Diverticulitis: A disease that can be hard to stomach

The specialist: Dr. Scott Nguyen on diverticulitis.

A gastrointestinal surgeon specializing in laparoscopic surgery, Scott Nguyen performs 300 to 400 operations a year. Ten percent of his patients at Mount Sinai have diverticular disease.

Who's at risk

You may never have heard of diverticular disease, but there's a fair chance you have it if you're over 60. Thirty percent of those over 60 have diverticula — pouches in the lining of the large intestine or ­colon.

"The good news is that the pockets themselves only cause problems for 20% to 30% of patients," says Nguyen. "When the pockets cause complications like localized inflammation or infection, we call it diverticulitis."

Another form of diverticular disease is diverticular bleeding, when pockets erode into the blood vessels of the colon and cause bleeding.

As of now, there's no known genetic component to diverticular disease. The primary cause of the disorder is thought to be the modern diet.

"This is a disease of developed countries," says Nguyen. "A low-fiber, high-fat diet is the biggest risk factor, so the obese and people who eat a lot of red meat and other fats are at elevated risk."

Because of the links to fiber, diverticular disease is also possibly associated with constipation.
Your odds of developing diverticular disease increase as you age. Both men and women develop the disease, but often at different points in their lives.

"Most people who develop diverticular disease before age 40 are men, and after age 70 are women," says Nguyen.

Signs and symptoms

The symptoms of both diverticulitis and diverticular bleeding can be extremely disabling.

"The red flag is the acute onset of lower abdominal pain, usually persisting for several hours, up to several days," says Nguyen. "The pain is relatively severe and often associated with a fever,
because it's a type of infection."

If left untreated, the pain often spreads throughout the abdomen and the infection can worsen into a severe infection like sepsis. In some cases the inflammation is so severe that it forms an abscess, erodes into organs like the bladder or blocks the colon.

"Most people have an attack or two of diverticulitis and go to see their doctor for relief," says Nguyen.

Diverticular bleeding is even easier to diagnose, and patients usually head to the hospital immediately. "The sign of diverticular bleeding is the sudden onset of painless rectal bleeding," says Nguyen, "This is profuse bleeding that often leads people to call 911."

The blood tends to be a bright, fresh red, but can also be darker old blood. In some cases, the bleeding is severe enough to cause fainting.

Traditional treatment

The first course of action for preventing or treating diverticular disease is lifestyle modification.

"That means changing your diet, getting exercise, losing weight," says Nguyen. "Unfortunately, it's very hard to change these habits."

During an acute attack, doctors use antibiotics to calm the infection. "Many people respond really well to this," says Nguyen. "But the standard of care is that if you have two or more attacks, you need surgery to remove the diseased area of the colon."

Surgical intervention is called for because these patients are more likely to have a recurrence and to develop complications like abscesses or serious infection.

"For people who had multiple attacks, surgery is successful and prevents another attack about 90% of the time," says Nguyen.

"If we can do it as an elective operation, where we can cool people off with antibiotics, they are usually in and out of the hospital within a week." The results of emergency surgery are much less ideal: Patients usually spend weeks in the hospital for recovery and often need an ostomy bag afterward.

Diverticular bleeding usually calls for admission to the hospital for intravenous fluids and possibly blood transfusions until the bleeding stops. Sometimes a colonoscopy or a special radiologic procedure can be used to halt the bleeding.

"If the bleeding doesn't stop, then we do emergency surgery to remove that section of the colon," says Nguyen.

Research breakthroughs

Doctors are still figuring out how diverticulitis works. "In the past, the traditional school of thought was that diverticulitis in people under 50 was a more virulent form of the disease, so we advocated earlier surgery," says Nguyen. "But now evidence shows that diverticulitis acts the same in young and old — that's a big change in dogma."

Another improvement is in surgical technique. "Laparoscopic surgery is becoming the preferred method, because it has a shorter recovering time and fewer complications," says Nguyen.

Questions for your doctor

If you have an attack of diverticular disease, ask: "What can I do to prevent this from happening again?"

A better lifestyle can protect you against recurrence.

Another essential question is, "Should I get a colonoscopy?" This test will both evaluate the extent of your diverticular disease and check for co-existing cancers.

"Diverticular disease is a sign that it's time to change your life, and it's never too late," says Nguyen. "Even at 90, improving your diet will do its best to correct diverticular disease."

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