Ішек қуысы аурулары: түрлері, көріністері және емдеу жолдары

Diverticular disease is when problems occur due to diverticulosis, a benign condition defined by the formation of pouches (diverticula) from the weak spots in the wall of the large intestine. This disease spectrum includes diverticulitis, symptomatic uncomplicated diverticular disease (SUDD), and segmental colitis associated with diverticulosis (SCAD). The most common symptoms across the disease spectrum are abdominal pain and bowel habit changes such as diarrhea or constipation. Otherwise, diverticulitis presents with systemic symptoms such as fever and elevated white blood cell count whereas SUDD and SCAD don’t. Treatment ranges from conservative bowel rest to medications such as antibiotics, antispasmodics, acetaminophen, mesalamine, rifaximin, and corticosteroids depending on the specific conditions.

Acute diverticulitis is thought to arise from either trauma or lack of blood flow to the existing diverticulum in the colon. The traumatic theory proposes that a fecalith, which is a hardened fecal matter, becomes trapped in a diverticulum, leading to colonic mucosa abrasion and local inflammation. Subsequent bacterial overgrowth and infection spreads from the mucosal wall to full bowel wall, eventually leading to bowel perforation. Complicated acute diverticulitis is distinguished from uncomplicated diverticulitis by the presence of abscess or colonic perforation. Chronic smoldering diverticulitis is caused by recurrent acute diverticulitis that does not respond to medical treatment but does not progress to complications such as abscess, peritonitis, enteric fistula, or bowel obstruction.

Similar to the diverticulitis ischemia theory above, SUDD is thought to be caused by sustained colonic contraction leading to mucosal ischemia within the diverticulum. Low grade inflammation of the colonic mucosa within the diverticulum and visceral hypersensitivity are also thought to cause SUDD.

Uncomplicated diverticulitis is generally treated conservatively with bowel rest and no antibiotics given recent studies have shown that antibiotics are likely not necessary. Complicated diverticulitis is treated with antibiotics and may require surgical interventions such as abscess drainage or fistula repair. Antibiotics should be used selectively in most cases of uncomplicated diverticulitis. However, antibiotic use is strongly advised in immunocompromised patients. Elective segmental colectomy can be considered in selective group of patients to reduce risk of recurrent diverticulitis. However, the procedure does not completely eliminate the risk of recurrence.

Currently there is no supported effective treatment for SUDD. Anti inflammatory agent mesalamine and non absorbable antibiotic rifaximin might improve symptoms and prevent acute diverticulitis. Probiotics could also be used to reduce symptoms but there is currently insufficient supporting evidence.

SCAD is a benign and self limited condition that resolves on its own. In ongoing or recurrent cases, medical treatments with antibiotics, mesalamine, and corticosteroids might be required.