Sunday, October 6, 2019

Treatment for Diverticulitis Revisited


Is there stuff that you do just because that’s the way you’ve always done it?   I’ll answer for you – yes.

In many circumstances, this makes sense.  For example, I stop my car at red lights just as I have always done.  I recommend that readers do the same as there is an underlying logic for this recommendation.  It is not simply a rote routine that has no rationale.   However, the particular order that we pour ingredients into a pot when making soup, may be more random than rational.   We follow the same order we always have, never pausing to wonder why or if there might be a better way.

And, so it is with many practices and procedures in the medical profession. Let’s return to the medical condition of diverticulitis, which I presented on this blog recently.  Follow the link, if interested.

For the last several decades, this disease has been treated in the same way – with antibiotics.  This means that physicians believe this to be an infectious disease – like strep throat – caused by bacteria.  But, the real reason I think that physicians like me prescribe antibiotics for this condition as because that’s the way we’ve always done it.

Changing established medical practices is like having an ocean liner make a U-turn.  It’s not easy.  For example, when I was a medical student, kids with red ear drums, or otitis, were routinely given antibiotics, assuming that this was a bacterial infection.  But, after a few decades, experts concluded otherwise.


Not Easy to Make a U-Turn


Similarly, I have a strong sense that the established treatment for diverticulitis may be revised.   The classic understanding of this disease was that this was a bacterial infection in the wall of the colon.  The theory was that a tiny puncture would develop in one of the diverticula, which are pouches that are weak points in the colon.  Germs from inside the colon would travel through the puncture site to the outside wall of the colon, which is usually sterile, and an infection would start.  We prescribe antibiotics and the patients generally recover well. 

But, should the antibiotics really get the credit?  What if these patients would have recovered anyway on their own?  I believe many of them would have.   In fact, many patients who have had diverticulitis, often have had episodes that recovered spontaneously without having seen a physician. 

In fact, a prominent gastroenterology professional society recently issued guidelines that expressed that not every case of diverticulitis requires antibiotic treatment.   It may take another 10 years for this recommendation to gain traction. 

I’m not abandoning antibiotics for diverticulitis in my practice yet.  But, I am following the issue closely in the journals.  There needs to be a better reason to do stuff than simple habit and routine – and that includes reading this blog.


4 comments:

Rich Maranoff M.D. said...

good idea but must be taken with a grain of salt. I,m old enough to remember a time before antibiotics and everyone did not die or not get well of their infection. The body has an amazing ability to fight infection, it just took longer. That said, you are right in questioning current therapies that have never been proven but just done because thats the way it,s always been done.

Michael Kirsch, M.D. said...

Thanks so much, Rich, for your thoughtful comments. Looks like you and I have the 'long view' here! Be well. MK

bluerose said...

My brother in-law suffered from diverticulitis in the early 1950’s and his treatment was treated with changes in diet, such as eliminating seeds, nuts, etc. It worked as long as he didn’t cheat.

Michael Kirsch, M.D. said...

@bluerose, I don't think your brother-in-law was cheating, he was merely 'experimenting'!
So many folks have given up eating nuts even thought there is not a shred of medical evidence that this is beneficial.

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