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Diverticulosis, How to Prevent and Treat Diverticulitis

What is the difference between diverticulitis and diverticulosis? Diverticulosis when small pockets crop up in the large intestine. These pockets are called diverticula. They are harmless in themselves, and most people never know they exist. Diverticulitis is the inflammation of the diverticulum.

Diverticulitis Symptoms

If the diverticulum is inflamed or infected, the patient experiences pain and cramps in the abdominal area. Mostly on the left side of the abdomen. This condition is diverticulitis. Symptoms occur in one-fourth of the subjects, and one-third with complications. The diagnosis is mainly confirmed by colonoscopy.

Prevention

According to Dr. Denis P Burkitt, the use of a squat toilet in Asia and Africa is another factor for the low incidence of diverticulitis in that part of the world. In Japan, the prevalence of the disease has grown with the spread of the Western type of diet and toilet in recent decades.

Using a squatting stool, (toilet stool, toilet leg raiser) simulate the usage of a squat toilet. You will be in a squatting position while on the toilet. The squatting position help prevent colon diseases, constipation, hemorrhoids, and diverticulitis.

Regular physical activity is on average, reduce diverticulitis by 25%. Obesity (BMI over 30), on the other hand, increases the chance for diverticulitis 1.78 fold.

People must eat at least 30 grams of dietary fiber each day to have a regular bowel movement. Eating enough fiber will significantly prevent the occurrence of diverticulitis.[1]

Uncomplicated Diverticulitis Treatment

What Does Diverticulitis Diet Include?

If the gastroenterology has diagnosed you with diverticulitis and is uncomplicated diverticulitis, your doctor will probably suggest some dietary changes. Although the lack of fiber in the diet may have caused the condition, the doctor may ask you to skip food with fiber content for a few days as they may aggravate the pain.

Diet in acute and painful diverticulitis

What have to eat

The diet for a few days may include mashed potato, cooked white rice, white pasta, white bread, pumpkin, zucchini, or liquid foods such as soups and gelatin. Also, drink lots of water and 50-100 ml of Aloe Vera Juice twice a day to help relieve the pain and inflammation.

Foods to avoid

Some high fiber foods that you should limit or avoid till the inflammation ease: legumes (beans, chickpeas, lentils), fruits, vegetables, and whole grains.

During a diverticulitis flare-up also skip on high sugar and fat-containing foods, such as dairy, fried foods, red meat, sweets.

Treatment usually includes oral antibiotics (Rifaximin 2 x 400 mg daily) or in more severe cases, ciprofloxacin (2×500 mg), metronidazole (2–3×500 mg) for seven days to clear the infection.

Maintenance Treatment to Prevent the Recurrence of Diverticulitis and it’s Complications

The recommendations are vegetables, fruits, and a fiber-rich diet. It also seems essential to modify the intestinal flora. Previous studies have provided positive results, and a reduction in the number of relapses has been reported with the use of probiotics (Lactobacillus casei).

Lactobacillus casei and mesalazine co-administered with open-label randomized clinical trials. Both agents reduced the risk of diverticulitis recurrence, but the combined delivery was more effective.[2]

Also, antibiotics (Rifaximin 2 x 400 mg daily), regardless of the effect of probiotics, reduce inflammation. Studies have shown that aminosalicylates reduce the complaints of patients, improve the patient’s quality of life, and reduce complications.

Aminosalicylates (0.8 to 1.6 g per day of mesalazine) and Rifaximin (daily 800 mg) was more effective in reducing relapses. Patients had fewer complaints and fewer returning diverticulitis than Rifaximin alone.[3]

Overall, the studies showed so far that a maintenance treatment helps prevent a recurrence, and continuous treatment is more effective than cyclic.

Complicated Diverticulitis Treatment

Complicated diverticulitis needs hospitalization.



More severe or complicated diverticulitis treated with intravenous fluids and antibiotics. The choice of antibiotic is ciprofloxacin (2 × 400 mg) + metronidazole (3 × 500 mg). In case of intolerance: imipenem (4 × 500 mg) or meropenem (3 × 1 g), or third-generation cephalosporins.[4]

The antibiotic treatment usually resolves the inflammation. But, there are severe cases, or in case of a perforated bowel, there is no other choice, but an emergency operation. The damaged part of the intestine must be removed. That is a high-risk operation. The mortality during this process is 17%. If you survive, you have to wear a colostomy bag (stoma bag) for a lifetime.

Causes of Diverticulosis

Diverticulosis is widespread in the western world because the diet is low in fiber, and dominantly high the consumption of processed foods. The role of dietary fibers is significant as a source of short-chain fatty acids that nourish the intestinal mucosa. Also, dietary fibers have a prebiotic effect. i.e., favorably modifying the intestinal flora.

Only a relatively small proportion of people with diverticulosis develop diverticulitis. Many of these cases are mild and can be treated with diet and antibiotics.

Diverticulosis is the disease of Western civilization. It is common in economically advanced countries in Europe, North America, and Australia. It is affecting more than 50% of the population over 60 years of age.

Diverticulosis is uncommon in Africa, most of Asia, and rare among so-called natural peoples.

Ethnic and geographic differences are not only in the frequency of the disease but also in the location. In Western countries, it happens to be on the left side of the colon. Mostly in the sigmoid colon. For example, in Asia, diverticulosis predominantly occurs on the right side of the colon. Which points to that genetic factors may also play a role.

Although the results of recent studies unclear, it is also a fact that the incidence of diverticulosis is significantly less frequent with vegetarians.

There are many similarities between diverticulitis and IBD in the inflammatory and immune mechanisms.

Conclusion:

Prevention is always better than treatment. You make sure to follow all the advice as mentioned above to avert complications and hospitalization.

Related:

Q & A

What is the difference between diverticulitis and diverticulosis?

Diverticulosis when small pockets crop up in the large intestine.  Diverticulitis is the inflammation of the diverticulum.

References:

  1.  “Denis Burkitt and the origins of the dietary fibre hypothesis” | Pubmed https://www.ncbi.nlm.nih.gov/pubmed/28583217
  2. Tursi, A., Brandimarte, G., Giorgetti, G. M., et al.: Mesalazine and Lactobacillus casei in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomized, open-label study. J. Clin. Gastroenterol., 2006, 40, 312–316.
  3. “Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon.” | Pubmed https://www.ncbi.nlm.nih.gov/pubmed/12236485
  4. “Ciprofloxacin in combination with metronidazole.” | Pubmed https://www.ncbi.nlm.nih.gov/pubmed/3182096
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