Management of Diverticular Disease

Suzanne Albrecht, PharmD, MSLIS

Disclosures

US Pharmacist 

In This Article

Risk Factors

There is still not much known about diverticular disease, but some risk factors have been identified. Aging is the primary risk factor.[5] Patients 60 years of age and older are more likely to develop diverticulosis.[7] Low dietary fiber intake is the other most significant risk factor.[7] Because lack of fiber in the stool decreases transit time, the pressure in the colon increases and results in a "blowing out" of the weak areas of the colon.[7] With less fiber there is also a lower volume of stool, which causes greater segmentation of the bowel (the process of smooth muscle contraction), resulting in higher luminal pressures.[3] Eating a diet high in fiber may actually prevent patients with asymptomatic diverticulosis from progressing to symptomatic disease.[4] Physical inactivity may be a risk factor along with gender.[4] Diverticular disease is more common in women than in men.[5]

Obesity has been gaining recognition as a possible contributing factor in diverticulitis.[3,8] In a prospective cohort study done by Strate et al, 47,228 male health professionals were followed for 18 years to determine the relationship between diverticulitis and obesity, in particular central obesity.[8] After adjusting for known or potential risk factors for diverticular disease (total dietary fat, fiber, and red meat; total caloric intake, physical activity, and current nonsteroidal anti-inflammatory drug [NSAID] and acetaminophen usage), they found that men with a body mass index (BMI) ≥30 kg/m2 were 78% more likely to develop diverticulitis than men with a BMI <21 kg/m2 (P = .02). Although they found no association between obesity and diverticulosis, there was a positive association between weight gain and the risk of developing diverticulitis. Men who had gained more than 45 pounds since the age of 21 had a relative risk of 1.66 (P = .003). Likewise, there was a positive association between diverticulitis and waist size.[8]

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