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For further information, see CMDT Part 15-36: Diverticular Disease of the Colon

Key Features

  • Incidence increases with age in Western societies

    • 5% at age < 40

    • 30% at age 60

    • 50% at age > 80

  • Uncommon in developing countries

  • Most are asymptomatic, discovered incidentally at endoscopy or on barium enema

  • Causes

    • Diet deficient in fiber

    • Ehlers-Danlos syndrome

    • Marfan syndrome

    • Scleroderma

  • The extent to which abnormal motility and hereditary factors contribute to diverticular disease is unknown

Clinical Findings

  • Nonspecific complaints

    • Chronic constipation

    • Abdominal pain

    • Fluctuating bowel habits

  • Whether these symptoms are due to alterations in the colonic motility, visceral hypersensitivity, gut microbiota, or low-grade inflammation is unclear

  • Physical examination usually normal

    • May reveal mild left lower quadrant tenderness

  • Complications occur in 33%, including lower GI bleeding and diverticulitis

Diagnosis

  • Routine laboratory studies normal

  • Diverticula best seen on barium enema and CT imaging

  • Colonoscopy less sensitive than barium enema

Treatment

  • High-fiber diet or fiber supplements (bran powder, 1–2 tbsp twice daily orally; psyllium or methylcellulose)

  • When diverticulosis-associated lower GI bleeding occurs, more than 95% of cases require < 4 units of blood transfusion

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