Acquired diverticula form through the relative weakness in the muscle wall of the colon at the site where arteries (the vasa recta) penetrate the muscularis layer to reach the mucosa and submucosa. Diverticula generally are multiple. Each diverticulum is typically 5 to 10 mm in diameter, but at times they can exceed 20 mm. The most common site is the sigmoid colon, although diverticula can occur throughout the large bowel, with right-sided disease being more common in Asians and in patients younger than 60 years.2,3 Vegetarians and others who consume large amounts of dietary fiber have a lower incidence of diverticula. Although the pathogenic mechanisms of diverticular disease are poorly understood, they are clearly related to complex interactions of colon structure, intestinal motility, diet, and genetic features.4

Most diverticular bleeding in the elderly is well tolerated using nonoperative management. Success and safety of treatment does not seem to depend on a history of previous diverticular bleeding, initial hemoglobin, or amount of blood transfused. The majority of patients are treated nonoperatively. Surgical intervention seems to be well tolerated.

第2型糖尿病合併肥胖者的主要特性是胰島素的阻抗作用增加。減輕體重可以改善胰島素的阻抗作用，抑制肝臟葡萄糖的釋出，以及促進周邊組織對葡萄糖的吸收與利用。根據研究報告顯示，體重每減少5%，糖化血色素(HbAIC)可以降低0.6%。最近在芬蘭的研究指出，經過4年的追蹤研究，減重4.7%可以減少58%的糖尿病發生率。

　　除了高血糖外，血脂異常和高血壓也是造成糖尿病慢性併發症的重要原因。肥胖的第2型糖尿病人，減重不僅可以改善血糖的控制，同時也可以改善高血脂症和高血壓。在七十個研究的綜合結果發現，每減重一公斤，會降低總膽固醇1.93毫克/百毫升，低密度膽固醇0.77毫克/百毫升，三酸甘油脂1.33毫克/百毫升，在體重下降時，高密度膽固醇會跟著下降，但在體重維持時，高密度膽固醇會上升0.35毫克/百毫升。

　　許多研究顯示，肥胖的第2型糖尿病人減輕體重可以降低收縮壓和舒張壓。有一研究指出，每減輕一公斤體重，可以使收縮壓下降1.0到1.7毫米汞柱，舒張壓下降0.8到1.0毫米汞柱。

　　根據一個針對第2型糖尿病合併肥胖，共263個老年人的研究顯示，從被診斷出糖尿病開始，每減少一公斤體重，存活期可增加3到4個月；若減重10公斤，則其平均餘年與一般的群體一樣。

We don't know for sure what causes diverticulosis. It's likely that several processes are involved. Excess pressure caused by abnormal contraction and spasms in the colon probably plays a part, possibly compounded by aging, which weakens muscles in the colon wall. A low-fiber diet is also thought to contribute. Diverticular disease is rare in areas of the world such as rural Africa and Asia, where diets are high in roughage, including high-fiber grains. Other possible risk factors are obesity, lack of physical activity, and high consumption of red meat and fats. Scientists are also considering the potential role of low-grade chronic inflammation and connective tissue defects (perhaps inherited).

Fiber absorbs water as it passes through the intestine, producing bulky stools that move through more quickly, reducing the likelihood of constipation and the resulting pressure in the colon. When fiber is inadequate, stools are small and hard, and the colon must contract with greater force to expel them, putting extra pressure on the colon walls.

For people who can't or don't consume enough fiber in foods, supplements are available, including psyllium (Fiberall, Konsyl, Metamucil, others), methylcellulose (Citrucel, generic), and calcium polycarbophil (FiberCon). It's important to take these supplements with adequate water — usually at least 8 ounces, preferably more, with each dose.


Regular exercise, especially aerobic exercise, can also help. It speeds the movement of food through the colon, reducing the risk of constipation and the formation of hard, dry stools. Both fiber (which is filling) and exercise help combat obesity, which has been linked in several reports to the development of diverticulitis and diverticular bleeding.

Can diverticular bleeding be prevented?
Eating a high-fiber diet, getting plenty of fluid, and exercising regularly may help prevent the formation of diverticula. But if you already have diverticulosis, diet may not help prevent bleeding.

Diverticula develop at weak spots, such as where arteries that nourish the colon penetrate the muscle wall. The inner layers of the wall balloon outward, like an inner tube poking through a tire, forming sacs on the outside of the colon. Most diverticula are about the size of a pea, though some can be much larger. When many occur in one area, the colon wall in that area may thicken and narrow the passageway. Most diverticula are found on the lower left side — in the sigmoid, or descending, colon — where the colon is the narrowest and pressure on the colon walls is the greatest.

