What is the difference between diverticulosis and diverticulitis?

Diverticulosis vs. Diverticulitis: Understanding the Difference

Diverticulosis is the presence of multiple outpouchings (diverticula) in the colon wall, while diverticulitis is the inflammation of these diverticula, which can lead to complications such as abscess formation, perforation, or fistula development. 1

Key Differences

Diverticulosis

• Definition: The presence of diverticula (small pouches) that bulge outward through weak spots in the colon wall
• Symptoms: Often asymptomatic; discovered incidentally during colonoscopy or other imaging
• Prevalence: Very common, affecting over 50% of people over age 60 and over 60% of people over age 80 2
• Complications: Only 1-4% of people with diverticulosis will develop acute diverticulitis in their lifetime 1

Diverticulitis

• Definition: Inflammation of diverticula, usually accompanied by infection
• Symptoms: Left lower quadrant abdominal pain, fever, nausea, vomiting, and leukocytosis 1
• Diagnosis: Contrast-enhanced abdominal and pelvic CT scan (sensitivity 98-99%, specificity 99-100%) 1
• Classification:
  • Uncomplicated diverticulitis: Inflammation limited to colonic wall and surrounding tissue (85% of cases) 1
  • Complicated diverticulitis: Inflammation with abscess, perforation, fistula, obstruction, or bleeding 3

Classification of Acute Diverticulitis

According to the World Journal of Emergency Surgery guidelines, acute diverticulitis can be classified as 3:

1. Uncomplicated diverticulitis: Diverticula, thickening of the wall, increased density of the pericolic fat
2. Complicated diverticulitis:
   • Stage 1A: Localized pneumoperitoneum (gas bubbles)
   • Stage 1B: Small abscess (<4 cm)
   • Stage 2: Pelvic abscess (>4 cm)
   • Stage 3: Distant abscess
   • Stage 4: Other distant complications (abundant pneumoperitoneum and/or intra-abdominal free liquid)

Management Approaches

Uncomplicated Diverticulitis

• Most patients can be managed in an outpatient setting 3
• Antibiotics can be used selectively rather than routinely in immunocompetent patients 3
• Pain management (typically acetaminophen) and dietary modification with a clear liquid diet 1

Complicated Diverticulitis

• Intravenous antibiotics (ceftriaxone plus metronidazole or piperacillin-tazobactam) 1
• Percutaneous drainage for abscesses
• Surgical intervention for perforation, fistula, or obstruction

Important Clinical Considerations

• The first episode of diverticulitis is most likely to be complicated; the risk of complications decreases with recurrences 3
• Approximately 20% of patients with diverticulitis will have recurrent episodes within 10 years 3
• Risk factors for diverticular disease include age >65 years, genetic factors, obesity, use of NSAIDs, opioids, steroids, and certain medical conditions 1
• High-fiber diet appears to decrease the likelihood of symptomatic diverticulitis 2

Common Pitfalls to Avoid

1. Misdiagnosis: Diverticulitis can mimic other conditions like appendicitis, inflammatory bowel disease, or colorectal cancer
2. Overuse of antibiotics: Not all cases of uncomplicated diverticulitis require antibiotics 3
3. Unnecessary hospitalization: Most uncomplicated cases can be managed as outpatients 3
4. Dietary myths: The old recommendation to avoid nuts, corn, popcorn, and seeds has been debunked 2
5. Overemphasis on recurrence: Elective surgery should not be based solely on the number of episodes 3

By understanding the difference between diverticulosis and diverticulitis, healthcare providers can better diagnose and manage these conditions, leading to improved patient outcomes and quality of life.