Update: December 2018
Explicit symptoms in most patients with diverticulosis
colon (diverticular disease) is missing or identical with
manifestations of other bowel diseases. But it is established that
the frequency of diverticulosis increases with increasing age.
It is below 10% among persons under 40 years old and about 50 – 60%.
– older than 80. On the European continent, diverticula are diagnosed in
every 10th resident is up to the age of 40, after 60 years – at
каждого третьего, а с 75 лет — у каждого второго жителя.
Symptoms of intestinal diverticulosis are associated with localization
diverticulum. Among the population of Western countries, most often, in 90%
registered cases, they are found in the distal
colon, of which 50 – 60% – in the sigmoid colon and only 10%
— в правых отделах large intestine. Diverticulum localization in
the rectum is not detected.
The main mechanisms of symptoms
The prevailing frequency of the sigmoid diverticulum and
соответствующей симптоматики связаны с
anatomical and physiological features. The sigmoid has
smaller diameter and more bends than others
отделами large intestine. It performs tank function, in
which is the formation, compaction and accumulation of fecal
masses Regulating their advancement into the rectum, it is much more common.
other departments are segmented. ATсе эти причины ведут к повышенному
pressure and tension of the sigmoid colon wall.
ATозникновению дивертикул способствуют и возрастные изменения
connective tissue and muscle fibers of the transverse colon.
AT результате этого все больше возрастают мышечное напряжение и
resistance to the advancement of feces, intraintestinal pressure and
bulging of the mucous membrane through the defects of the muscular layer
AT то же время происходят патологические изменения и подслизистых
nerve plexus with impaired function of baroreceptors, thickening
circular and longitudinal layers of the intestinal muscular layer,
reducing the elasticity and tone of its walls, the convergence of circular
folds, as a result of which the intestine takes the form of an accordion. AT
turn this leads mainly to:
- compression of vessels located in the intestinal wall;
- deterioration of blood microcirculation and the development of ischemia;
- muscular layer atrophy;
- intestinal motility disorders;
- the formation of weak areas, which are formed
Клинические проявления дивертикулеза large intestine,
ATсе перечисленные изменения становятся причиной нарушения
intestinal function in general with the gradual development of symptoms
дивертикулеза large intestine и его осложнений:
- Diverticulitis (inflammation of the diverticulum)
- Perforation (perforation)
- Infiltration formation
- Internal or external fistula (rare)
- Acute or chronic intestinal obstruction
Болезнь носит в основном прогрессирующий характер с
clinical manifestations, the severity of which depends on
disease duration, complications of diverticular disease,
localization of diverticulum, the presence of associated diseases, age
patient and adherence to recommendations for proper
The most common clinical form is uncomplicated.
дивертикулез large intestine. It occurs in almost 80% of patients.
this disease. For many years it was believed that such forms of the disease
proceed completely in the absence of symptoms. But research
recent years have shown that 85% of patients even isolated
colon diverticula, not to mention diverticulitis,
accompanied by clinical manifestations of varying degrees
However, the symptoms are non-specific.
Often, patients either do not seek medical care at all,
or, if they nevertheless turned to a doctor, they were given such
diagnoses like dysbacteriosis, chronic colitis, thick dyskinesia
The most frequent and main symptoms of uncomplicated diverticulosis
- Inconsistent recurring pains spastic,
paroxysmal or blunt whining character in the left (most
often), medium (below the navel) or lower abdomen.
Предполагается, что эти боли возникают в результате повышения
pressure in the lumen of the intestine and the violation of its motility.
- The pain can go away on its own after several
hours, but may increase, especially after meals.
- ATозможно возникновение боли, сходной с приступом аппендицита (в
right lower abdomen), even if the diverticula
localized not in the ascending divisions (right), but in the sigmoid
- Sometimes there is an irradiation (spread) of pain: in the area
the anus, waist, sacrum, and also in the inguinal or gluteal
- Relief or complete disappearance of pain after the discharge of gases
or an act of defecation.
