Diverticular Disease Issues: Diverticulosis and Diverticulitis - Report Example

Diverticular disease (Diverticulosis and Diverticulitis)

History of issue

Diverticular disease refers to the condition where the colon develops diverticula that are not swollen. As would be borrowed from the work of Janes, Meagher & Frizelle (2006), diverticula are swellings of the colonic mucosa and submucosa that are caused by the strains on the muscle layers in the wall of the colon. At times, bleeding may occur especially in the event that there is inflammation. Most importantly, Elisei & Tursi (2016) emphasize that the inflammation mostly takes place in the sigmoid colon that is prone to increased pressure either on the left side or the right side.

Other scholars such as Spiller (2015) term diverticulosis as a condition that forms pockets in the bowel’s lining. The sizes of the diverticula differ from person to person depending on the extent if the damage. Spiller (2015) explains that the size may be that of a pea to a larger one. Stollman & Raskin (2004) also write that diverticula range from solitary to hundreds of findings and that their diameter is normally 5-10mm but in some instances they can go above 2 cm. In the case where there is increased pressure on the intestinal walls by gas, liquid or even solid waste, the wall of the colon reacts differently. During constipation for example, diverticula may form due to the strains in the bowel movement.

As far as prevalence is concerned, Tursi (2016) writes that diverticulosis is common to people over the age of 40. The condition is most prevalent in the Western countries. People that have lesser fiber are prone to the infection as opposed to ones that have high fiber. In Africa for example, the rates of infection have been indicated to be minimal due the lower rate of life expectancy and that Africans have high fiber. This makes the counterparts in countries such as Canada and United States prone to the condition (Comparato et al, 2007). However, it is important to note that many people are likely to have few or even no symptoms from the condition. People that succumb to the infection have various forms of complications that range from rectal bleeding and infections of the diverticular known as diverticulitis.

Current situations

With the condition affecting a great number of people especially after the age of 40 as discussed earlier, there has been nee to come up with new guidelines on the treatment and handling diverticulitis. Currently, as seen in the work of Tursi, et al. (2013), there has been the recommendation of the routine use of antibiotics on patients whose diverticulitis is not complicated. However, this must have been confirmed through a CT scan and a close follow up from medical practitioners. However, the authors warn that this kind of recommendation is not valid for patients that have severe infections, immunosuppression and other characteristics such high fever and excessive while blood cell count (Tursi, et al., 2013).

On another viewpoint, there has been the current debate on the treatment of diverticulitis through colonoscopy after diverticulitis is detected. This was decided after studies that related the condition to colorectal cancer among patients, specifically 15 out of 1000 patients from the research conducted by Daniels, et al (2014). This validates the current guideline on the application of colonoscopy is valid considering that it may save a patient from succumbing to cancer and has also been indicated to be a good solution to tissue thinning among patients.

Most importantly, there has been a recent discussion on the application of elective resection after diagnosis of uncomplicated diverticulitis. This is in line with the thoughts of Strate, Peery & Neumann (2015) who also argue that there is a 10% chance of complications after elective sigmoid resection and 20% in five years. Avoiding any chances of recurrence is viable though there may be short term complications like cardiothoracic complications and wound infections. Nonetheless, the author recommends fewer routine sigmoid resections to avoid related complications.

There has also been a discussion on fiber and diet as a way of handing diverticulitis. As had been discussed earlier, fiber has been indicated as a key factor in the prevalence of diverticulitis. Comparato et al (2007) write that fiber is of major benefit in the human body and reduces chances that individuals may succumb to diverticulitis. This calls for selection of diets that are rich in fiber. This study is then useful for patients that are prone to the infection as well as clinicians who strive to minimize the risks of the infection.

There has also been an ongoing discussion on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat cases of acute diverticulitis. Johnson (2016) explains how aspirin was used on patients with acute diverticulitis. Of essence, the author indicates that aspirin should not be avoided by any chance on patients with acute diverticulitis. Actually, the use of aspirin has recorded minimal chances of the recurrence of diverticulitis (Johnson, 2016). Conversely, if the patient has recorded various forms of complications, it has been recommended that they avoid the use of NSAIDs. In addition, rifaximin and mesalamine have also been highlighted as NSAIDs that are suggested in the handling of acute diverticulitis. These drugs are not only useful in the prevention of diverticulitis but also in the prevention of recurrence of the infection (Johnson, 2016). This explains that the condition can be handle prior to its becoming chronic and serious on patients.

The use of probiotics has also been current issue of discussion on diverticulitis. Tursi, et al (2013) explains how the recent use of probiotics has led to cessation of acute diverticulitis. Notably, patients that were indicated to use probiotics on a continuous schedule reported fewer complications. In the research by Tursi et al (2013) mesalamine and Lactobacillus casei were used repeatedly by patients for ten days. After the period lapsed, there was 0% recurrence of the condition among the 120 patients under the treatment of the probiotics (Tursi et al., 2013). This means that the use of probiotics should not be ruled out completely as remedy to diverticulitis but as a potential solution to the condition.

Clearly, there is a paradigm shift that diverculitis should not be treated with antibiotics. Despite the few cases of inflammations and not infections with the use of antibiotics on diverticulitis’ patients, it is agreed that antibiotics should be continued on uncomplicated cases and closely followed on patients that have fewer complications (Tursi et al., 2013). Thanks to the developments in Science, patients with complications related to diverculitis have a sense of relief.

