What is the best way to treat colon diverticulum?

The treatment of colon diverticulum must be carried out actively, but if it is simple diverticular disease and does not cause symptoms, then no treatment is required. Instead, it should be adjusted through dietary methods. If it is serious, surgical treatment should be considered.

1. Treatment of simple diverticular disease

Simple diverticular disease generally does not cause symptoms and does not require treatment. It can be managed by adjusting diet and eating fiber-rich foods to keep bowel movements smooth. Some scholars have found that a high-fiber diet can not only control the symptoms of diverticular disease, but also reduce intracavitary pressure and prevent complications such as diverticular inflammation and bleeding. Since the 1980s, statistics have confirmed that a high-fiber diet has kept the number of acute hospitalizations for diverticular disease stable, with no upward trend.

Diverticulitis is usually treated with nonsurgical therapies, including dietary modification, antispasmodics, and enteral antibiotics (eg, sulfasalazine). If the patient has no fever, abdominal symptoms are relieved, and intestinal function is restored, liquid food can be taken and gradually transitioned to normal food. In the past, the diet used low-residue foods, but now more high-residue foods plus absorbent colloids are used.

2. Non-surgical treatment: Painter et al. reported that after increasing the fiber content of the diet and reducing the sugar content, the symptoms of 62 out of 70 patients with diverticulum were controlled, bowel movements returned to normal, abdominal pain was relieved, and 7 patients needed to continue taking laxatives. Brodribb and Humphries reported that after adding 24g of bran to the diet every day for 6 months, 33 of 40 patients (82%) improved their condition and responded well. In 60% of the patients, the symptoms completely disappeared, the bowel movement time became normal, the stool weight increased, and the colon pressure during and after eating decreased. Brodribb later conducted a randomized study in which 18 patients were given cellulose and placebo respectively. The symptoms of the former were significantly improved compared with those of the placebo group. However, some studies have shown that there is no significant difference between a high-fiber diet and a placebo for patients with asymptomatic diverticulum.

3. Prevention and treatment of severe diverticular disease Hyland and Taylor reported that if patients with severe diverticular disease continued to consume a high-fiber diet after their first hospitalization, about 90% of the patients would have their disease symptoms disappear within 5 to 7 years. This result was very different from that of patients with diverticular disease who took a low-fiber diet, in which the symptom recurrence rate was 36% to 62%. For patients with severe diverticulum, in addition to medical treatment, they should also actively eat high-fiber foods to prevent complications.

4. Generally, preventive colectomy is not suitable for the treatment of diverticular disease for the following reasons: ① Less than 50% of patients with severe diverticular disease admitted to the hospital due to emergency treatment have a history of diverticular disease; ② Only 10% to 20% of patients who are admitted to the hospital for emergency treatment and do not undergo surgery will have recurrence of symptoms; ③ There is no significant difference in the postoperative symptoms and complication rates of patients who undergo elective surgical resection of the colon compared with non-surgical treatment. Prophylactic colon resection is not justified in view of the patient's age, the risk of death from concomitant diseases, and the need for a high-fiber diet to prevent complications. The indications for prophylactic colectomy are limited to a small number of cases with severe recurrent acute attacks.