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From diverticula to inflammation: Why do these factors lead to intestinal crises?
Diverticulitis, also known as colonic diverticulitis, is a digestive disease characterized by inflammation of abnormal pouches—diverticula—in the walls of the large intestine. Symptoms of this disease usually include sudden lower abdominal pain, but sometimes symptoms can develop gradually over a few days. Patients may experience symptoms such as nausea, diarrhea, or constipation, while fever or blood in the stool may indicate the presence of comorbidities. The cause of diverticulitis remains unclear. Risk factors include obesity, physical inactivity, smoking, family history, and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Although the evidence is not clear as to whether a low-fiber diet is a risk factor, it cannot be ignored that the multiple factors that affect intestinal health are intertwined and may constitute an intestinal crisis that cannot be underestimated.
The presence of diverticula when they are not inflamed is called diverticulosis, however, diverticulitis occurs in 10% to 25% of cases at some point in time, usually due to bacterial infection.
Clinical features and etiology
The classic symptom of diverticulitis is sudden onset of lower abdominal pain. Patients often have superficial reactions, such as increased white blood cell count or elevated C-reactive protein, which are usually located on the right side (ascending colon) in Asia and on the left side (sigmoid colon) in North America and Europe. In addition to abdominal pain, fever, nausea, diarrhea or constipation, and even blood in the stool may occur. According to research, people with diverticulosis actually have more frequent bowel movements, which goes against the popular belief about constipation.
Complications
In complicated diverticulitis, the inflamed diverticula may rupture, allowing bacterial infection from outside the intestine to spread into the abdominal cavity, causing peritonitis. Sometimes, inflamed diverticula can cause the intestine to narrow, which can lead to intestinal obstruction. In addition, the affected portion of the intestine may adhere to the bladder or other pelvic organs, forming fistulas, which are abnormal connections between the intestine and an adjacent organ.
Associated symptoms may include: intestinal obstruction, peritonitis, abscesses, fistulas and strictures.
Diagnosis and classification
The diagnosis of diverticulitis is usually based on a CT scan, but blood tests, colonoscopy, or low bowel imaging may also provide additional support. Depending on the severity, diverticulitis can be divided into two categories: uncomplicated and complicated. According to the German classification, uncomplicated acute diverticulitis is defined as inflammation of a localized diverticulum, while complications include abscesses, peritonitis, intestinal strictures, and fistulas.
Preventive measures and lifestyle
Both dietary modifications and healthy lifestyle changes can be part of preventing diverticulitis. Some studies have shown that a healthy lifestyle, such as maintaining a normal BMI, regular exercise, and low meat intake, can significantly reduce the risk of diverticulitis. In addition, adequate fiber intake and regular bowel movement frequency are also believed to have a certain protective effect.
A prospective cohort study showed that a healthy lifestyle can significantly reduce the risk of diverticulitis, with a relative risk ratio of 0.27 (0.15 to 0.48).
Treatment status
For mild, uncomplicated diverticulitis, oral antibiotics and a clear liquid diet are usually the recommended treatment. More severe cases may require intravenous antibiotics, hospitalization, and complete bowel rest. Surgery is usually used for complications such as abscesses or fistulas. When deciding on surgical treatment, there are many factors to consider, including the stage of the disease, the patient's age, and overall health.
Future Challenges
The incidence of diverticulitis increases with age, especially in Western countries. In the future, whether we can find clearer causes and effective prevention and treatment plans is a challenge faced by all gastrointestinal health experts. As lifestyle and eating habits change, research on diverticulitis needs to continue in depth to answer more questions behind this intestinal crisis.
When it comes to intestinal health, can lifestyle changes really be the key to preventing diverticulitis?
