Colonic diverticulosis

Rifaximin, a nonabsorbable derivative of rifamycin, has shown promising bactericidal action against both aerobes and anaerobes, such as bacterioides, lactobacilli and clostridia [33, 34], The development of resistance to this antibiotic can occur, but resistant strains rapidly disappear from the intestine thus allowing cyclic administration of rifaximin. Controlled clinical trials showed efficacy of rifaximin in adult and pediatric patients with infectious diarrhea [36,37], hepatic encephalopathy [38], post-surgical complications [39] and colonic diverticulosis [40], Only recently was the efficacy of rifaximin in the treatment of SIBO demonstrated [41-43]. 

The prevalence of colonic diverticulosis is common in developed countries and has been increasing in the past centuries. In autopsy studies from 1910, diverticulosis was found in about 5%, and in the early 1980s diverticula were seen in about 50% of autopsy studies (Farag Soliman et al. 2004). 

Colonic diverticulosis is a very common condition in Western society, affecting 5%-10% of the population over 45 years, and 80% over 85 years of age [46]. 

Antiflatulents are used for die relief of painful symptoms of excess gas in the digestive tract. These drugs are useful as adjunctive treatment of any condition in which gas retention may be a problem (ie, postoperative gaseous distention, air swallowing, dyspepsia, peptic ulcer, irritable colon, or diverticulosis). In addition to its use for tiie relief of intestinal gas, charcoal may be used in the prevention of nonspecific pruritus associated with kidney dialysis treatment and as an antidote in poisoning. Simethicone is in some antacid products, such as Mylanta liquid and Di-Gel liquid. 

A laxative is most often prescribed for the short-term relief or prevention of constipation. Certain stimulant, emollient, and saline laxatives are used to evacuate the colon for rectal and bowel examinations. Fecal softeners or mineral oil are used prophylactically in patients who should not strain during defecation, such as after anorectal surgery or a myocardial infarction. Psyllium may be used in patients with irritable bowel syndrome and diverticular disease. Fblycarbophil may be prescribed for constipation or diarrhea associated with irritable bowel syndrome and diverticulosis. Mineral oil is... 

There is some evidence that long-term cyclic administration of rifaximin combined with fiber supplementation is effective for inducing symptomatic relief in patients with uncomplicated diverticular disease of the colon. A therapeutic gain of approximately 30% compared to fiber supplementation only can be expected. The drug is well tolerated and no relevant side effects have been reported. Symptoms attributed to diverticula (abdominal pain or discomfort, bloating, disturbance of bowel habits) are nonspecific symptoms and are also features of irritable bowel syndrome. It has been suggested that irritable bowel syndrome and diverticular disease of the colon may coexist in many people and when bowel symptoms occur with diverticulosis coli, they may be due to a coexistent irritable bowel rather to the diverticula themselves [47, 48]. This hypothesis is supported by the fact that many patients with symptomatic diverticular disease show co-... 

Narasaka T, Watanabe H, Yamagata S, Muna-kata A, Tajima T, Matatsunaga F Statistical analysis of diverticulosis of the colon. Tohoku J Exp Med 1975 115 271-275. 

Gold MH, Carlson GM, Mathias JR Colonic myoelectric activity in diverticulosis. Gastroenterology 1979 76 1139. 

Menstrual losses of blood average 28 milligrams monthly. One in four college-age women are iron deficient, possibly due to ignoring the need for increased iron intake prior to and during menstruation. Diseases that cause iron deficiency are colon cancer, hiatal hernia, ulcers, hemorrhoids, bladder tumor, and diverticulosis. Soft drinks high in phosphates cause iron to be excreted in the urine. Lack of copper or manganese in the diet reduces iron assimilation, as does a deficiency of vitamin C. Oxalic acid foods, such as chard and rhubarb, can block iron intake. 

Simethicone is an antifiatulent that relieves flatulence by dispersing and preventing formation of mncns-snrronnded gas pockets in the GI tract. It is indicated in relief of painful symptoms and pressnre of excess gas in the digestive tract. It is an adjunct in treatment of many conditions in which gas retention may be a problem, snch as postoperative gaseous distention and pain, endoscopic examination, air swallowing, functional dyspepsia, peptic nicer, spastic or irritable colon, and diverticulosis. 

Traditionally,contrast enemahasbeen the mainstayin the evaluation of patients suspected of having diverticulosis or acute colonic diverticulitis (Fig. 3.1). 

Diverticulosis can also be diagnosed by endoscopy (Fig. 3.2) however, when diverticulits is suspected clinically, endoscopy is contraindicated. After the acute phase of inflammation, the colon should be examined to exclude a colon carcinoma. So a complete colonic evaluation should generally be performed 6-8 weeks after the resolution of a diverticulitis. In cases of inflammation, coloscopy is often incomplete and painful for the patient. The risk for perforation is also higher because of the air insufflation. 

Acute colonic diverticulitis is a common cause of acute abdominal symptoms, especially in elderly patients. In turn, diverticulitis develops in 10-25% of the population vyith diverticulosis (Roberts et al. 1995). It is, in virtually all cases, the result of a micro-perforation of a single diverticulum (Fig. 3.5). 

Elderly people with diverticulosis may also have diffuse atherosclerotic vascular disease and thus are also at risk for ischaemic colitis. Ischaemic colitis is found frequently on the left side. Often the thickening is sharp bordered to the normal colon. A thickening with diminished vascularisation is highly suspicious for ischaemic colitis however, colour signals in a thickened bowel loop do not exclude ischaemia, since non-occlusive ischaemia may be present. 

Fig. 13.1a-c. Diverticulosis a axial planes show multiple gas-filled outpouchings of colon wall in nearly all parts of the colon (arrow)-, b VE shows complete dark rings (arrow)-, c global volume rendering views show the extent of the disease with reduced colonic distension (concertina appearance), especially in the sigmoid colon (arrow)... 

Fig. 14.2.a Diverticulosis in a patient with normal CT Colonography. Note the focal outpouchings of the colonic lumen on 2D axial image. b,c 3D endoluminal images showing diverticular (arrows) orifices projecting from the colonic lumen on 3D endoluminal images... 

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