Gastroenterologie
a hepatologie

Diverticular disease

Julius Špičák ^{Orcid.org  1}, Gabriela Suchánková ^{Orcid.org  2}, Miloš Kučera ^{Orcid.org  3}

+ Affiliation
¹ Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
² Klinika hepatogastroenterologie, IKEM, Praha
³ Klinika transplantační chirurgie, IKEM, Praha

Summary

Diverticular disease has a high prevalence percentage and an increasing incidence, even in young individuals. Its incidence is usually associated with relatively low-fibre diet. Other risk factors include smoking, opiate or corticoid consumption, obesity, alcoholism and smoking and non-steroid antiphlogistics. Patients with diverticular disease also display abnormal intestinal motility, intestinal dysbiosis and other physiological and morphological abnormalities. Most diverticuloses occur in the sigmoid colon, however, occurrence in the colon ascendens is increasing, especially in Asia. There are also several classification schemes, among which individual assessment of complications is becoming the most important. The incidence of diverticulosis used to be over 10% of all the diverticuloses, but nowadays it is lower. The diagnosis includes clinical testing, general laboratory tests of the inflammation, coloscopy, ultrasound, CT and magnetic resonance. The treatment of symptomatic uncomplicated diverticulosis is based on medicines bringing symptomatic relief, fibre, mesalazine, probiotics and non-absorbed antibiotics. Diverticular disease with a mild progression can be treated only by hydration and modification of the dietary regimen. In the case of complications and sepsis, antibiotics are administered. By way of prevention of further attacks, again probiotics, mesalazine and non-absorbed antibiotics are administered, these at one-month intervals. The ratio of operated patients is decreasing even in the case of acute states, and the efficiency of the conservative treatment of diverticulosis is above 80%. The abscess should be primarily treated by non-surgical drainage. Even peritonitis can be treated by means of laparoscopic drainage without the necessity of subsequent operation. In the past, elective resection was recommended after two attacks of diverticulitis, but today emphasis is laid on an individual approach considering age, comorbidities and the character of the disease. The percentage of laparoscopic resections is increasing. The results for the Hartmann's operation and the primary resection are almost identical.

Keywords

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