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Health Protocols

Diverticulosis and Diverticular Disease

Introduction

The presence of small pouches or pockets in the wall of the large intestine is common with advancing age. These pockets are called diverticula, and most often form in the lower part of the large intestine, the colon (NIDDK 2012; Mayo Clinic 2014a). In Western countries, more than half of people older than 70 have diverticula; and in the United States, colonic diverticula are present in about two-thirds of individuals over age 85 (Peery 2013; Ferri 2015).

Many long-held beliefs about diverticula and associated conditions have been challenged over the past several years. For example, it used to be thought that fragments of foods containing large fibrous particles, such as popcorn, nuts, seeds, and corn, could become trapped in diverticula and cause inflammation (Thaha 2015). However, a large study that monitored over 47 000 men for 18 years showed that eating these foods did not increase risk for diverticular inflammation; in fact, study participants who ate the most nuts and popcorn actually had a decreased risk of diverticular complications (Strate 2008).

Diverticula do not by themselves ordinarily cause symptoms (Boynton 2013; Sopena 2011). In fact, many people are not even aware they have diverticula until they are detected during a routine colonoscopy or other procedure (Strate, Modi 2012; Thaha 2015; Mosadeghi 2015). A person who has diverticula without inflammation or any associated symptoms is said to have diverticulosis, a term that simply denotes the presence of diverticula in the large intestine (NIDDK 2012).

Less commonly, however, diverticula do cause problems. A person who has symptoms associated with diverticula is said to have diverticular disease (Spiller 2015; Strate, Modi 2012; Aydin 2012; Peery 2013).

Inflammation of diverticula—called diverticulitis—is a form of diverticular disease that can cause symptoms ranging from mild abdominal pain and fever to potentially life-threatening hemorrhage (NIDDK 2012; Thaha 2015; Ferri 2015). Diverticulosis is thought to progress to diverticulitis in about 1‒4% of cases (Shahedi 2013).

For decades, the standard of care for diverticulitis emphasized hospitalization and treatment with antibiotics, and possibly invasive surgery. However, a growing body of evidence suggests this aggressive approach may not improve outcomes compared with a more conservative approach that emphasizes individualized evaluation and treatment, and the judicious use of antibiotics and minimally invasive surgical techniques. Additionally, emerging therapies such as probiotics, non-systemic antibiotics, and anti-inflammatory drugs are increasingly being studied for the treatment of diverticular disease (McDermott 2014; Turley 2013; Razik 2015; Kruse 2014; Regenbogen 2014; Morris 2014).

In this protocol you will learn about how diverticulosis and diverticular disease develop, and what factors are thought to increase risk of these conditions. You will also discover how new evidence is reshaping the treatment of these conditions. Several promising novel and emerging approaches to treating diverticular disease will be reviewed, and a number of integrative interventions such as probiotics, butyrate, and natural anti-inflammatory agents will be described as well.