Diverticulosis natural history, complications and prognosis: Difference between revisions
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{{Diverticulosis}} | {{Diverticulosis}} | ||
{{CMG}}{{AE}} [[User:Seyedmahdi Pahlavani|Seyedmahdi Pahlavani, M.D.]] | {{CMG}}{{AE}} [[User:Seyedmahdi Pahlavani|Seyedmahdi Pahlavani, M.D.]] | ||
==Overview== | ==Overview== | ||
Diverticulosis generally develops among elderly patients (> 65 years), but it is not uncommon to be diagnosed among 40-50 years old individuals. Patients with diverticulosis are usually asymptomatic, and without development of complications, the majority of patients are not diagnosed. A minority of patients develop complications of diverticulosis. Common complications of diverticulosis include diverticular bleeding, [[diverticulitis]], [[abscess]] or [[fistula]] formation, or [[perforation]]. Overall, the prognosis of diverticulosis is excellent. The prognosis may vary based on development of complications and patient co-morbidities. | |||
==Natural History== | ==Natural History== | ||
*Diverticulosis generally develops among elderly patients (> 65 years), but it is not uncommon to be diagnosed among 40-50 years old individuals. | |||
* | *Patients with diverticulosis are usually asymptomatic, and without development of complications, the majority of patients are not diagnosed.<ref name="pmid12603892">{{cite journal |vauthors=Simpson J, Spiller R |title=Colonic diverticular disease |journal=Clin Evid |volume= |issue=8 |pages=436–44 |year=2002 |pmid=12603892 |doi= |url=}}</ref> | ||
*Only 15-20% of patients with diverticulosis report symptoms that are not related to complications of the disease, such as abdominal discomfort. | |||
*A minority (15% to 25%) of patients develop complications of diverticulosis (commonly diverticular bleeding, [[diverticulitis]], [[abscess]] or [[fistula]] formation, or [[perforation]]).<ref name="pmid5359917">{{cite journal |vauthors=Parks TG |title=Natural history of diverticular disease of the colon. A review of 521 cases |journal=Br Med J |volume=4 |issue=5684 |pages=639–42 |year=1969 |pmid=5359917 |pmc=1630185 |doi= |url=}}</ref><ref name="pmid16303575">{{cite journal |vauthors=Strate LL |title=Lower GI bleeding: epidemiology and diagnosis |journal=Gastroenterol. Clin. North Am. |volume=34 |issue=4 |pages=643–64 |year=2005 |pmid=16303575 |doi=10.1016/j.gtc.2005.08.007 |url=}}</ref> | |||
==Complications== | ==Complications== | ||
Common complications associated with | Common complications associated with diverticulosis include:<ref name="pmid5359917">{{cite journal |vauthors=Parks TG |title=Natural history of diverticular disease of the colon. A review of 521 cases |journal=Br Med J |volume=4 |issue=5684 |pages=639–42 |year=1969 |pmid=5359917 |pmc=1630185 |doi= |url=}}</ref><ref name="pmid16303575">{{cite journal |vauthors=Strate LL |title=Lower GI bleeding: epidemiology and diagnosis |journal=Gastroenterol. Clin. North Am. |volume=34 |issue=4 |pages=643–64 |year=2005 |pmid=16303575 |doi=10.1016/j.gtc.2005.08.007 |url=}}</ref><ref name="pmid1085269">{{cite journal |vauthors=Meyers MA, Alonso DR, Gray GF, Baer JW |title=Pathogenesis of bleeding colonic diverticulosis |journal=Gastroenterology |volume=71 |issue=4 |pages=577–83 |year=1976 |pmid=1085269 |doi= |url=}}</ref><ref name="pmid4536683">{{cite journal |vauthors=Casarella WJ, Kanter IE, Seaman WB |title=Right-sided colonic diverticula as a cause of acute rectal hemorrhage |journal=N. Engl. J. Med. |volume=286 |issue=9 |pages=450–3 |year=1972 |pmid=4536683 |doi=10.1056/NEJM197203022860902 |url=}}</ref> | ||
*[[Lower | *[[Lower gastrointestinal bleeding|Lower GI bleeding]]<ref name="pmid1085269">{{cite journal |vauthors=Meyers MA, Alonso DR, Gray GF, Baer JW |title=Pathogenesis of bleeding colonic diverticulosis |journal=Gastroenterology |volume=71 |issue=4 |pages=577–83 |year=1976 |pmid=1085269 |doi= |url=}}</ref><ref name="pmid4536683">{{cite journal |vauthors=Casarella WJ, Kanter IE, Seaman WB |title=Right-sided colonic diverticula as a cause of acute rectal hemorrhage |journal=N. Engl. J. Med. |volume=286 |issue=9 |pages=450–3 |year=1972 |pmid=4536683 |doi=10.1056/NEJM197203022860902 |url=}}</ref> | ||
*[[Diverticulitis| | *[[Diverticulitis|Acute diverticulitis]]<ref name="pmid12603892">{{cite journal |vauthors=Simpson J, Spiller R |title=Colonic diverticular disease |journal=Clin Evid |volume= |issue=8 |pages=436–44 |year=2002 |pmid=12603892 |doi= |url=}}</ref><ref name="pmid1613298">{{cite journal |vauthors=Gore S, Shepherd NA, Wilkinson SP |title=Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance |journal=Int J Colorectal Dis |volume=7 |issue=2 |pages=76–81 |year=1992 |pmid=1613298 |doi= |url=}}</ref><ref name="pmid8540614">{{cite journal |vauthors=Makapugay LM, Dean PJ |title=Diverticular disease-associated chronic colitis |journal=Am. J. Surg. Pathol. |volume=20 |issue=1 |pages=94–102 |year=1996 |pmid=8540614 |doi= |url=}}</ref> | ||
