Diverticulosis

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

  • Systemic sclerosis (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, > 95% of cases require < 4 units of blood transfusion