Кроме основных проявлений дивертикулеза large intestine,
there may be common symptoms characteristic of breaking it
- constipation that are stubborn;
- constipation alternating diarrhea;
- Excessive mucus;
- abdominal distention and significant discharge of offensive gas;
- false urges (tenesmus) or multiple acts of defecation;
- feeling of incomplete emptying after an act of defecation (often
accompanied by the presence of a diverticulum in the sigmoid colon.
При осмотре врач отмечает вздутие живота, болезненность
при пальпации (прощупывании) по ходу всего large intestine. These
the phenomena are most pronounced in the left sections, but at the same time the protective
reaction (tension) of the abdominal wall is absent. Palpated also
spasm of the colon, which are localized
Some distinguishing features of diverticulosis of various departments
|Intestinal section||Changes in the muscular layer of the intestine and the nature of chyme||The most frequent age of manifestations||The nature of the most frequent complications|
|right||intestinal fragmentation and thickening of feces||young (under 40) age||Bleeding tendency|
|left||atrophy of muscle fibers, reservation and the formation of dense
|чаще пожилые люди||Tendency to diverticulitis (inflammation)|
При присоединении осложнений в виде дивертикулита,
bleeding, perforation, and so forth, the corresponding
- with changes in clinical blood tests, urine
- the appearance of temperature
- blood in feces
- a change in the nature of the pain syndrome, etc.
Diagnostics using basic instrumental methods
such as irrigology (X-ray examination after
filling the intestine with a contrast agent), endoscopy,
colonoscopy, computed tomography, allows more accurate
establish the presence, localization and condition of diverticula.
Treatment of uncomplicated diverticulosis
Important in the treatment of intestinal diverticulosis (uncomplicated form)
– food products rich in dietary fiber. AT
according to the latest data, their use by patients with
asymptomatic disease contributes to the prevention of its
прогрессирования и возникновения complications. Exists
contradictory opinion of individual researchers that the inclusion in
the diet of these products even leads to a regression of the diverticula.
Dietary or dietary fiber is diverse in composition.
and the structure of vegetable fibrous substances that are not
digested and not absorbed in the intestines. When calorie
ration of 2500 kcal daily physiological need for them
makes 30 g. Most of the types of plant fiber
contains non-digestible polysaccharides, pectin, cellulose and
hemicellulose, lignin, alginates. Their main property is
the binding of water in the intestinal lumen, which increases the volume of chyme,
снижает давление внутри intestines и способствует более
быстрому транспорту по кишечнику и выводу feces и токсинов
from the body.
In addition, insoluble dietary fiber covering about 6 –
9% of the body’s energy needs are created in the colon
large additional surface on which occurs
placement and fixation of a large number of beneficial intestinal bacteria.
ATолокна являются для «дружественных» бактерий питательной средой,
on which they grow and multiply rapidly, leading to suppression
Table characteristics of the positive effect of dietary fiber on
|Direct effect||Mediated action|
It becomes clear why diet products containing
отруби, являются эффективным питанием при дивертикулезе intestines.
The greatest ability to reduce intra-intestinal pressure and
wheat bran bran has an increased chyme volume.
They need to be introduced into the diet gradually over from
2 weeks to 1 month. The daily rate starts from 5 – 10 g to 20 –
30 g. To this end, the daily dose (2 – 4 tablespoons) of bran
pour 1 cup of boiling water and incubate for 30-40 minutes,
after which the water must be drained. Brewed bran can be added
в овощные блюда, dairy products, каши, супы.
AT течение первого месяца такой диеты при дивертикулезе
intestines, содержащей большое количество растительных пищевых
fibers, abdominal pain may appear or intensify. therefore
taking antispasmodic drugs is recommended, for example, but-shpy
or mebeverin 20 to 30 minutes before a meal in the morning and evening at 400 mg,
meteorospasm, bukopan and others.
An effective source of dietary fiber is considered
препараты Мукофальк, Файберлекс, Испагол, Солгар Псиллиум,
consisting of shells of psyllium seeds oval growing
in the arid regions of the Mediterranean, Pakistan and India. In the shell
plantain seeds of this particular species are contained in high
concentration of mucous components, thanks to which the drug
refers to soft dietary fiber.
