From the Guidelines
Diverticulitis and diverticulosis are two distinct conditions, with diverticulosis referring to the presence of diverticula in the colon without symptoms or inflammation, and diverticulitis referring to the inflammation or infection of these diverticula, often requiring medical attention. The key difference between the two conditions lies in the presence of symptoms and inflammation, with diverticulitis typically presenting with severe abdominal pain, fever, and changes in bowel habits 1.
Key Characteristics of Diverticulosis and Diverticulitis
- Diverticulosis:
- Presence of diverticula in the colon without symptoms or inflammation
- Often discovered during routine screenings
- Affects about 50% of people over age 60
- Diverticulitis:
- Inflammation or infection of the diverticula
- Symptoms include severe abdominal pain, fever, nausea, changes in bowel habits, and sometimes bleeding
- Requires treatment, which may include antibiotics or hospitalization for severe cases
Management and Treatment
Treatment for diverticulitis may include antibiotics, such as ciprofloxacin and metronidazole, for 7-10 days, while severe cases may require hospitalization for IV antibiotics, bowel rest, and possibly surgery. Management of diverticulosis focuses on prevention through a high-fiber diet, adequate hydration, regular exercise, and avoiding constipation, as increased pressure in the colon due to low-fiber diets can lead to the formation of diverticula 1.
Prevention and Risk Reduction
To reduce the risk of recurrence, patients should consume a high-quality diet, have a normal body mass index, be physically active, not smoke, and avoid nonsteroidal anti-inflammatory drug use except aspirin prescribed for secondary prevention of cardiovascular disease. Patients should also understand that genetic factors contribute to diverticulitis risk, and the risk of complicated diverticulitis is highest with the first presentation 1.
From the Research
Definition and Difference
- Diverticulitis is defined as inflammation and/or infection associated with diverticula, affecting an estimated 10-25% of patients with colonic diverticula 2.
- Diverticulosis, on the other hand, refers to the presence of diverticula in the colon, which is a common condition in developed countries, with its prevalence increasing with age 2.
- The key difference between the two conditions lies in the presence of inflammation and/or infection in diverticulitis, whereas diverticulosis is often asymptomatic and may not require treatment unless complications arise 3.
Clinical Presentation and Treatment
- Uncomplicated diverticulitis is typically treated with liquid diet and oral antimicrobials, such as ciprofloxacin and metronidazole 3, 4.
- Complicated diverticulitis, however, requires hospitalization, bowel rest, and intravenous antibacterial agents 3.
- Recent studies suggest that antibiotics may not be necessary for uncomplicated diverticulitis, and societal guidelines now recommend against their routine use 5, 6.
- Treatment for diverticulosis focuses on preventing complications, such as acute diverticulitis, through a fiber-rich diet and fiber supplementation 3.
Management and Prevention
- A fiber-rich diet is recommended for patients with asymptomatic diverticulosis to reduce intraluminal pressure and slow down the worsening of the disease 3.
- Fiber supplementation, in combination with poorly absorbed antibiotics like rifaximin, may help alleviate symptoms and prevent acute diverticulitis in patients with symptomatic diverticulosis 3.
- Continuous fiber intake and intermittent courses of rifaximin may improve symptoms and reduce diverticulitis recurrence in patients with a history of diverticulitis 3.