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Can Diverticula Be Infected Despite Having No Symptoms?

Posted on Wed, 19 Feb 2014

Question: Requesting answer from a gastroenterologist! I'm 55-yr old, ideal weight female. DX'd via 8/13 colonoscopy with several diverticula. This scope was done due to moderate level, off and on pain in lower left quadrant for 6 wk prior period--for which abdo & transvaginal u/s & abdo/pelvic CT revealed no cause. (CT with contrast did not even reveal diverticula, which I still don't understand!) Pain eventually went away, but now is back--again mild to moderate off and on. Have no other symptoms like vomiting, fever, change in bowel habits, etc., except that lower back tends to ache a little when lower left quad pain comes on. Gastro doc gave me cipro & flagyl RXs to keep on hand in case of emergency. Questions: 1) Can diverticula actually be INFECTED despite having no symptoms other than mild to moderate pain? 2) If pain is caused by INFLAMED, but not infected diverticula, is it appropriate to still take the antibiotics? In other words, do these 2 antibiotics help to also eliminate inflammation? 3) Have taken at least cipro--and maybe flagyl--in past for other health issues. All antibiotics seem to really tear my stomach up. If pain is due to inflammation only, would it be appropriate to just take the full course of flagyl to see if that cures it...then if not, start on the cipro? Or must the two be taken together regardless of inflammation or infection in order to stop the pain? 4) Could just going on a clear liquid diet for 3 days be enough to stop the pain and RESOLVE any inflammation without having to resort to antibiotics? Would like to take ibuprofen 2-3 times a day for 3 or so days to see if that cures inflammation, but keep reading that NSAIDS irritate diverticula so am afraid to! Gastro doc is on vacation; thus the reason I'm requesting your advice! Thanks!

Answered by Dr. Ashish Verma (5 hours later)

Brief Answer: Antibiotics are needed Detailed Answer: Hi, Thanks for writing to XXXXXXX This is Dr. Ashish Verma, a general surgeon. First thing first, a contrast CT can miss diverticule as during acute inflammation, the mouth of the diverticule may get closed due to swollen mucosa, so contrast may on enter inside and so it wont be detected on CT. Now coming to your main queries in their sequence: 1) Having pain is the proof the your diverticula is infected, as it is the infection only that causes inflammation to occur. So this should also answer your second query also. 2) As explained earlier, that it is the infection that leads to inflammation, so you have to take antibiotics and antiinflammatory drugs both. 3) A combination of drugs are given to prevent development of drug resistance and to increase the antibiotic spectrum. Taking a single drug will promote growth of resistant organisms. As for your stomach pain, it is due to drug induced gastritis, and you need to start on a ppi for the same, for a week longer than you are taking antibiotics or analgesics. 4) Going on a clear liquid diet of a few days may help, but wont cure the condition permanently. After the pain resolves after your liqueid diet, you need to switch over to a fiber rich diet to avoid constipation. NSAIDs do cause problems so take them only in case of severe pain, to dont take them for prolonged duration. You may try mepridine instead of ibuprofen for it, but for the prescription you need to see your local doctor. Hope, that I have answered to all your queries. If you have further queries, I will be glad to answer them. Regards, Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ashish Verma (20 hours later)

Dr. XXXXXXX Thank you SO much! Your answers were incredibly thorough and helpful! When you say to take a PPI during and after the antibiotics, would Zantac or Pepcid (which I occasionally take now) be equally effectiv, or must it be Prilosec or one of the other official PPIs?eOne last question: Should I take an anti-inflammatory along with the antibiotics, or will the flagyl help with that (I'm thinking flagyl also has anti inflammatory properties)? Loads of thanks and gratitude to you! Best wishes! XXXXXXX

Answered by Dr. Ashish Verma (48 minutes later)

Brief Answer: prilosec will be better Detailed Answer: Hi, Prilosec will be more effective for you. Flagyl does have antiinflammatory effect...but that is mild...if your symptoms are controlled with that then you continue with it only...else you may have to add one... Hope that i have answered to all your queries. If you dont have further queries, you may close this discussion and rate the response. Regards, Dr. Ashish Verma

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Above answer was peer-reviewed by : Dr. Raju A.T