Diverticular disease affects 5-10% of Western people over the age of 45; the incidence rises to 80% in those over 80. Colonic dysmotility with increased intracolonic pressure, and diets high in refined carbohydrate and low in fibre are important pathogenic factors. Some patients experience abdominal pain from dysmotility whilst others remain asymptomatic. Infection of diverticula occurs in a minority, giving potential for rupture or abscess formation.
Symptomatic diverticular disease often responds to an increase in dietary fibre, and addition of a stool bulking agent. Antispasmodic drugs are helpful in controlling the pain of colon spasm but antimotility drugs encourage stasis of bowel contents, increase intracolonic pressure, and should be avoided. Diverticulitis requires treatment with broad spectrum antimicrobials for 7-10 days (e.g.
ciprofloxacin and metronidazole, or ampicillin, gentamycin and metronidazole).
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