Wednesday, 4 December 2013

Diverticulitis: The Causes and Risk Factors

Diverticulitis is defined as a condition of inflammation of the small, bulging sacs or pouches of the inner lining of the intestine that bulge outward through weak spots as a result of small pieces of stool (feces) trapped in these pouches. In most cases, the disease is found in the large intestine (colon). According to the statistic, approximately, About 10 percent of Americans older than 40 have diverticulosis.
In the examination of the data fom January 2004 to June 2005 of 796 consecutive patients referred for total colonoscopy to 17 physicians included age, gender, presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding, showed that the prevalence of colonic diverticula increased from less than 10% in adults under 40 to about 75% in those over 75 years. Of these patients, nearly one third presented with right-sided involvement(1).
III. Causes and Risk factors
A. Causes

Accoutring to the study by Dr. Ryan P, in the study in Changing concepts in diverticular disease, Conventionally, acquired diverticular disease of the colon has been regarded as a single entity, so far as complications go. Experience at St. Vincent’s Hospital, Melbourne, suggests that there are two kinds of diverticular disease, one with the classic muscle abnormality, chiefly confined to the left colon and characterized by inflammatory and perforative complications and the other without muscle abnormality, but with diverticula throughout the colon, in which bleeding is common, perhaps due to a connective-tissue abnormality which, on the one hand, allows development of diverticula in the absence of abnormal intraluminal pressure and, on the other, provides inadequate support for vessels in the diverticular wall or for vascular malformations, which are therefore likely to bleed(11).
Others, according to the srticle by C-health, It’s believed that most diverticula are caused by unnoticed muscle spasms, or by pairs of muscles that don’t contract in a synchronized manner. This puts brief but intense pressure on the mucosal layer, causing pressure at the weakest points. The weakest points are the areas around blood vessels that pass through the inside of the wall of the large intestine (also called the colon). Older people have frailer tissue lining the bowel – this is probably why they have more diverticula(12).
B. Risk factors
1. Deficiency of dietary fiber diet, obesity and red meat intake
Deficiency of dietary fiber diet such as American typical diet, obesity and red meat intake are associated to increased risk of diverticolosis(13).
2. Smoking
Although the finding in inconsistence, but researchers suggested that smokers are at increased risk for complications, particularly perforation(14).
3. Alcohol
Alcohol may increase the risk of asymptomatic diverticulosis and diverticulitis(15).
4. Physical inactive and over weight
In the study to investigate the association between obesity and physical inactivity and diverticular disease in a population-based cohort of women, conducted by the Danderyd University Hospital, The National Institute of Environmental Medicine, showed that Overweight, obesity, and physical inactivity among women increase diverticular disease requiring hospitalization(16).
5. Age and race
The disease prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those > or =65 years of age. Of patients with diverticula, 80-85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15-20% of patients develop symptomatic diverticular disease, according to the study by University of Parma, Parma(17). Other study indicated that in Western countries diverticular disease predominantly affects the left colon, its prevalence increases with age and its causation has been linked to a low dietary fibre intake. Right-sided diverticular disease is more commonly seen in Asian populations and affects younger patients(18).
6. Etc.
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