Chronic Bowel Disorder

coeliac disease, diverticular disease / diverticulitis

What is coeliac disease associated with?

Autoimmune disease causing an immune response in the small intestine (specifically the intestinal mucosa) associated with gluten i.e. wheat, barley, rye.

What effect does coeliac disease have on nutrient absorption?

Can cause malabsorption of nutrients.

What is the aim of coeliac disease treatment? I.e. via symptoms

To manage symptoms and avoid malnutrition.

Symptoms may be: diarrhoea, constipation, flatulence, bloating, abdominal pain.

Assess nutritional deficiencies: iron, folic acid, calcium, vit D.

What is the only effective option for the treatment of coeliac disease?

AVOID gluten

What is diverticula?

Small pouches protruding from the walls of the large intestine

• Occurs in around 80% of people > 85 years

• Formation associated with low fibre diet

What is diverticulosis? How is it managed?

= Diverticula present with NO symptoms.

• Increase fibre if constipated / low fibre diet

• Drink adequate fluid esp if increasing fibre intake otherwise can cause intestinal blockage

What is diverticular disease? When is a hospital admission indicated?

= Diverticula present WITH symptoms.

• Intermittent lower abdominal pain, constipation, diarrhoea, there is NO inflammation or infection

• Urgent admission IF significant rectal bleeding

How is diverticular disease managed?

• Bulk forming laxatives

• Paracetamol

• Mebeverine (antispasmodic)

What is acute diverticulitis? What are the signs and symptoms?

Occurs when diverticula suddenly become inflamed or infected.

Signs and symptoms include:

• constant lower abdominal pain (usually severe) together with features such as fever, a sudden change in bowel habits and significant rectal bleeding, lower abdominal tenderness, or a palpable abdominal mass

How does complicated acute diverticulitis present?

Diverticulitis associated with complications such as abscess, bowel perforation and peritonitis, fistula, intestinal obstruction, haemorrhage, or sepsis.

How do we treat acute diverticulitis if systemically well?

Offer simple analgesia such as paracetamol.

Consider a watchful waiting and a no antibacterial prescribing strategy, and advise patients to re-present if symptoms persist or worsen.

How do we treat acute diverticulitis if systemically unwell?

Oral first line: Co-amoxiclav