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Chapter 4: Inflammatory bowel disease 167

Aetiology
Disorders of the large bowel
Caused by an infection by Tropheryma whippelii,anacti-
and inflammatory bowel
nomycete. The route of infection is unknown. The or-
disease
ganism is found in intestinal macrophages.
Diverticular disease
Clinical features
Patients present with steatorrhoea, abdominal pain and Definition
systemicsymptomsoffever,weightloss,lymphadenopa- Adiverticulum is a mucosal out-pouching, diverticular
thy and arthritis. Heart, lung and CNS involvement may disease is a general term that encompasses diverticulosis
occur. (the presence of diverticula) and diverticulitis (inflam-
mation of a diverticulum).

Investigations and management Incidence
Electron microscopy can demonstrate the organism. Rare before the age of 35, but by 65 years one third of
PCR is now available for diagnosis. Various antibiotics the population is affected.
are used often in combination and for prolonged courses
(up to 1 year).
Geography
Primarily a Western condition (due to diet). Immigrants
to the West are also at risk.
Tropical sprue
Definition Aetiology
AseveremalabsorptionsyndromeendemicinAsia,some Diverticulae are associated with high intraluminal pres-
Caribbean islands and parts of South America. sure, muscle hypertrophy can be seen before diverticulae
develop. There is a relationship with a low fibre diet and
chronic constipation.
Aetiology/pathophysiology
The condition occurs in epidemics and improves on an-
tibiotics thus it is likely that it has an infective cause. Pathophysiology
They occur most commonly in the sigmoid colon and
may become obstructed with a faecolith. Repeated in-
Clinical features
flammation and scarring may result in an ulcer difficult
Patients present with diarrhoea, anorexia, abdominal
to distinguish from carcinoma. Diverticulitis is caused
distension and weight loss. The onset may be acute or
by obstruction of the neck of the diverticulum resulting
insidious.
in mucosal inflammation.
Investigations Clinical features
The diagnosis can be made on jejunal biopsy, there is Diverticulosis is frequently asymptomatic. Patients
colonisation of the gut lumen by toxin producing enter- may however report intermittent lower abdominal
obacteria associated with partial villous atrophy. and left iliac fossa pain, altered bowel habit or oc-
casional minor rectal bleeding.
Diverticulitis presents as pyrexia, nausea, vomiting,
Management
with pain and tenderness, a mass may be palpable.
Severely ill patients require resuscitation for dehy-
dration and electrolyte imbalance. Nutritional defi-
ciencies should be corrected and antibiotics given, Macroscopy/micropscopy
but patients often improve when they leave endemic On the surface of an opened section the slit like openings
areas. of diverticula can be seen.