Diverticular Disease

Andrea Gamber, Sodexo Intern

noun: Medicine
noun: diverticulitis

1. inflammation of a diverticulum, esp. in the colon, causing pain and
disturbance of bowel function.



diverticulitis
/dvrtikyltis/
Diverticulum (plural: diverticula)
http://en.wikipedia.org/wiki/File:Diverticula,_sigmoid_colon.jpg
Did you know?
Very common medical condition in U.S.
Takes 40 years to develop
Deficiency disease of Western civilization (BMJ- 1971)
Disease Hx
Early 1900s
Increase in prevalence over a century
Refining of carbs
Unknown to developing countries
http://www.mohrresults.com/tag/carbs-in-white-bread/
Disease Hx
Inverse relationship between fiber intake & incidence of diverticular disease
1971 - Diverticular disease of the colon: a deficiency disease of Western civilization.
Painter, et al. (BMJ, 1971).
1972 - Effect of dietary fibre on stools and the transit-times, and its role in the causation of
disease. Burkitt, et al. (Lancet, 1972).
1994 - A prospective study of diet and the risk of symptomatic diverticular disease in men.
Aldoori, et al. (AJCN, 1994).
1998 - A prospective study of dietary fiber types and symptomatic diverticular disease in
men. Aldoori, et al. (AJCN, 1998).
2011 - Diet and risk of diverticular disease in Oxford cohort of European Prospective
Investigation into Cancer and Nutrition. Crowe, et al. (BMJ, 2011).
2012 - Refined Carbohydrate Foods and Disease: Some Implications of Dietary Fibre
. Painter, et al. (Academic Press Inc, 2012).
2014 - Source of dietary fibre and diverticular disease incidence: a prospective study of UK
women. Crowe, et al. (Gut. 2014).

Disease Hx
ONE study suggests the opposite
2012 - A high-fiber diet does not protect against asymptomatic
diverticulosis Perry, et al. (Gastroenterology, 2012).
Only examined asympotomatic diverticulosis, not the disease as a whole
Etiology
Unknown
A diet high in fiber reduces risk but a diet low in fiber is not
necessarily the cause
RDA fiber= 25-35gm vs. avg intake= 15gm
Other factors ^ risk
http://www.nutritioulicious.com/2013/01/dietary-fiber-insoluble-
and-soluble-fiber/
Diverticulitis
Bacteria collect in diverticula
10-25% of people
Classification is based on symptoms
Asymptomatic diverticulosis and SUDD
Complicated diverticulitis
Treatment
Present to hospital w/ fever, leukocytosis and lower abdominal pain
Tests to confirm Dx- radiology or BE
Therapy bowel rest & antibiotics
Colonoscopy 1-2 months post-treatment
Resection of colon possible
MNT
Diverticulosis fiber & fluid
Diverticulitis NPO, clears, low fiber
Nuts, Seeds, Popcorn?
Long-held belief
Not supported by current research Tarleton, et al, (Nutrition in Clinical Practice, 2011.)
It is actually beneficial! Marcason, (JADA, 2008).

http://www.popcorn.org/AboutUs/PopcornPoppinMonth/FunPopc
ornFacts/tabid/118/Default.aspx
Protective Effect?
Vegetarians have 31% lower risk Crowe, et al (BMJ, 2011).
Probiotics lactobacillus casei and mesalazine Boynton, et al (Therapeutic advances in
gastroenterology, 2013).
http://www.weightplan.com/why_weightplan/diets/vegetarian_diets
Presentation of Patient
PMHX
Cerebral vascular incident, cataracts, asthma, bronchitis, iron-
deficiency anemia, vitamin D deficiency, E. coli urinary tract
infection, hypertension, bilateral pulmonary embolism, bilateral
lower extremity deep vein thrombosis, pulmonary nodules,
bacteremia, diarrhea, diverticulosis, diverticulitis
Meds & Labs
WBC 77, H/H - 8.6/28.6, Mg 1.2, K+ 3.2, Vit D OH-11, Fe 18,
BUN 3, B/C 6, Ca 7.8, Total Protein 4.0, Alb 1.4
Flagyl, Zosyn, Klorcon, MgSulfate, Niferex, Vitamin D,
Coumadin, MiraLAX
Diagnostic Tests
Abdominal CT scan- sigmoid colitis and proctitis- retained, formed
fecal material
Flat plate of abdomen- extensive amount of stool retained in colon
Colonoscopy revealed colonic mass, likely malignant (CEA 14.9,
CA-125 44.3)
Treatment
Hemi-colectomy with colostomy & hysterectomy
Celiac Disease?
Cerebral vascular incident, cataracts, asthma, bronchitis, iron-
deficiency anemia, vitamin D deficiency, E. coli urinary tract
infection, hypertension, bilateral pulmonary embolism, bilateral
lower extremity deep vein thrombosis, pulmonary nodules,
bacteremia, diarrhea, diverticulosis, diverticulitis
References
1. Crowe, FL, et al. Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British
vegetarians and non-vegetarians. BMJ: British Medical Journal. 2011;343:1-18.
2. Aldoori, WH, et al. A prospective study of diet and the risk of symptomatic diverticular disease in men. The American journal of clinical nutrition. 1994;60(5):757-764.
3. Burkitt, DP, Walker, AP, Painter, NS. Effect of dietary fibre on stools and transit-times, and its role in the causation of disease. The Lancet. 1972;300(7792):1408-1411.
4. Aldoori, WH, et al. A prospective study of dietary fiber types and symptomatic diverticular disease in men. The American journal of clinical nutrition. 1998;128:71419.
5. Painter, NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. British Medical Journal. 1971;2:450.
6. Marlett, JA, McBurney, MI, Slavin, JL. Position of the American Dietetic Association: health implications of dietary fiber. Journal of the American Dietetic Association.
2008; 102(7):993-1000.
7. Tarleton, S, DiBaise, JK. Low-Residue Diet in Diverticular Disease: Putting an End to a Myth. Nutrition in Clinical Practice. 2011; 26(2):137-142.
8. Marcason, W. What is the Latest Research Regarding the Avoidance of Nuts, Seeds, Corn, and Popcorn in Diverticular Disease? Journal of the American Dietetic
Association. 2008;108(11):1956.