Diverticulitis hurts on the left in Europe but usually on the right in Asia
Small pouches in the wall of the large intestine are common in Western countries and rare in rural Africa. When they become inflamed, the result is diverticulitis. Oddly, where the pain strikes depends on geography, and the old advice to avoid nuts and seeds has been dropped for lack of evidence.
Having the pouches, called diverticula, without inflammation is diverticulosis. In the West about 35 percent of people have it, compared with under 1 percent in rural Africa. It becomes more frequent with age, from about 5 percent of under-40s to half of those over 60, and it is rising worldwide. It is the most common structural disease of the colon. Roughly 10 to 25 percent of people with pouches develop bacterial inflammation at some stage. In Europe the disease caused about 13,000 deaths in 2003, and in 2013 diverticular disease cost the United States around 2.4 billion dollars a year.
An attack usually begins with lower abdominal pain, often sudden but sometimes building over days, perhaps with nausea, diarrhoea or constipation. In North America and Europe the pain tends to sit low on the left, where the sigmoid colon lies; Asian patients more often feel it on the right, near the ascending colon. Fever or blood in the stool points to complications, and blood tests typically show raised C-reactive protein and white cells. Diagnosis generally relies on a CT scan. Contrary to a common assumption, diverticulosis is linked with more frequent bowel movements, not constipation.
Why pouches form is poorly understood; age, diet, gut bacteria, genes, bowel movement patterns and structural change probably interact. Possible risk factors include obesity, inactivity, smoking, family history and NSAID painkillers, while the role of low-fibre diets is uncertain. Mesalazine and rifaximin appear to help prevent attacks.
Mild cases are usually handled with oral antibiotics and a liquid diet; severe ones may need hospital care, intravenous antibiotics and complete bowel rest. The value of probiotics is unclear. In complicated disease an inflamed pouch can burst and spread infection to the abdominal lining, causing peritonitis, narrow the bowel, or form a fistula joining the colon to the bladder or another organ, and surgery may be required.
Source: Diverticulitis
