Diverticulosis of the digestive tract

　　Because the blood vessels in the upper part of the jejunum and the distal ileum are relatively thick, and the muscular layer of the intestinal wall is fragile at the thickened blood vessels, diverticula are more likely to occur at these sites, especially in the upper part of the ileum. In addition, long-term intake of low-fiber foods may cause a continuous increase in intraluminal pressure, and the elderly are more prone to it due to weakened muscular strength of the intestinal wall. Although the specific cause of diverticula formation is not yet known, most experts believe that the main cause is the pressure produced by the small, hard feces produced by defecating low-fiber diet. The high pressure produced by abnormal movement of the colon (possibly due to low fiber content in the diet) will force the intestinal endothelium to penetrate the fragile points of the external muscular layer of the colon.

　　Patients with gastrointestinal diverticular disease may have complications such as intestinal perforation, abscess, fistula, intestinal obstruction, massive hemorrhage, inflammation, perforation, and cancer within the diverticulum, which seriously危害患者健康，威胁患者生命，therefore it is necessary to treat it in time.

　　First, Esophageal Diverticulum

　　1. Pharyngoesophageal Diverticulum

　　The clinical manifestations include mild difficulty in swallowing, the food retained in the diverticulum can reflux into the oral cavity, coughing is more likely to occur after meals and during sleep. In the late stage, there are symptoms such as hoarseness caused by compression of the recurrent laryngeal nerve, a water passing sound when drinking water, and recurrent aspiration pneumonia. During physical examination, a dough-like mass can be found above the clavicle at the root of the neck, and a water passing sound is emitted when pressed. X-ray barium swallow film can clearly diagnose the disease. In cases where cancer develops in the diverticulum, early surgical treatment is required.

　　2. Middle Esophageal Diverticulum

　　It is relatively rare and is a pulled-out true diverticulum caused by adhesion between the tracheal prominence subcarinal lymph node tuberculosis or other inflammatory lesions and the anterior wall of the esophagus, pulling the entire thickness of the esophagus. The opening of the diverticulum is large, and the bag position is higher than the neck of the bag, making it difficult to occur food retention. Generally, there are no symptoms, and a few people have difficulty swallowing, extremely few cases of mediastinal abscess or esophageal tracheal fistula. Patients with symptoms can be treated with water balloon or balloon dilation, and those without symptoms do not require surgical treatment.

　　3. Esophageal Diverticulum Above the Diaphragm

　　The esophageal diverticulum is the least common, belonging to the pseudodiverticulum, located 10 cm above the diaphragm at the lower segment of the esophagus, more common in males, often accompanied by esophageal spasm, cardiospasm, reflux esophagitis, or esophageal hiatus hernia. Diagnosis depends on X-ray examination; CT examination can differentiate mediastinal tumors, abscesses, or hiatus hernia. Patients without symptoms do not require treatment; those with obvious symptoms such as dysphagia, posterior sternum pain, or carcinoma require surgical resection.

　　2. Gastric diverticulum

　　Most patients are asymptomatic, and a few complain of intermittent upper abdominal fullness or lower chest pain after meals or when lying flat, accompanied by nausea, vomiting, and a burning sensation, which is related to the retention of food in the diverticulum. Common complications include hemorrhage.

　　3. Small intestinal diverticula

　　1. Duodenal diverticulum

　　It is the most common type of small intestinal diverticulum. The vast majority of patients are asymptomatic, and about 10% of patients complain of upper abdominal pain and discomfort, accompanied by nausea and belching, which worsens after eating. When complications such as inflammation or ulceration occur, symptoms may be more severe or persistent. The site of the diverticulum may be tender. Approximately 27% of periampullary diverticula are associated with gallstones and can also cause biliary duct obstruction, cholangitis, recurrent pancreatitis, and other complications such as hemorrhage and perforation, which are not common. Hemorrhage can be caused by mucosal erosion or maldevelopment of blood vessels, or due to penetration of nearby mesenteric vessels, perforation can lead to portal vein, bile duct, or pancreas, causing abscesses. Duodenal diverticula can cause partial or complete duodenal obstruction, leading to postprandial upper abdominal fullness, cramping pain, and vomiting, which is relieved after vomiting.

