GP Dr Roger Henderson advises on what practice nurses need to consider when reviewing patients with diverticular disease
Module summary
Diverticular disease is a common condition that affects the colon (large intestine). It involves the development of small pouches or sacs called diverticula in the lining of the colon. These pouches can become inflamed or infected, leading to various symptoms and complications. The two main forms of diverticular disease are diverticulosis and diverticulitis and it is important that all healthcare professionals are aware of the differences between them as well as how best to diagnose and manage these conditions.
Learning objectives
By the end of this module, you will have a greater understanding of:
- The definition of diverticular disease and its causes.
- How it may present in patients.
- Possible differential diagnoses.
- How diverticular disease is managed.
- Possible complications, and when referral to a specialist is needed.
- How it may be prevented, or risks minimised.
What is diverticular disease?
Diverticular disease is best defined as any clinical state caused by symptoms linked to diverticula in the large bowel. Diverticula are small bulges or pockets in the intestinal wall – due to herniation of mucosa through thickened colonic muscle. Patients may have a solitary diverticulum or hundreds of diverticula. Diverticula are typically around 5-8mm in diameter, but may exceed 2cm in size occasionally.1
There is a wide range of possible effects from diverticula, ranging from no symptoms to severe and complicated disease:
- Diverticulosis refers to the presence of diverticula that are asymptomatic.
- Diverticular disease is when diverticula cause symptoms, and is sometimes also referred to as painful diverticular disease. It is often characterised by episodic left-lower abdominal colicky pain with or without other non-specific symptoms of bloating, constipation, or diarrhoea that may all become recurrent.
- Diverticulitis indicates inflammation of a diverticulum or diverticula and may be caused by infection.
- Other complications of diverticular disease include bleeding, infection, abscess, perforation, peritonitis, fistula formation and bowel obstruction.
What causes diverticular disease?
Diverticular disease is thought to have many causes, especially a low dietary fibre intake, which in Western populations is thought to be the main contributing factor along with increasing age.2 Other causes include lack of exercise, obesity (especially in younger people), increased red meat consumption, tobacco smoking, excessive alcohol and caffeine intake, steroids, and NSAIDs.3-5
It is common, occurring in 80% of people aged 85 and over and in 10% of people aged over 45. (It is rare below the age of 40.)6
Around three quarters of people with diverticula have no symptoms. Of the rest who do develop symptoms, about three quarters of these will develop diverticulitis. The severity of acute diverticulitis is graded using the Hinchey classification:7
- Stage I: small or confined pericolic or mesenteric abscess.
- Stage II: large paracolic abscess often extending into pelvis.
- Stage III: perforated diverticulitis where a peri-diverticular abscess has perforated resulting in purulent peritonitis.
- Stage IV: perforated diverticulitis, where there is free perforation and is associated with faecal peritonitis.
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Dr Roger Henderson is a senior GP based in Scotland
