Diverticular disease is one of the most common gastroenterological diseases. Its morphological basis are
diverticula, whose prevalence in adults nears 50 %, with 25% clinical symptomatology and 5% occurrence of complications. It is a disease of older age, however its incidence is also rising in younger individuals, where it takes a more severe course. Its incidence is ascribed to a diet with a relatively low fibre content, however studies do not yield such clear results. Further risk factors include smoking, use of
opiates and
corticoids,
obesity,
alcoholism and smoking,
hypertension, polycystosis, immunosuppression and use of non-
steroid antiflogistics. Patients with
diverticular disease also present with abnormal intestinal motility, intestinal
dysbiosis and other physiological and morphological abnormalities. The most types of
diverticulosis occur in the sigmoid colon, though especially in Asia the colon ascendens is more frequently affected. There are several classification schemes among which an individual assessment of complications is gaining in importance. The diagnosis includes clinical data, routine laboratory tests for
inflammation,
calprotectin in stool, coloscopy, ultrasound, CT and magnetic resonance. The basis for the treatment of symptomatic uncomplicated
diverticular disease consists of drugs bringing symptomatic relief, fibre, probiotics,
mesalazine and non-absorbable
antibiotics, nonetheless the results of a number of studies are not fully convincing. The recommended treatment should be initiated with dietary fibre and probiotics, in the case of lasting problems add a non-absorbable
antibiotic rifaximine with cyclic administration. Mild
diverticulitis should essentially be treated by means of hydration and adjustments in the dietary regimen,
antibiotics are not necessary when its course is uncomplicated and improvement is achieved, however the decision is individual and risk factors such as immunosuppression, diabetes, old age, pregnancy etc.
Antibiotics are reserved for the treatment of severe or repeated
diverticulitis,
sepsis and complications. As prevention of further attacks, again probiotics,
mesalazine and cyclically non-absorbable
antibiotics are used, e,g. for a period of 10 days at monthly intervals. The proportion of surgeries is decreasing also where acute conditions are concerned and the efficiency of
conservative treatment of
diverticulitis is on the increase.
Abscess should primarily be treated via non-surgical drainage. Even perforation and
peritonitis can be treated via laparoscopic drainage without subsequent surgery being necessary, of course considering an overall condition an individual decision needs to be made. Generalized and fecal
peritonitis are treated by open surgery. Earlier, elective resection was recommended after 2 attacks of
diverticulitis, currently an individual approach is emphasized with respect to age, comorbidities and a character of the complaint and it is only indicated exceptionally. The proportion of laparoscopic resections is growing. The results are basically identical for Hartmann's procedure as well as primary resection. Key words: calprotecin -
diverticular disease - dietary fibre -
diverticulosis -
mesalazine - non-absorbable
antibiotics - probiotics.