Diverticular Disease: A Common Intestinal Disorder You May Not Know About

Diverticular disease, ranging from mild to painful disorders, more than a third of all Australians over 45 years of age may be affected by this group of diseases.

Diverticular disease: the basics

Diverticulosis is a condition where random parts of the muscles of the large intestine or colon form small pouches, called diverticula. Diverticulosis is very common, affecting about a third of all Australians over 45 years of age, and significantly increasing in prevalence with age: more than 65% of older adults (over 85 years old) develop diverticulosis¹.

For most people, diverticulosis is a condition with no evident symptoms. However, when the number of intestinal pouches (diverticula) increases, the condition can affect the normal functioning of the intestine. Symptoms associated with diverticulosis can include abdominal pain and bloat, constipation or diarrhoea, flatulence, and bloody stools.

In some people, diverticulosis can develop into a more serious condition, called diverticulitis, which occurs when the intestinal diverticula become infected and inflamed. This can cause symptoms like a sharp, localised pain in the abdominal area, fever, nausea, and vomiting. Diverticulitis is considered a medical emergency, requiring immediate hospitalisation.

Both conditions, collectively known as diverticular disease represent an important health burden, costing healthcare systems billions and causing as many as 23,000 deaths per year in Europe^2-3.

Factors influencing Diverticular disease

• Underlying factors
  While there is no clear understanding of the causes behind diverticulosis, genetics has been established as an important underlying factor^4-5. Other important underlying factors that have been identified include inflammation, gut microbial dysbiosis, and abnormal colon motility.

• Inflammation
  Chronic inflammation occurring in and around diverticula has been strongly associated with diverticular diseases like Symptomatic Uncomplicated Diverticular Disease and acute diverticulitis⁶.

• Colon Motility
  Abnormal colon motility is another problem tightly associated with diverticular disease. People with diverticular disease have been shown to have physiological problems like “spastic colon”, where there is an excess of contractions⁷. Also, anatomical issues, like the reduced density of certain cells have been identified in patients with diverticular disease⁸.

• Gut Microbiota
  Following a low fibre diet is a known factor affecting the composition of the gut microbiota, potentially causing gut dysbiosis. This has an important factor for people suffering from diverticular disease, as gut dysbiosis, as well as Small intestinal bacterial overgrowth (SIBO), can lead to a decrease in the abundance of certain beneficial gut bacteria. Various species of gut bacteria produce short-chain fatty acids (SCFA) that are important for the optimal functioning of the intestine, especially for mucosal barrier and immune function^9-10.

• • For example, the SCFA butyrate, commonly produced by certain strains of gut bacteria has been shown to decrease the risk of recurrent diverticulitis¹¹.

• • Studies have shown that people with a history of acute diverticulitis have a gut microbiota composition that is different from that of people with diverticulosis or with other intestinal conditions (Table 1).

Associated factors that increase risk

In Australia and other developed regions such as Europe, the United States and Canada, research has identified multiple factors that increase the risk of hospitalization for diverticular disease. These factors include obesity, high intake of red meat, smoking, hypertension, hyperlipidaemia. Also, the use of some drugs, like oral contraceptives, hormone replacement therapy, or over the counter medications like corticosteroids and nonsteroidal anti-inflammatory drugs (like aspirin or ibuprofen) have been shown to increase this risk¹⁷.

Below are further details about the key factors associated with the development of diverticulitis or diverticular disease:

• Diet
  This is the most important factor that can influence different aspect of diverticular diseases.
  • Fibre – a high fibre diet has been associated with decreased risk of hospitalisation by diverticular diseases¹⁸. However, more research in this area is needed to fully understand the role of fibre in this condition.

• • Vitamin D – this is an important micronutrient involved in the maintenance of homeostasis in the colon through the regulation of inflammation. Supplementation of Vitamin D has been shown to a reduction in the risk of developing diverticulitis¹⁹.

• • Red Meat – high consumption of red meat is a high-risk factor in colon cancer obesity. Now, red meat has also been linked to higher risk of diverticular disease by some studies^20-21.

• Stress
  It is important to reduce your stress levels, as studies show that stress activates inflammatory pathways in the intestine²².

• Smoking
  Smoking is the world’s leading preventable cause of death, and it also associated with worst outcomes in diverticular disease^23-24.

• Physical activity and obesity
  A recent review that evaluated multiple research reports concluded that even small increased in your ideal Body Mass Index (BMI) may increase your risk of developing diverticular disease. Likewise, this review found that regular exercise reduces this risk^25-26.

• Drug use
  Use of over-the-counter and prescription drugs, like opiate analgesics, corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) has been shown to increase the severity of diverticular diseases. Among these NSAIDs, such as aspirin and ibuprofen have shown strong evidence for their role worsening diverticular diseases, leading to conditions like diverticular perforation, diverticular bleeding or diverticulitis^27-29.

Treatment and prevention of Diverticulitis

Treatment of diverticular disease depends on the severity of the condition. For example, most patients who are only experiencing the development of diverticula will not progress to a more serious condition. Hence, these patients do not receive any pharmacological treatment. Below are some examples of standard treatments for different diverticular diseases:

• SUDD
  Patients with this condition can be treated with a high-fibre diet³⁰, antibiotics³¹, anti-inflammatory drugs such as mesalazine or balsalazide³² and probiotics³³.

• Acute diverticulitis
  Treatment for this condition depends on the severity of the disease, as patients can exhibit uncomplicated diverticulitis, diverticulitis complicated with abscess, perforation or peritonitis. The standard treatment involves anti-microbial treatment, but some patients may require surgery^12-145.

An extensive review of standard treatments of diverticular diseases can be found here.

What You Can Do

• Reduce levels of stress, change your lifestyle

• Follow an optimal diet, design by a dietician

• Take prebiotics, minerals supplements and probiotics, consult your functional medicine practitioner for a personalised plan

• Evaluate the health of your gut microbiota, consult with our expert team at AUSCFM

Functional Medicine and Diverticular Disease

The Australian Centre for Functional Medicine in Perth takes a comprehensive approach in the treatment of diverticulitis and other diverticular diseases.

Our approach is backed by systematic and state-of-the-art testing of all possible factors that influence this disease and employs a combination of evidence-based therapies. We consider the symptoms and problems you report but we also investigate potential problems you may not be aware of, hence building a complete picture of your pathology.

BECOME A PATIENT TODAY

BECOME A PATIENT

References

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