All in a name – medical terms


Diverticular disease is an umbrella term which covers the physical changes in the colon wall and the effects from diagnosis to life-threatening complications and all the different symptoms which result from the disease. The muscular deformity with the characteristic bulging hernia or pouches called diverticula is known as diverticulosis. This definition is of a visible physical abnormality and does not indicate the extent of damage to the colon or describe its effects. Some people do not know that they have diverticulosis but after diagnosis about ¾ of patients have some type of symptoms.

Awareness of diverticulosis is sometimes the result of the first attack of diverticulitis which is when the diverticula become infected. This gives severe, continuous pain and often a raised temperature; the sufferer feels poorly and needs medical attention, sometimes in hospital, to stop the infection getting out of control and leading to serious complications or surgery.

Many people have other symptoms ranging from an exaggeration of normal colon responses to frequent severe pain and bowel dysfunction. This could be the result of damage causes by repeated attacks of diverticulitis. There are changes in nerves, neurotransmitters, electrical activity patterns and sensitivity to drugs which are also characteristic of the colon with diverticular disease. A few years ago this condition was called painful diverticular disease and in research reports it is also known as uncomplicated diverticular disease  or symptomatic diverticular disease. When such symptoms are severe it is difficult to distinguish them from diverticulitis and this name is often used. Because the diverticula themselves are not the cause of such symptoms it is fashionable at the moment in this country to call them Irritable Bowel Syndrome (IBS) even if this diagnosis should exclude conditions with recognised colon changes.

Another name increasingly found in research reports is diverticular colitis. This is when no infection is present but the bowel lining is inflamed similar to inflammatory bowel disease (IBD) i.e. ulcerative colitis and Crohn’s disease.

It is important to know which of these facets of diverticular disease is causing the symptoms and not to confuse similar names because the treatment needed may be different. For example, laxatives are obviously taken for constipation and not for diarrhoea. High fibre diets, bran, laxatives and antispasmodics recommended for diverticulosis should not be taken when infection and inflammation is present – diverticulitis needs a low fibre fluid diet to rest the bowel. Antibiotics may be needed and bed rest, sometimes in hospital.

I have recently had to make NHSDirect aware that their online information confused diverticulosis with diverticulitis.* and their section on diverticular disease has now been rewritten. This was important because of the changes in the NHS where people taking emergency calls such as NHSDirect or the ambulance service will decide priorities and the previous information indicated that acute diverticulitis was neither serious nor urgent and the treatment recommended was dangerous.

It does raise the question of how far confusion between diverticulosis and diverticulitis goes unchecked. The web site previously said that 90% of diverticulitis causes no symptoms and goes unnoticed. How many relatives, carers and friends have seen and believed such false information and changed their attitude towards a sufferer in agony with diverticulitis. The difference between diverticulosis and diverticulitis is far more than just two letters in a name.

* Griffiths M,  NHSDirect Correction, Pharm J, 2004, 273, 514.

© M Griffiths 2004 

Note This article appeared in the Incontact magazine Spring/Summer 2005. The last two paragraphs were not used except for the last sentence.

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