rare congenital anomalies at each location and therefore of little clinical significance) we must first explain how they are formed and what factors may be the consequence. In other words, to clarify the etiology of colonic diverticulosis, causes and mechanisms, ie, involved in the development of this pathology. Very briefly we can say that in all probability will contribute anatomofunzionali modifications of the large intestine (age-related) in association with increasing consumption of refined foods and low in vegetable fiber.

It follows a major reduction of fecal volume which would lead to a “narrowing” of the intestinal lumen with the result of an increase in pressure within the same. This increase in pressure would, therefore, the direct cause of the formation of diverticula (so-called by drive) through a herniation of the intestinal mucosa at the points of least resistance of the visceral wall.

Turning to clinical aspects of this widespread disease, most scholars now agree in considering as uncomplicated diverticulosis totally asymptomatic. This morbid situation, therefore, would show only the appearance of clinical complications, represented, as is known, by the frequent diverticulitis, the intestinal obstruction, perforation of the diverticulum with peritonitis, abscesses, fistulas and the not infrequent bleeding. At this point one might ask what percentage will present cases of diverticulitis complicated than non-symptomatic, or what is the incidence of complications over the total. Some statistics show an average of 20% of complicated cases, we sincerely value that seems excessive.

With regard then the diagnosis must premise that in the case of a silent diverticulosis (not complicated, that is) the abutment of the same is entirely occasional and most often the symptoms which led to the radiological exam (which has allowed the ‘investigation ) is not attributable to diverticulosis. Often it is painful abdominal crisis, with constipation and / or diarrhea, which are most likely related to a concomitant irritable bowel syndrome.

More interesting for our readers, think is the therapeutic aspect, especially if we remember what we said about the pathogenesis, ie the mechanism of formation of diverticula. Until a few years ago, in fact, the majority of physicians (and also of gastroenterologists) had agreed that a diagnosis occasional (barium enema) of an asymptomatic diverticulosis did not require any therapy. Today we have seen, thanks to some interesting studies, that a diet high in fiber allows an improvement of the motor alterations of the colon (and therefore also the prevention of complications), and, when present, also serves to improve the painful symptoms, although often attributed to irritable bowel syndrome, as we observed. Recent experiments have confirmed the effectiveness of such treatment, especially when practiced with the use of raw bran at doses of 20 -30 grams per day.

We will not dwell on the medical treatment that, in diverticulitis, is reidradante and antibiotic and surgical therapy include only the information that currently is limited to cases of perforation with generalized peritonitis, abscesses, fistulas and to the serious bleeding. Sigmoid resection is reserved for rare cases of diverticulitis who do not respond to medical therapy and are subject to frequent recurrences.

With the appropriate reservations for cases with major complications we can conclude that the diverticular disease has generally a good prognosis and, moreover, is not to be considered a precancerous condition.