QUESTION: My son died of diverticulitis in January. According to the paperwork about this disease, it is treatable through antibiotics and a high-fibre diet. Can you explain this?
DR GREEN: How very saddened I was to hear of your bereavement. Let me first provide some explanation about your son’s condition. This begins as something called diverticular disease, where multiple, harmless, sac-like pouches protrude from the large intestine. These pouches are increasingly common with age they occur in about one in 20 people by their 40s, and six in 10 people in their 80s. The exact cause of these pouches are unknown, but one contributing factor is a lifelong low-fibre diet, which means digested food moves slowly along the gut. Furthermore, a low-fibre diet leads to an increase in the pressure inside the large intestine, which causes the lining to bulge.
The pressure in the intestine is reduced when it’s stretched by a greater volume of contents. That’s why increasing
the bulk contents of the diet – and eating more fibre – minimises the chances of diverticular disease. Patients who develop these pouches are often advised to avoid seeds – such as poppy and sesame seeds – in the belief that they might become impacted in one of these pouches and trigger infection. However, digested food will become impacted in the pouches at times. This is because the large intestine is essentially a compost heap and contains material of different shapes and sizes. But because the intestine is in a constant state of muscular movement, the material will be dislodged from the pouches.
A high-fibre diet can prevent the disease getting any worse. However, it won’t help once one of the pouches is infected
with trapped material, which is called diverticulitis. Symptoms include abdominal pain, nausea, vomiting, constipation or diarrhoea. A CT scan is the diagnostic test of choice. Patients are usually admitted to hospital and treated with antibiotics delivered directly into the vein. However, in severe cases the infected swelling can rupture and cause bleeding and inflammation in the abdomen. Immediate treatment and surgery is required to remove the affected part of the intestine. The danger arises when this infection spirals out of control, leading to septicaemia (blood poisoning), kidney failure and, ultimately, death.
There are a number of factors that may influence this, such as the general health of the patient and whether they
suffer from any existing conditions, such as diabetes or lung troubles from smoking. Another vital factor is how long the condition has persisted before the diagnosis is made and how soon treatment started. As you say, most cases of diverticulitis are cured with antibiotics, but on rare occasions this is not successful and the defences of the patient are overwhelmed by the infection.