Transcription:
Diverticulitis

Cheryl Martin (Host): Di diverticulosis erticultitis and diverticulitis are two conditions that both occur in the colon are large intestine, but what's the difference? And when is treatment necessary? Our expert has the answers. This is Wake Med Voices, a podcast brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm Cheryl Martin. Our guest is Dr. Eric Duberman, a general and colorectal surgeon at WakeMed, Western Wake Surgical. Welcome Dr. Duberman.

Dr Eric Dubberman: Thank you, happy to be here.

Cheryl Martin (Host): What's the difference between diverticulosis and diverticulitis?

Dr Eric Dubberman: Well, diverticulosis is a very common position. Most people over 50 years old will have diverticulosis. Diverticulosis are little pockets that form in the large intestine over time Diverticulitis is when one of those little pockets gets blocked and causes an infection So almost everybody has diverticulosis, but, not everybody gets diverticulitis.

Cheryl Martin (Host): And what are the symptoms of diverticulitis?

Dr Eric Dubberman: Diverticulitis begins with pain in the left lower, part of the abdomen The pain is constant. There can also be a low grade fever and some anorexia loss of appetite.

Cheryl Martin (Host): Do we know what causes it?

Dr Eric Dubberman: Well, as I say everybody over about 50 has these little pockets and when something blocks, one of these little pockets that can't empty. And so the bacteria that normally go in and out of the pockets has no way to get out and it forms an infection. We used to think it was related to intake of things like seeds, nuts and popcorn, but that's been disproven. So there is no particular food that causes diverticulitis. It's just the off chance that one of these pockets gets blocked by a piece of fecal material.

Cheryl Martin (Host): And are there mild as well as severe symptoms? I mean, in other words, when would a person know they need to call the healthcare provider?

Dr Eric Dubberman: Yes, there are mild symptoms. If you develop a little pain in the left, lower abdomen, and it goes away after 24 hours, then that's mild. And those will generally resolve on their own. If the pain persists more than about 24 hours or gets very severe, you should call your primary care physician.

Cheryl Martin (Host): What are the treatment options for diverticulitis?

Dr Eric Dubberman: In mild cases, the treatments are a seven to 10 day course of an oral antibiotic And that works well. 90% of the time. If it doesn't work, then one would need to go to the hospital to get a course of intravenous antibiotics and generally stay in the hospital for 24 to 48 hours. And, continue oral antibiotics at home.

Cheryl Martin (Host): At what point would surgery be considered?

Dr Eric Dubberman: In the past, there were some hard and fast rules about surgery that if you were under 40 years old and you had two attacks, diverticulitis surgery be recommended. And if your over 50 and had three attacks, surgery would be recommended, but we don't do that anymore. It's a very individualized recommendation. Now, basically, if the diverticulitis becomes extremely frequent, several times a year, and is interfering with your quality of life, we would recommend surgery. Otherwise, it can just be treated periodically when it occurs. So we're very conservative in our recommendations for surgery these days.

Cheryl Martin (Host): So, what would you say is a percentage of symptoms of diverticulitis, that you have to have surgery?

Dr Eric Dubberman: Extremely unlikely. Many, many people get D diverticulitis and perhaps one out of a hundred would ever need surgery. If it's a severe case, which includes a complication of diverticulitis like perforation or rupture of the colon or blockage of the colon, you might need emergency surgery, but that is very infrequent.

Cheryl Martin (Host): Okay. And you talked about certain foods you used to think helped cause both of these, but not anymore. So is there anything a person needs to do, especially if they have a recurrence of diverticulitis that they need to change their diet in some way, and this would make a difference?

Dr Eric Dubberman: The only thing that's shown to make a difference is increasing the amount of fiber that you take on a daily basis. And we normally recommend fiber supplementation with the product such as Metamucil, Benafiber, or Citruscell. It's very hard to get enough fiber just through dietary means. so generally fiber supplement is all that's recommended to prevent future attacks.

Cheryl Martin (Host): Do you recommend a person who doesn't have any symptoms of either of these right now, just as a standard course of good health to supplement their diet with Metamucil or some of the others?

Dr Eric Dubberman: Yes, absolutely. There's lots of benefits to increasing fiber in the diet. It decreases cholesterol. It's been shown to decrease the developments of, colon polyps and cancer, and there's really no downside. So I would strongly recommend considering fiber supplementation.

Cheryl Martin (Host): And what are some of the food's highest in fiber?

Dr Eric Dubberman: Well, generally things like beans, and whole grain breads, bran cereal. Oatmeal is very good. Fresh fruits and vegetables are an excellent source of fiber.

Cheryl Martin (Host): Now if a person has a bout of diverticulitis, how often will you see the repeat episodes?

Dr Eric Dubberman: It's fairly uncommon, probably 25% of people that have one attack would have subsequent attacks, but many people just have one attack during their lifetime.

Cheryl Martin (Host): Okay, anything else you wanna add on this topic, doctor?

Dr Eric Dubberman: Well, I'd like to talk about the surgery itself. The surgery used to be a very big operation with a big, incision and a lower abdomen and a seven to 10 day hospitalization with about a six week recovery. But since the advent of laparoscopic and robotic surgery, it's gotten much, much easier. The surgery takes about two hours to do. It's done with three tiny incisions and a two inch incision to remove the bad piece of colon. And generally the hospital stays 24 to 48 hours with a two week to full recovery. So it's still major surgery, but it's much, much better than it was 20 years ago.

Cheryl Martin (Host): And is there just one surgery option for this?

Dr Eric Dubberman: In general, if the surgery is as an emergency, you may end up with what's called a colostomy or a bag that you wear temporarily to drain the stool until the infection clears up. And then that would be reversed. In six to 12 weeks, but we try to avoid colostomy surgery as much as possible. If we can do the surgery on an elective basis between infections, then there's no bag that's required. So that would be our preference.

Cheryl Martin (Host): And by having the surgery, does this also reduce the chances of a repeat episode?

Dr Eric Dubberman: Yes. The majority of do diverticulitis occurs in what's called a sigmoid colon, which is a piece of large intestine, about eight inches from the end. And it's about a 10 inch piece of colon. Once that's removed, if it's done correctly and enough colon is removed, then there is a 98% chance that there will not be subsequent attacks of diverticulitis. So it's a very good operation.

Cheryl Martin (Host): Great. Well, Dr. Duberman, thank you so much for this discussion. Clarifying everything in the medical and surgical treatment options for these two conditions. Glad to have you on.

Dr Eric Dubberman: Great. Thank you very much Cheryl.

Cheryl Martin (Host): Dr. Eric Duberman is a general and colorectal surgeon at WakeMed Western Wake Surgical. To learn more about general surgery and colorectal services at WakeMed, please visit wakemed.org. That's wakemed.org I'm Cheryl Martin with WakeMed Voice has brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Be sure to check out the entire podcast library for other topics of interest to you.