Management of Diverticular Disease

Suzanne Albrecht, PharmD, MSLIS

Disclosures

US Pharmacist 

In This Article

Abstract and Introduction

Introduction

Diverticular disease comprises diverticulosis and diverticulitis. Diverticulosis—the presence of diverticula without inflammation—is very common, affecting approximately 50% of Americans by age 60 years, although most patients remain asymptomatic.[1–3] Diverticula are pouches or sacs within the colon that occur normally or via herniation of the mucous lining. However, roughly 5% to 20% of patients with diverticulosis will develop inflammation and subsequent sequelae.[3,4] Once there is inflammation, the condition is called diverticulitis. It is thought that a micro- or macroperforation is the precipitating factor in the development of diverticulitis.[4] The perforation may be the result of increased intraluminal pressure or thickened fecal matter in the neck of the diverticulum.[4]

In the Western world, the left colon (descending and sigmoid) is the area most often affected, with approximately 95% of the cases of acquired diverticular disease involving the sigmoid colon (which is closest to the rectum).[3,5,6] In Asian countries, the right colon (cecum and ascending) is most often affected.[2] This suggests a genetic, lifestyle, or environmental component for developing right-sided diverticular disease.[5] With most right-sided diverticula, there is an outpouching of all three layers of the colonic wall (mucosa, submucosa, and muscle layer).[3] This constitutes a "true" diverticulum.[3,7] However, most left-sided diverticula involve only the mucosa and the submucosa. When a diverticulum affects only the mucosa and the submucosa, it is called a pseudodiverticulum.[3,7] Patients with right-sided diverticular disease are often 20% younger than left-sided patients when they first present with the disease. Their pain is in the right lower quadrant, and it is often difficult to distinguish from appendicitis.[2]

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