　　2. Meckel diverticulum

　　It is a true diverticulum located at the end of the ileum, caused by incomplete closure of the ileal end of the yolk sac during embryogenesis. Most patients are asymptomatic, and symptoms appear when complications occur. When the diverticulum protrudes into the intestinal lumen, it can cause intussusception and obstructive intestinal obstruction, with symptoms such as vomiting, abdominal distension, constipation, or red jelly-like stools. Atypical gastric mucosa can secrete hydrochloric acid and pepsin, causing diverticular peptic ulcers and hemorrhage, which are common complications in pediatric cases.

　　3. Acquired jejunoileal diverticula

　　This disease is rare. Solitary diverticula are often asymptomatic. When there is a large amount of bacterial proliferation in multiple diverticula, symptoms such as dyspepsia may occur, such as abdominal pain, bloating, diarrhea, malabsorption, and weight loss, anemia, and steatorrhea. Small and large intestinal diverticular disease is one of the common causes of small intestinal malabsorption syndrome. Complications are rare, including acute inflammation, hemorrhage, perforation, small bowel obstruction, and cancer within the diverticula.

　　4. Colonic diverticula

　　Currently, there is chronic intermittent left lower quadrant abdominal pain, and typical patients complain of constipation accompanied by abdominal distension and dyspepsia. During physical examination, there may be tenderness in the left lower quadrant, and the cecum can be palpated as firm and full of fecal mass.

　　Eat less of fruits with a lot of fiber or rough vegetables and刺激性食物, to avoid increasing intestinal motility and exacerbating symptoms. During the acute phase, consume a liquid diet to make stools soft and slippery, reduce retention, and facilitate excretion through the diverticula. You can take 5ml of liquid paraffin or astringent leaves as a tea drink before going to bed every night, and it is not advisable to do colon lavage to avoid perforation.

　　1. Abdominal flat film examination

　　Plain abdominal films for simple diverticulosis are usually normal and therefore of little value. The imaging characteristics of diverticulitis are: intestinal wall displacement or narrowing, mucosal changes, and multiple diverticula may be visible in the intestinal segments near or far from the lesion. Abdominal films may show abdominal abscesses, multiple air-fluid levels and distended bowel caused by small and large bowel obstruction.

　　2. Enema imaging

　　The use of barium or water-soluble contrast agents for contrast enema is of great value in the diagnosis of asymptomatic diverticulosis, more reliable than colonoscopy. The barium-filled diverticula appear as spherical protuberances projecting from the colon wall, and the diverticula can still be seen after the barium is excreted, showing no inflammatory signs, which may mask the diverticula. Sometimes, inversion of the diverticula or the accumulation of feces may be confused with polyps, so multiple views and filming should be observed, and filming after emptying can improve the accuracy of diagnosis.

　　What kind of food is good for gastrointestinal diverticulosis patients to eat

　　1. Drink at least 6 cups of water daily to prevent constipation. If you already have constipation, plums, plum juice, or special herbal tea formulas for treating constipation can be used as natural laxatives.

　　2. Maintain a low-fat diet, as fat can slow down the time it takes for food to pass through the intestines. Conduct some food sensitivity tests to find out which foods irritate your digestive system and avoid eating them.

　　3. During the acute attack of diverticulitis, try to limit the diet to 1-3 times a day with water or vegetable juice. When the diverticula still have inflammation and sensitivity, eat low-volume foods (soup and low-fiber diet). During the acute phase of diverticulitis, increase the proportion of the following foods in your diet: cooked vegetables, cooked fruits, and apples, all of which can lubricate the intestines. Avoid milk and dairy products (yogurt and cheese), as they can worsen the condition, especially when you have diarrhea.

　　Asymptomatic diverticula do not require treatment. If symptomatic, treat the latter first when it coexists with other abdominal diseases. If the symptoms are indeed caused by diverticula, then adopt comprehensive internal medical treatment, including dietary regulation, acid reduction, antispasmodic, and positional drainage. Unless there are uncontrollable complications or malignancy, surgery is generally not considered. Especially when the anatomical position around the diverticula is complex, surgery should be done with caution. Most diverticulitis without complications should be treated conservatively, eat less of coarse fruits or vegetables and spicy foods to avoid increasing intestinal peristalsis and exacerbating symptoms. During the acute phase, consume liquid foods to make stools soft and reduce retention, making it easier for them to be excreted from the diverticula. You can take 5ml of liquid paraffin or astringent leaves as tea at bedtime, and avoid colonic irrigation to prevent perforation. Antibiotics can be used to control infection.