Diverticular Disease of the Colon
Diverticulum = sac-like protrusion of the colonic wall
Diverticulosis = describes the presence of diverticuli
Diverticulitis = inflammation of diverticuli
Epidemiology
•Incidence rises with age
–33% general population by 60 years
–66% general population by 85 years
–Rare in patients < 40 years
•Male: Female ratio is equal
•Race
–Disease of Western industrialized nations
–??? Diet
Pathogenesis
•More prevalent in countries with low fiber intake
•Colon depends on minimal amount of bulk to propel contents towards rectum
•Low bulk increases contractions and pressure causing herniation
•Herniation usually at entry of arteriae rectae along mesentery and lateral tenia
•Involve mucosa covered by serosa
–True diverticulum contains all layers of the GI wall (mucosa to serosa)
–Colonic pseudo-diverticulum
Mucosa-submucosa herniates through the muscle layer (muscularis propria) and then is
only covered by serosa
1
, Lifestyle factors associated with diverticular disease
•Low fiber diverticular disease
–Not absolutely proven in all studies but strongly suggested
–Western diet is low in fiber with high prevalence of diverticulosis
–In contrast, African diet is high in fiber with a low prevalence of diverticulosis
•Obesity associated with diverticulosis –particularly in men under the age of 40
•Lack of physical activity
2
Diverticulum = sac-like protrusion of the colonic wall
Diverticulosis = describes the presence of diverticuli
Diverticulitis = inflammation of diverticuli
Epidemiology
•Incidence rises with age
–33% general population by 60 years
–66% general population by 85 years
–Rare in patients < 40 years
•Male: Female ratio is equal
•Race
–Disease of Western industrialized nations
–??? Diet
Pathogenesis
•More prevalent in countries with low fiber intake
•Colon depends on minimal amount of bulk to propel contents towards rectum
•Low bulk increases contractions and pressure causing herniation
•Herniation usually at entry of arteriae rectae along mesentery and lateral tenia
•Involve mucosa covered by serosa
–True diverticulum contains all layers of the GI wall (mucosa to serosa)
–Colonic pseudo-diverticulum
Mucosa-submucosa herniates through the muscle layer (muscularis propria) and then is
only covered by serosa
1
, Lifestyle factors associated with diverticular disease
•Low fiber diverticular disease
–Not absolutely proven in all studies but strongly suggested
–Western diet is low in fiber with high prevalence of diverticulosis
–In contrast, African diet is high in fiber with a low prevalence of diverticulosis
•Obesity associated with diverticulosis –particularly in men under the age of 40
•Lack of physical activity
2
