They are quite frequent colon disorders, but not everyone knows how to distinguish them, nor do they know the causes, symptoms or risk factors. Here is the advice of our experts to prevent these diseases.
“First of all we must distinguish – explains Prof. Alessandro Repici, head of digestive Endoscopy at Humanitas – “Diverticulosis is a pathology, while diverticulitis is the complication of the disease or the inflammation of the diverticula”.
Are there any data on the incidence of diverticulosis in Italy?
“Diverticulosis is a disease about which we have inaccurate incidence and prevalence data because it often gives few symptoms and to make a diagnosis an instrumental investigation such as colonoscopy is required, or opaque enema or CT scan of the abdomen. In general, we can say that it is a very common condition and that about 30-35 people over 60 years of age have diverticulosis of the colon with an equal distribution between the two sexes and with a greater prevalence in those subjects who have a long history of constipation or irritable colon.
What are diverticulosis and diverticulitis?
“Diverticulosis is a pathological condition whereby in the walls of the colon and in particular in those of the left colon (immediately above the rectum) small pockets, bags (extroversions) are formed. These pockets or bags are formed as a consequence of an altered intestinal motility that through excessive contractions of the colon generates an increased pressure inside the colon, pressure that acting on areas of the intestine of lower resistance determines the exhaustion and then the progressive deformation. In addition to the altered motility, the presence of very hard stools that pass with difficulty through the colon can also help to determine the conditions for a progressive formation of the diverticula. Once the diverticula have formed, they in turn represent a pathological element that negatively affects intestinal transit, colon contractions and the passage of feces”.
Why do the diverticula become inflamed?
“The diverticula become inflamed when fecal material stagnates inside them for a long time causing an alteration in the bacterial flora with a prevalence of some bacteria that are normally saprophytes (therefore non pathogenic) but that in the presence of diverticula and fecal stagnation can increase in concentration and become responsible for an inflammatory process on a bacterial basis”.
What are the risk factors?
“There are two types of risk factors for inflammation of the diverticula: disease related risk factors, i.e. large diverticula are more susceptible to inflammation, and fecal transit risk factors. Hard feces and slow transit are another risk factor. In general, overweight is also a significant risk factor. The role of food is controversial even if it can be said that foods that leave a large residual fibrous indigestible, for example artichokes or legumes whose outer skin is not absorbed but remains indigestible inside the colon, may increase the risk of diverticulitis. Finally, it is evident that a diet poor in water significantly increases the risk of diverticulitis.
Can you totally recover from diverticulitis?
“Diverticulitis can be completely cured with appropriate antibiotic therapy and specific behavioral norms (both daily and with diet). Diverticula cannot be cured in the sense that once the anatomical condition is established it will return, unless it undergoes surgery to remove a section of the colon. But the resection intervention of a section of the colon affected by diverticulosis must be taken into consideration for those forms of severe diverticulosis that are very symptomatic or that encounter frequent episodes of diverticulitis”.
How to prevent diverticulitis?
“With physical activity, keeping weight under control, drinking at least two liters of water a day and a balanced diet and a good supply of fiber. However, it is important to avoid excess fibers, fruit with the skin and all those vegetables that leave a large component of undigested fiber in the intestine, which can stop inside the diverticula (artichokes or legumes)”.