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Incidence increases with age in Western societies
5% at age < 40
> 50% by age 60
Uncommon in developing countries
Most are asymptomatic, discovered incidentally at the time of an endoscopy, barium enema, or colonoscopy
Colonic diverticula may vary in size from a few millimeters to several centimeters, and in number from one to several dozen
Almost all patients have involvement in the sigmoid and descending colon; only 15% have proximal colonic disease
Causes
The extent to which abnormal motility and hereditary factors contribute to diverticular disease is unknown
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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
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Physical examination usually normal but may reveal left lower quadrant tenderness with a thickened, palpable sigmoid and descending colon
Routine laboratory studies normal
Diverticula best seen on colonoscopy and CT
Involved segments of colon may be narrowed and deformed
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High-fiber diet (fruit, vegetables, whole grains) or fiber supplements (bran powder, 1–2 tbsp orally twice daily; psyllium or methylcellulose)
Exercise
Avoidance of red meats and non-steroidal anti-inflammatory drugs