In this discussion, gastroenterologist Sahil Khanna and colorectal surgeon Sherief Shawki share their expertise on diverticular disease. They explain the rising prevalence of diverticulosis, particularly among younger folks, and highlight lifestyle factors that can mitigate risks. The importance of fiber in diet and its impact on preventing complications like diverticulitis is emphasized. They explore diagnostic techniques and the significance of minimally invasive surgical options, underscoring the benefits of a collaborative healthcare approach for better patient outcomes.
Diverticulosis prevalence increases with age, impacting dietary habits and emphasizing the need for awareness in younger populations.
Management of acute diverticulitis has evolved to prioritize lifestyle modifications and a multidisciplinary approach before considering surgery.
Deep dives
Understanding Diverticulosis and Its Pathology
Diverticulosis is a common gastrointestinal condition characterized by the formation of outpouchings in the colon, particularly on the left side. These outpouchings occur due to sheer stress on the intestinal wall, which lacks a complete muscular outer layer, making it susceptible to forming diverticula. As individuals age, the prevalence of diverticulosis increases significantly, with a notable rise in cases among those over 50. Additionally, risk factors include a low-fiber diet, history of constipation, and genetic predispositions, leading to a growing awareness of diverticulitis in younger populations.
Navigating Diverticulitis and Its Management
Diverticulitis arises when diverticula become inflamed or infected, with potential causes including obstruction from hard stool or entrapped bacteria. Contrary to long-held beliefs, recent studies indicate that avoiding nuts and seeds does not significantly influence the incidence of diverticulitis. The overall risk of developing diverticulitis from diverticulosis varies widely, estimated at 5% to 25%, while general management focuses on lifestyle modifications such as adequate hydration and fiber intake. Interestingly, the approach to treating acute diverticulitis has evolved, as many mild cases can be managed without antibiotics.
Surgical Interventions and Considerations
Surgery for diverticulitis is usually considered when patients experience recurrent or complicated episodes. Current guidelines advocate a careful assessment and avoidance of immediate surgical intervention for the first occurrence, emphasizing the importance of ruling out other conditions like cancer. When surgery is indicated, minimally invasive techniques, such as laparoscopic and robotic methods, are preferred for their shorter recovery times. As diverticular disease management progresses, a multidisciplinary approach involving primary care providers, gastroenterologists, and surgeons is critical to optimize patient outcomes and quality of life.
Diverticulosis is quite common. Its prevalence varies with age from fewer than 20% at age 40 to 60% by age 60. It's far more common in the left colon and tends to be progressive with both the number and size of the diverticula, both increasing with age. There are potential complications of diverticulosis, with diverticulitis being most common. This also tends to increase in prevalence with age and appears to be increasing with time. Can diverticulitis be prevented? What’s the best way to manage a patient with acute diverticulitis and when is surgery indicated? I’ll be asking these questions and more to my guests, Sahil Khanna, M.B.B.S., M.S., from the Division of Gastroenterology and Hepatology and Sherief Shawki, M.B., B.Ch., M.D., from the Division of Colorectal Surgery at the Mayo Clinic. The topic for this podcast is diverticular disease.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
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