Comparisons and contrasts on different viewpoints on diverticulitis

Different authors and researchers have differing views on diverticulitis in different approaches ranging from the symptoms to the treatment of the same. According to Spiller (2015), there have been divergent views on diverticular disease. The author, just like the previous authors agree to the idea that diet plays a major role in the prevalence of diverticular disease. The author highlights that consumption of diets low in fiber may lead to the development of diverticulitis. The author also emphasizes that diets that are high in red meat and animal fat are likely to increase the chances of diverticulitis (Spiller, 2015). This means that dietary induced changes in microbiota may lead to the development of chronic or acute diverculitis.

However, on the same view on diet, Decher & Krenitsky (2012) differ partly with other authors like Spiller (2015) as they argue that instructing patients to take low fiber diets is useful for a medical nutrition therapy. The author then indicates fiber needs to be increased gradually and that proper hydration must be adhered to at the time. The authors continue to question the benefit of seeds, nuts and the like in the treatment of diverticulitis. Strate et al (2008) differ with the arguments of Decher & Krenitsky (2012) as they opine that out of the 47000 men indicated to take foods with fiber, none presented indications of diverticulitis disease. Actually, these foods were associated with lower risks of the disease.

As far as management of the condition is concerned, different authors have differing opinions. In the work, it had been indicated that the condition can be managed through the use of NSAIDs and consumption of diets rich in fiber. On the contrary, Janes, Meagher & Frizelle (2006) write that there is high risk of perforation with the use of NSAIDs and the long term use of opioids. This disqualifies the ideas presented by Johnson (2016) who credited the use of antibiotics such aspirin have been useful in the treatment and management of diverculitis. Though the authors advocate for meals rich in fiber, they also advise the use of calcium channel blockers in the reduction of diverticular perforation.

The thoughts on prevalence are similar among many researchers who are of the opinion that diverticular disease is sporadic among people younger than forty years. The studies also agree to the thought that the infection is rare in African countries and in some parts of Asia. High prevalence rates have been reported in USA, Australia and Europe (Comparato et al, 2007; Tursi (2016). This may act as a good basis on determining the prevalence of the infection.

Future outlook and the efficacy of treatments for this disease

The incidences reported on diverticular and diverticulosis is increasing by the day. In as much many of the reported patients end up being asymptomatic, Elisei & Tursi (2016), argue that this condition is slowly becoming a burden to the existing health systems in the USA. This means that there are both direct and indirect costs that are involved in the treatment and management of the condition. Still, there is hope for patients that are not having complications from the disease since probiotics, fiber and antibiotics have come in handy to help deal with the infection. However, more research needs to be done on the medical strategies that have been involved in the prevention of acute diverticulitis.

Surgical interventions have also been applied as measures to deal with the condition. Johnson (2016) writes that surgical interventions have been applied in cases where the patient has severe complications and has gotten to a point where they can barely handle oral meals and have high fever. Worse still if the patient continues to show complications like obstruction, fistula and abscesses, they are also forced to undergo surgery (Johnson, 2016).

It is also important to note that many complications may result from fistula. As noted above, peritonitis is among the complications and it involves painful toxicities on the abdominal fissure. Surgery is then adopted as a measure of removing the damaged part of the colon. Abscesses are also side effects that involved infections on the wall of the abdomen. Stollman & Raskin (2004) explain that in the occurrence of the abscesses, the patient needs to undergo a process of draining the fluid or even go through surgery to remove part of the infected colon.

In other patients, the infection may lead to damaging of the colon to an extent of causing blockage; partial or complete (Stollman & Raskin, 2004). Patients that are unfortunate to have suffered complete blockage have no option but to go through surgery that removes the blockage. Lastly, is the formation of the fistula that causes an abnormal connection between the bladder and the colon. In this case, the patient also needs to go through surgery that will remove the affected part of the colon (Stollman & Raskin, 2004).

These complications then call for the prevention of diverticulitis as way of preventing future infection and high rates of people with the condition. First, it is recommended that individuals uphold good bowel habits that involve constant and consistent bowel movements (Janes, Meagher & Frizelle, 2006). This will help prevent chances that constipation will take place or mere straining of the colon muscles. Though, this cannot happen in isolation, the individual needs to take foods that are rich in fiber and taking enough water in a day. Exercises have also been noted as a way of regulating the bowel movements. In this case, many people will be spared from the occurrence of such conditions.

Consumption of fiber, at least 20-35 grams in a day is recommended as a measure of handling the condition. Such foods include wholegrain bread, cereals, broccoli amongst others (Strate et al., 2008). Individuals then need to observe any changes in the bowel, whether constipation or any form of loose stool. Enough rest and sleep have also been noted as ways of preventing the diverticular disease (Janes, Meagher & Frizelle, 2006).

Conclusion

Though the diverticular disease is a condition that affects older people, I am of the assessment that this condition is a lifestyle disease. This can be deduced from the fact that prevention can be done through lifestyle choices like regulating bowel movements, taking lots of water, regular exercising amongst others. However, it is extremely alarming how the number of people with the condition is increasing by the day. This means that a lot needs to be done to handle the same. In this century where many people do not mind their dietary composition, it is then likely that this general will suffer from the same condition in years to come. It is not the responsibility of the clinicians alone, but every person to handle and manage the condition.

I have had an easy to me gathering information and collecting data on this topic since there are many authors and researchers that are interested in the condition. I have learnt that the condition can be controlled and prevented if individuals are keen on their lifestyle behaviors. I also noted that the prevalence rates are higher in USA since many people do not consume foods rich in fiber as opposed to their counterparts in Africa. Generally, the research was quite informative and interesting.