The dietary treatment for diverticulitis flare ups has taken an about-face in recent years. In the past, people were advised to adhere to bland and low-residue diets. These are exactly the diets which, it seems, were responsible for causing the diverticulosis in the first place. Nowadays, people are encouraged to consume diets that are higher in fiber and roughage. The fiber increases the quantity of stool and softens its consistency. Commercial preparations, such as Metamucil, also have a similar effect.

Although fiber may not be of benefit to all people, it does seem that a high fiber diet lessens the frequency of the problems that may result from diverticulosis. It is hoped that high fiber diets, when eaten at younger ages, may even help to prevent diverticulosis from occurring at all.

The key to the use of fiber is to use it in moderation. As many people already have discovered, fiber, found in cereals, fibers, and vegetables, can itself cause a sense of bloating and cramps. People should eat a quantity of fiber that does not cause these problems, yet is sufficient for softening the stools. This can only happen with trial and error, and anywhere from three to eight weeks must be allowed to see if fiber has an effect.

It is hoped that as people become much more aware of the importance of dietary fiber, then diverticulosis, a disease of modern society, may become a thing of the past.

Diverticulitis is often incorrectly diagnosed on presentation and computed tomography (CT) scanning is probably the best tool for correcting this situation. That’s the conclusion of a retrospective analysis of 125 acute diverticulitis cases undertaken by researchers at the University of Alberta, Edmonton. The cases were seen between mid - 2005 and early 2007.

The study was undertaken in part to assess compliance with treatment guidelines for complicated and uncomplicated diverticulitis endorsed by the Canadian Society of Colon and Rectal Surgeons. Results were presented here at the annual meeting of the Royal College of Physicians and Surgeons by Dr. David Williams, a general surgery resident at the university.

Guidelines recommend complicated potential diverticulitis surgery cases with free perforation or fistula be treated surgically. Percutaneous drainage is recommended if an abscess is found. Conservative management is advocated for uncomplicated cases with antibiotics and bowel rest recommended.

In their analysis, the researchers assessed how valuable clinical markers such as fever, pain and white blood cell count were in making a correct diagnosis. A similar assessment of ultrasound, CT and contrast enema studies was undertaken.

We wanted to see how we were treating our patients and if it was treatment according to the guidelines,” Dr. Williams said in an interview. Ten patients were excluded from the outcome analysis, he said, because although they were diagnosed with diverticulitis on admission they were later found to have a different problem.

The researchers found only 60% of patients had the correct diagnosis made at presentation. The sensitivity and specificity of CT was better than any of the other tests. Patient - reported pain was a reliable marker of a diverticulitis diet candidate but had no specificity.

The average American consumes only 11 grams of the 25 to 30 grams of fiber recommended daily. Increasing fiber in our diet is fairly easy to do. Start by choosing Diverticulitis Foods whole-grain cereals and breads. Eat whole fruits instead of juices, and increase the amount of vegetables in your diet. Eat the peel on the fruits and vegetables you can tolerate. Leave the skin on potatoes when making mashed potatoes. Avoid processed foods. When having rice with dinner, choose whole-grain brown rice in lieu of the prepared Rice-a-Roni or Minute variety.

Analyze recipes for ways to increase the fiber. For example, instead of bread crumbs in meatloaf, use uncooked oats. While each change may only make the difference of a gram or two of fiber, by the end of the day you may reach your goal of 25 to 30 grams. In addition to decreasing your risk of diverticulitis, you’ll be reducing your risk of some types of cancer, heart disease and diabetes as well.

Diverticulosis of the colon is an acquired condition thought to occur as a result of disordered colonic peristalsis, leading to areas of high intra-luminal pressure that push the mucosa out through the submucosa and muscularis of the colon. This occurs at the relatively weak points at the site of entry of blood vessels through the circular muscle.

Disordered peristalsis probably results from the frequent passage of low-volume, low-residue stools. Both the circular and longitudinal muscle are characteristically hypertrophied, leading to thickening and shortening of the colon. Diverticulae and muscular hypertrophy are most commonly seen in the sigmoid colon but any part, or all of the colon may be affected.

The term diverticulosis simply describes the presence of diverticulae and no symptoms need be present. Diverticulitis describes the clinico- pathological condition associated with inflammation of diverticulae. Diverticular disease is an all-encompassing description applicable to diverticulosis and its complications.

Diverticulosis is uncommon in patients under 30 years of age, but its prevalence increases with age and by the age of 50 years up to 30 per cent of the population will have diverticulae in their colon. Men and women are equally affected.

Only 20 per cent of those with diverticulosis will ultimately develop symptoms. Diverticulosis is a ‘disease’ of Western populations, its development being strongly associated with an inadequate dietary fiber intake - it is less commonly seen in vegetarians, and is rare among rural Africans.

It is thought that environmental factors, particularly diet, play an important role in pathogenesis, although unknown genetic factors may be implicated in some individuals who develop diverticulae at a young age or who have predominantly right-sided disease.

Most patients with diverticulosis will remain asymptomatic. Patients with uncomplicated diverticular disease may present with an altered bowel habit, often associated with colicky abdominal pain, flatulence and distension. These symptoms may be indistinguishable from the irritable bowel syndrome.

Acute diverticulitis is characterized by left iliac fossa pain and is usually associated with features of acute inflammation: tachycardia, pyrexia, localized peritonism and a leucocytosis. Acute diverticulitis may be complicated by localized abscess formation resulting from a perforation of an inflamed diverticulum. Such patients may present with swinging pyrexia and a tender mass.