* | *Segmental [[colitis]]<ref name="pmid12555996">{{cite journal |vauthors=Ludeman L, Shepherd NA |title=What is diverticular colitis? |journal=Pathology |volume=34 |issue=6 |pages=568–72 |year=2002 |pmid=12555996 |doi= |url=}}</ref> | ||
*[[Perforation]] | |||
*Fistula formation | |||
*[[Abscess]] formation | |||
*Stricture | |||
==Prognosis== | ==Prognosis== | ||
Overall prognosis of | *Overall, the prognosis of diverticulosis is excellent. | ||
*Once patients are symptomatic, mortality rates vary depending on the presence of complications and patient comorbidities.<ref name="pmid16741596">{{cite journal |vauthors=Rafferty J, Shellito P, Hyman NH, Buie WD |title=Practice parameters for sigmoid diverticulitis |journal=Dis. Colon Rectum |volume=49 |issue=7 |pages=939–44 |year=2006 |pmid=16741596 |doi=10.1007/s10350-006-0578-2 |url=}}</ref>. In patients with acute uncomplicated diverticulitis, conservative treatment is successful in 70 to 100 percent of patients and mortality is negligible<ref name="pmid16741596">{{cite journal |vauthors=Rafferty J, Shellito P, Hyman NH, Buie WD |title=Practice parameters for sigmoid diverticulitis |journal=Dis. Colon Rectum |volume=49 |issue=7 |pages=939–44 |year=2006 |pmid=16741596 |doi=10.1007/s10350-006-0578-2 |url=}}</ref>. | |||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D.
Overview
Diverticulosis generally develops among elderly patients (> 65 years), but it is not uncommon to be diagnosed among 40-50 years old individuals. Patients with diverticulosis are usually asymptomatic, and without development of complications, the majority of patients are not diagnosed. A minority of patients develop complications of diverticulosis. Common complications of diverticulosis include diverticular bleeding, diverticulitis, abscess or fistula formation, or perforation. Overall, the prognosis of diverticulosis is excellent. The prognosis may vary based on development of complications and patient co-morbidities.
Natural History
- Diverticulosis generally develops among elderly patients (> 65 years), but it is not uncommon to be diagnosed among 40-50 years old individuals.
- Patients with diverticulosis are usually asymptomatic, and without development of complications, the majority of patients are not diagnosed.[1]
- Only 15-20% of patients with diverticulosis report symptoms that are not related to complications of the disease, such as abdominal discomfort.
- A minority (15% to 25%) of patients develop complications of diverticulosis (commonly diverticular bleeding, diverticulitis, abscess or fistula formation, or perforation).[2][3]
Complications
Common complications associated with diverticulosis include:[2][3][4][5]
- Lower GI bleeding[4][5]
- Acute diverticulitis[1][6][7]
- Segmental colitis[8]
- Perforation
- Fistula formation
- Abscess formation
- Stricture
Prognosis
- Overall, the prognosis of diverticulosis is excellent.
- Once patients are symptomatic, mortality rates vary depending on the presence of complications and patient comorbidities.[9]. In patients with acute uncomplicated diverticulitis, conservative treatment is successful in 70 to 100 percent of patients and mortality is negligible[9].
References
- ↑ 1.0 1.1 Simpson J, Spiller R (2002). "Colonic diverticular disease". Clin Evid (8): 436–44. PMID 12603892.
- ↑ 2.0 2.1 Parks TG (1969). "Natural history of diverticular disease of the colon. A review of 521 cases". Br Med J. 4 (5684): 639–42. PMC 1630185. PMID 5359917.
- ↑ 3.0 3.1 Strate LL (2005). "Lower GI bleeding: epidemiology and diagnosis". Gastroenterol. Clin. North Am. 34 (4): 643–64. doi:10.1016/j.gtc.2005.08.007. PMID 16303575.
- ↑ 4.0 4.1 Meyers MA, Alonso DR, Gray GF, Baer JW (1976). "Pathogenesis of bleeding colonic diverticulosis". Gastroenterology. 71 (4): 577–83. PMID 1085269.
- ↑ 5.0 5.1 Casarella WJ, Kanter IE, Seaman WB (1972). "Right-sided colonic diverticula as a cause of acute rectal hemorrhage". N. Engl. J. Med. 286 (9): 450–3. doi:10.1056/NEJM197203022860902. PMID 4536683.
- ↑ Gore S, Shepherd NA, Wilkinson SP (1992). "Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance". Int J Colorectal Dis. 7 (2): 76–81. PMID 1613298.
- ↑ Makapugay LM, Dean PJ (1996). "Diverticular disease-associated chronic colitis". Am. J. Surg. Pathol. 20 (1): 94–102. PMID 8540614.
- ↑ Ludeman L, Shepherd NA (2002). "What is diverticular colitis?". Pathology. 34 (6): 568–72. PMID 12555996.
- ↑ 9.0 9.1 Rafferty J, Shellito P, Hyman NH, Buie WD (2006). "Practice parameters for sigmoid diverticulitis". Dis. Colon Rectum. 49 (7): 939–44. doi:10.1007/s10350-006-0578-2. PMID 16741596.