Is It Diverticular Disease or Is It Irritable Bowel Syndrome?

Abstract

Symptomatic diverticular disease (SYMP-DD) and irritable bowel syndrome (IBS) share many features. Both are characterised by recurrent episodes of abdominal pain which may be slightly more frequent in IBS than SYMP-DD. They may also both exhibit an erratic bowel habit with diarrhoea, constipation and alternating types. It is important to assess anxiety, depression and somatisation since this can be increased in both types of patients and may be associated with visceral hypersensitivity. There are also significant differences between IBS and SYMP-DD. In particular, SYMP-DD patients are older, lack the female predominance seen in IBS and may often have fever with prolonged episodes of pain. For them, abnormalities of the gut are probably more important than cerebral factors, while for IBS the reverse is true. Treatments should be directed at the predominant abnormality which will vary in every patient.

Incidence and predictive factors of irritable bowel syndrome after acute diverticulitis in Korea

“…As mentioned earlier, clinical diagnosis of diverticulitis can lead to misdiagnosis and produce significant sampling bias. In addition, symptomatic uncomplicated diverticulosis or asymptomatic diverticulosis can present with IBS-like symptoms [25][26][27][28][29][30]. However, we found active inflammation in the diverticular sac and confirmed acute diverticulitis by CT scan.…”

Clinically Diagnosed Acute Diverticulitis in Outpatients: Misdiagnosis in Patients with Irritable Bowel Syndrome

“…However, this triad is insensitive, as it is absent in many patients with well-documented diverticulitis [3,4,7,8,14], which has led to efforts to improve diagnostic accuracy with a clinical scoring system [9]. The entity of symptomatic diverticular disease has recently been proposed as a cause of chronic symptoms that may be distinguishable from IBS [29,36,37]; however, this matter is unsettled [38] and was not addressed by this study.…”

“…More accurate diagnosis of diverticulitis without imaging is needed because CT is expensive, often not promptly available to outpatients and introduces a radiation risk [40]. However, careful clinical evaluation of outpatients with abdominal pain and tenderness, especially history taking to elicit symptoms typical of IBS, other symptom-based somatic and mental comorbidities, medication use, and the longer pain duration typical of diverticular disease [36] could improve diagnosis. Measurement of a biomarker, such as C-reactive protein, could also be useful [41].…”

Failure to Use Ultrasound Is a Glaring Shortcoming

“…[151,154], Gichtarthritis [150], Immunsuppression [151,154], Hypalbuminämie [153], Steroideinnahme [151,153] und ASA-Kategorie III/IV [155]. Einige Autoren empfehlen daher, für diese Risikogruppen eine elektive, prophylaktische Sigmaresektion zu erwägen [150,151,154] Die Definitionen der Divertikelkrankheit / symptomatische unkomplizierte Divertikelkrankheit und Divertikulitis sind in der Literatur nicht scharf, wobei vor allem die Abgrenzung Divertikulose mit Reizdarmsyndrom versus symptomatische unkomplizierte Divertikelkrankheit nicht präzise möglich ist [10,73,[172][173][174].…”