Mukofalk, unlike bran, almost does not have side
effects in the form of flatulence and spastic pain, but it has
anti-inflammatory effect and far superior to wheat
bran according to the degree of reduction of intraintestinal pressure, effectively
promotes reproduction of lacto – and bifidobacteria.
Dietary fibers that are part of Mukofalk have
the following physico-chemical characteristics:
- Slow down the process of evacuation from the stomach of the food mass
- Increase the viscosity of the food mass in the small intestine
- Enhance mucus formation on mucosal cells
- Bind and hold a volume of water, the number of superior
the mass of the fibers themselves, thereby reducing the wall tension
intestines moisturize fecal masses and ensure their accelerated
passage through the intestines
- Collect and hold on their surface in colloidal
the state of toxic elements of external and internal
- Provide additional space beneficial microbial
associations and undergoing enzymatic degradation
microorganisms, become the latest energy
- Do not obstruct the intestinal absorption of trace elements and
In the nutrition of patients with intestinal diverticulosis is recommended
- bran bread or wholemeal white flour
- crumbly cereals from wheat and buckwheat groats with vegetable
- vegetable casseroles
- vegetable soups in broth
- dairy products
- baked vegetables (with good portability)
Exclude from the diet preferably binding and delaying
peristalsis food. These include:
- fine flour bread
- semolina and rice porridge
- jelly, coffee and strong tea
- red wine, cocoa and chocolate
Dietary fiber is the primary treatment and
профилактики дивертикулеза large intestine. Without
complicated forms of the disease are recommended their constant
use, with the exception of the summer and autumn seasons, due to
the inclusion in the diet of sufficient fresh vegetables,
fruit and greens.
With intestinal diverticulosis, treatment tactics are determined by the general
the patient’s state of health, the severity of the disease, the presence
With asymptomatic diverticulosis
when a disease is diagnosed by chance (random
finding), the patient is recommended only to follow the diet, with
an increase in the daily diet of fruits, vegetables, beans, cereals,
use at least 2 liters of fluid per day (if not
contraindications). According to the testimony may use probiotics
(see the list of drugs analogs of Linex), enzyme preparations,
drugs that reduce flatulence (causes).
In the presence of uncomplicated inflammatory process
With the development of the inflammatory process, symptoms of diverticulosis
intestine, but without serious complications, perhaps outpatient
treatment. In addition to the above diet with the maximum amount
fiber and drinking regime are assigned to:
- broad-spectrum antibiotics, drugs
5-aminosalicylic acid, butyric acid
- enzymes to improve digestion
- GI motility stimulants such as Domperidone (Motilium,
Pasaziks, Motilak), Metoclopromid, etc.
- antispasmodics – Noshpa, Drotaverinum, Spasmol,
- laxatives – prebiotics (based on Lactulose –
Normaze, Romfalak, Portalak syrup, Duphalac, Lactulose
Поли, Гудлак, Лактулоза Штада, Ливолюк-ПБ).
With the progression of the disease during treatment – is shown
If within 3 days of treatment, there is no improvement,
то пациенту показана hospitalization, с коррекцией лечения и
the definition of further tactics of therapy. Produced by
additional diagnostics, prescribed infusion therapy –
glucose solution, saline solutions, the question of surgical
When is surgery indicated?
If the patient had 2 bouts of diverticulosis, according to
recent clinical studies, it is advisable to
planned surgery. Since repeated attacks
poorly amenable to drug treatment and, as a rule,
end with intestinal perforation followed by peritonitis.
Moreover, patients over the age of 40, even after episode 1
дивертикулита рекомендуется хирургическое treatment.
Surgical treatment is to remove (resect)
plot of the intestine, which is affected by diverticula. Indications for
Surgery are the following complications:
- heavy bleeding
- progressive intestinal obstruction
- perforation of the diverticulum with peritonitis or retroperitoneal
- opening an abscess when developing external or internal
In each specific clinical case, the amount of surgery
determined individually, sometimes with emergency surgical
the intervention is to remove the intestine in an unnatural way.
on the abdominal wall. Timely patient appeal to
gastroenterologist and coloproctologist, adequate therapy and elective
surgical treatment (especially after an attack) improves the prognosis. AT
80% of cases of diverticulosis occur without complications, with complications
the risk of relapse is 25%.