What is Diverticular
Diverticular Disease is a disorder of the large intestine (colon).
The colon is a muscular tube about 2 metres long. The main function
of the colon is to absorb water and allow fibre to be broken down
by bacteria. Food residue passes along the colon by the well co-ordinated
muscular action of the colon to be excreted as faeces from the rectum.
Should the rhythm be disturbed, areas of high pressure within the
colon produces small outpouchings at the points of weakness where
blood vessels penetrate its muscular wall. These outpouchings are
Diverticulitis occurs when these pouches become inflamed.
Diverticular Disease is considered to be caused by inadequate
bulk or fibre in the diet and therefore is very common in Western
communities where we tend to eat more refined foods. The age of
onset can be as early as the 3O's and increase thereafter.
- Many people with Diverticular Disease have no symptoms.
- Abdominal pain - crampy lower left abdominal pain is common.
It is often worse in the morning and relieved by passing wind
or bowel motion.
- Variable bowel habits - diarrhoea, constipation.
- Urgency of bowel motion.
- Gas and / or bloating.
Symptoms Of Diverticulitis May Also Include
- Pain - which is often continuous and severe in the left lower
- Marked constipation or diarrhoea.
Relevance To Cancer
Whilst there is no direct association, it is such a common disease
that cancer can be hidden by it, producing similar symptoms and
therefore colonoscopy is advised.
Complications Of Diverticular Disease
- Narrowing and distortion of the bowel lumen.
- Rarely - abscess formation which may rupture causing acute abdominal
pain and requiring emergency treatment.
- Fistula or abnormal communication to the bladder may produce
infection or gas bubbles in the urine.
Treatment - Prevention And Control
- A high fibre diet from an early age (cereals, vegetables, fruit
and an avoidance of refined, processed foods).
- Regular exercise and fluids are important particularly if constipation
- For severe spasmodic pains and cramps, antispasmodic medication
may help temporarily.
- Prolonged use of laxatives which stimulate the bowel wall to
contract should be avoided. Instead, use bulk forming agents eg.
- Where inflammation develops (diverticulitis), antibiotics may
be used, however in severe cases, or where complications such
as abscess formation or obstruction occur, surgical removal of
the diseased part of the colon may be required.
- A permanent colostomy (bag) however is almost never necessary
The Helicobacter pylori story is one of the most exciting, but
complex chapters in the history of gastroenterology.
More than 10 years ago an Australian gastroenterologist and Nobel
laureate, Dr Barry Marshall proposed that gastritis and ulcers may
be due to bacteria. The story continues to be updated with new recommendations
particularly concerning the treatments available.
The following information is to help you understand what the presence
of this bacteria means and why your Doctor may or may not recommend
treatment for it.
How do we get the bacteria?
The bacteria usually enters the stomach before the age of 10. It
is thought that it is transmitted between children by direct contact.
It may be transmitted because of poor food hygiene or hand washing.
The bacteria is extremely common with almost 50% of adults having
evidence of the bacteria.
There is little risk of passing the bacteria between adults or
from adults to children, as long as normal hygiene precautions are
followed. These include washing of hands after using the toilet
and before preparing food.
Where does the bacteria live?
In the normal stomach there are many bacteria present.
The Helicobacter pylori bacteria (HP) has special features that
allow it to survive in the stomach. It is thought that it may remain
in the stomach for many years before it causes problems.
The HP bacteria is able to produce a special substance that allows
it to pass through the layer of mucus that protects the lining of
This ability to hide beneath this layer sometimes makes it difficult
to get rid of the bacteria.
How does the HP bacteria cause problems?
It is known that the HP bacteria does not cause problems in everyone.
Most have no problems at all.
In some the HP bacteria is thought to damage the cells lining the
stomach and duodenal wall allowing acid to further attack the lining
causing inflammation and, or ulcers.
Other treatments that reduced the acid levels in the stomach allowed
the ulcer to heal only to form again at some time in the future
because the bacteria were still present in the stomach.
What is the role of the bacteria in various
DUODENAL AND GASTRIC ULCER
There is now convincing evidence that the HP bacteria is the major
cause of gastritis and ulcers. Other factors such as high levels
of acid, smoking and taking some pain killing tablets act together
with the bacteria. If we get rid of the bacteria we can cure ulcers.
At this stage we do not believe that HP is responsible for heartburn.
In some patients who are on treatment for a long time we recommend
that the HP bacteria is treated as a precaution.
In this condition there may be inflammation or the stomach may appear
completely normal. Most patients with dyspepsia who have the HP
bacteria present are no better after treatment to eradicate the
bacteria. Your doctor may decide to treat the bacteria depending
on your symptoms and response to other treatments.
The role of the HP bacteria in other diseases of the stomach at
this stage is unclear. Remember that a large number of people without
problems have the bacteria.
The result of the test to detect the bacteria will be kept and
acted on later if necessary.
Treatment of the HP bacteria is difficult, and involves a large
number of tablets (with unpleasant side effects). The bacteria is
so good at hiding under a layer of mucus in the stomach it is difficult
for antibiotics to reach them.
It is very important with all treatments that you complete the
There is no concern that you will pass the bacteria to others.
The treatment given will depend an why you are receiving the treatment.
Helidac - A combined therapy
based on a bismuth compound together with two antibiotics - metronidazole
and tetracycline for 14 days.
Losec RelicoPak - An acid suppressing
agent together with two antibiotics. amoxycillin and metronidazole
for 14 days.
Side Effects - of both can
include altered taste, vomiting, nausea, and diarrhoea. (if severe
you should contact your doctor). Helidac can cause discoloration
of the tongue and black motions.
You should not drink alcohol for the 14 days that you are taking
Depending on your condition we may suggest a test to ensure that
the bacteria has been cleared. A gastroscopy can also test again
for the bacteria and can determine if the ulcer has healed.
If the bacteria has been cleared then it is unlikely that you will
Coeliac disease (caused by gluten sensitivity) is much more common
than previously thought. The prevalence in Australia is one in 300
- 500 people and may even he higher. It is most likely in patients
of western European background.
Symptoms are very variable or may indeed be absent, only diagnosed
during investigationfor the consequences of nutritional deficiencies.
It can present at any age, Symptoms may include diarrhoea, weight
loss and other gastrointestinal distrurbances. Nutrient deficiencies
include iron and foliate leading to anaemia, and less commonly,
calcium deficiency results in osteoporosis.
Gluten (a protein present in wheat, barley and rye) causes immune-mediated
damage to the proximal small intestine in genetically susceptible
individuals, leading to a marked reduction in the absorptive surface
area of the small intestine. Corn and rice are safe. Up to 10% of
first degree relatives of patients with coeliac, disease will he
The "gold standard" in diagnosis remains the endoscopic
small bowel biopsy and must he performed before committing a patient
to a life long gluten free diet. Serology is a useful screening
test in those patients with suggestive symptoms or anaemia. Tests
include transglutaminase and endomysial antibodies.
Management includes a strict lifelong gluten free diet and correction
of nutritional deficiencies. Patients should be encouraged to join
the Coeliac Society.