What is diverticular bleeding?
Diverticular bleeding occurs when pouches (diverticula) that have developed in the wall of the large intestine (colon) bleed. If you have these pouches, you have a condition called diverticulosis.



What causes diverticular bleeding?
Pouches (diverticula) form along the wall of the large intestine (colon) when high pressure inside the colon pushes against weak spots in the colon wall. Bleeding occurs when a hole (perforation) develops between a pouch (diverticulum) and a blood vessel.

Bleeding from diverticula:

Diverticular bleeding is the most common cause of brisk hematochezia, accounting for over 30 percent of cases of massive rectal bleeding. Many patients with diverticular bleeding, which occurs in 15 percent of patients with diverticulosis, are elderly. Diverticular bleeding occurs when a vessel in the dome of the herniating diverticulum is exposed to recurrent injury over time. This leads to weakness and eventual rupture of the vessel wall. Constipation requiring straining during bowel movements can contribute to vessel weakening and lead to a diverticular bleed. This non-inflammatory cause of lower GI bleeding results in no symptoms associated with the bleeding, other than bloating discomfort in some patients.

Diverticular bleeding is detected on colonoscopy as active bleeding from a diverticulum, a nonbleeding visible vessel, or an adherent clot. The most common source of bleeding diverticula is in the right colon. Bleeding often stops spontaneously in the majority of patients who require blood transfusion of less than four units of blood per day.

It is not fully understood why some people develop symptoms as a result of diverticula, though some risk factors have been acknowledged:

•Smoking.
•Being overweight.
•Living a sedentary lifestyle.
•Using non-steroidal anti-inflammatory drugs (ibuprofen is the most common example of an NSAID).
•Suffering from constipation on a regular basis.

It may not be possible to prevent diverticular disease but there are steps you can take to reduce the risk. The main means of cutting your risk is to eat plenty of fibre and you should aim for at least 18 grams of fibre per day. Good sources of fibre include:

•Wholegrain foods, including wholemeal pasta, bread and brown rice.
•Fruit and vegetables.
•Nuts.
•Pulses (such as beans and lentils).
•Wholegrain cereals.
It is also important to drink plenty of water and you should aim for at least 2 litres of fluid each day.
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Surgical intervention is rarely required because the bleeding is self-limited in 86 percent of patients, and there is a high rate of success at controlling bleeding by nonsurgical means.

Although most diverticular bleeding is self-limited and resolves spontaneously,8,34 blood loss is massive and rapid in 9 to 19 percent of patients.

To prevent progression of diverticular disease, patients should increase their dietary fiber intake or begin fiber supplementation (32 g per day), and increase their level of physical activity.38–40 Obesity (body mass index greater than or equal to 30 kg per m2) is a significant risk factor for diverticular bleeding (relative risk = 2.0).41 Avoidance of certain nuts, corn, or popcorn to prevent complications is no longer recommended in patients with diverticular disease.

•Diverticulosis is usually caused by chronically increased pressure and strain on the colon wall.


Diverticulitis and diverticulosis are not related to colon cancer.

Prevention of Diverticulosis and Diverticulitis



•Eat a high-fiber, low-fat diet. Foods high in fiber include fruits, vegetables, and whole-grain breads and cereals.


•Drink plenty of fluids (at least eight full glasses of water a day) to help soften stools.


•Exercise regularly to help maintain regularity of bowel movements.


How To Treat Diverticulosis and Diverticulitis



•Following prevention tips for diet (especially incorporating fiber) and exercise is important to prevent diverticulosis.


•Your doctor may recommend a bulking laxative containing the fiber psyllium or an artificial fiber like calcium polycarbophil. However, do not take laxatives without consulting your doctor and never use enemas—these may only further aggravate a diverticular disorder.


•For diverticulitis, your doctor may prescribe antibiotics and bed rest, often in the hospital.


•Injections of painkillers may be warranted in severe cases of diverticulitis.


•Antispasmodic drugs may be prescribed to relax the muscles around the digestive tract.


•You may need to have your stomach kept empty (with a tube passed through the mouth into the stomach) and to be fed intravenously to allow inflamed diverticula to heal. You should be able to eat and drink normally when symptoms of diverticulitis have subsided (generally in a few days).


•Surgery may be necessary to drain an abscess.


•Blood transfusions may be necessary in patients with profound bleeding from diverticuli.


•In severe or recurrent cases of diverticulitis, surgery may be necessary to remove the affected part of the colon. In a few cases, a temporary colostomy may be required, with later operations to reconnect the colon.