Question

Digestive disorders are nothing new. As long as humans have consumed food, there have been problems with digestion. Now think about how human nutrition has changed over time and across geographical locations. TASK: Identify a digestive disorder that is closely linked to a particular time or place. For example, a lower incidence of colorectal cancer has been documented in parts of the world where the local diet consists primarily of fresh fruits and vegetables with low consumption of cooked red meat. (Note: colorectal cancer is an example—please do not use this disorder in your discussion.) CONTENT: Discuss the causes and symptoms of your chosen disorder and possible treatment options. Include information on the role of diet in mitigating or treating symptoms of the disorder. Cite at least two sources in your response. These can include sources in our LEO course.

Answer 1

Diverticular disease of the colon is an importance cause of hospital admission and a significant contributor to healthcare costs in the Western and industrialized societies. A diverticulum is a sac-like protrusion of the colonic wall. Diverticulosis is defined by the presence of diverticula and diverticular disease is defined as clinically significant and symptomatic diverticulosis due to diverticular bleeding, diverticulitis, segmental colitis, or symptomatic uncomplicated diverticular disease. Diverticular bleeding is characterized by painless hematochezia due to segmental weakness of the vasa recta associated with a diverticulum. Diverticulitis is the inflammation of the diverticulum, which could be acute or chronic. Segmental colitis is characterized by inflammation in the interdiverticular mucosa without involvement of the diverticular orifices.

Prevalence: The prevalence of diverticulosis is age-dependent, increasing from less than 20 percent at age 40, to 60 percent by age 60. The distribution of diverticulosis within the colon also varies by geography. Western or industrialized nations have prevalence rates of 5-45%. The distribution of diverticula might also vary by race. In Asia, the prevalence of diverticulosis is between 13-25% and diverticulosis is predominantly right-sided. The prevalence of diverticulosis had increased in both the Western hemisphere and the countries that have adopted more Western lifestyle. For example, Japan has experienced an increase in the prevalence of right-sided diverticulosis similar to the increase in left-sided diverticula in westernized countries.

Risk factors: Several lifestyle factors have been associated with diverticular disease. High dietary intake of red meat, low dietary fiber, lack of vigorous physical activity, and smoking were all associated with an increased risk of diverticular disease.

Clinical manifestations: The clinical presentation of the diverticular disease depend on the severity of the underlying inflammatory process and the presence of associated complications. The common symptoms include abdominal pain, abdominal bloating, low-grade fever, nausea and vomiting, changes in bowel habits.     

Treatment: The need for inpatient vs. outpatient treatment can be determined based on the severity of the symptoms. Patients are usually treated with oral or intravenous antibiotics based on outpatient vs inpatient treatment. IV fluids should be provided to correct the volume deficits. Analgesics would be provided for pain management. Dietary restrictions including liquid/modified diet would also be recommended. If patients fail to improve after 2-3 days of antibiotic therapy, CT of the abdomen and pelvis would be repeated to rule out any new complications, including diverticular fistula, bleeding, and stricture/obstruction. Patients would require surgical interventions if required to correct the complications.

Role of diet in mitigating or treating symptoms: Fiber is an important part of the diet for patients with diverticular disease. A high-fiber diet softens the stools and helps prevent constipation. It can also help decreasing the pressure in the colon and help prevent the flare-ups of diverticulitis. High-fiber food include beans, legumes, bran, whole wheat bread, whole grain cereals, brown rice, fruits and vegetables. Improved hydration would also prevent constipations.   Probiotics can also be effectively used in treating symptomatic diverticular disease. The typical western diet that is high in red meat and refined grains, has low fiber content and is associated with an increased risk of diverticulitis. Food that are rich in FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) can also cause abdominal bloating, gas, and diarrhea.