Diverticulitis

Dietary tips for large bowel obstruction and colitis

The colon is part of the digestive system and reabsorbs water and electrolytes through the colon mucosa. In addition, the large intestine fends off diseases and bacteria and also functions as a storage facility for stool. Colitis (inflammation of the colon) is an inflammatory process that can be acute or chronic. One of the most common forms of colitis is the widespread and well-known appendicitis.

Diverticulitis should be distinguished from such acute inflammatory processes. Diverticulitis describes chronic infections of mucosal protrusions as a chronic process with recurring symptoms.

In connection with diverticulitis, questions are repeatedly asked about a diet that suits the disease. It must also be taken into account that diverticulitis is a typical disease in Western civil societies and is practically not observed at all in Asia or Africa. Accordingly, it can be assumed that one of the main causes of the disease patterns is to be found in lifestyle and diet. In this context, it is also interesting that long-time vegetarians are significantly less affected.

Diet in the acute stage of diverticulitis

In the acute course of diverticulitis, one or more diverticula (protrusions of the intestinal mucosa) are usually infected. Typical symptoms are pain in the left lower abdomen, fever and increased inflammation values in the laboratory test. In case of such manifestations, the family doctor should be consulted urgently, who may also prescribe hospital care, antibiotic medication and a sparing diet. In an extreme emergency, surgery must be performed immediately, especially if fever and an unstable circulation are accompanied by the typical pain.

If no surgery is required acutely, special attention must be paid to nutrition in the acute stage of diverticulitis. It is advisable to completely avoid solid food for a few days. Liquid food and sparing food are compulsory and can be gradually built up to a light sparing food under individual nutritional counselling.

A diet plan in the sequence could then look something like this: Start with water, continue with tea and rusks, clear soups, creamy soups and yoghurt. This sequence is spread over a time frame of several days and must be set individually.

In the phase of the build-up diet, it is imperative to avoid fatty, spicy or flatulent foods in order not to further irritate the intestines. As soon as intestinal activity returns to normal, other foods can gradually be reintroduced into the diet.

A change in diet is recommended after diverticulitis

The top recommendation is: Change your diet to a high-fibre diet, similar to diverticular prophylaxis, even after an infection. In this way, you prevent a new inflammatory episode and also prevent a new diverticulum formation through a softer and more voluminous stool.

It is important when changing to a high-source diet that you also drink enough now. Water and tea are preferable.

In summary, we would like to give the following tips on dietary changes after diverticulitis:

• Eat plenty of fruit and vegetables. Important are the vegetable fibres and high water content.
• Drink a lot! Dietary fibre is only helpful if you drink at least two litres of water or tea in parallel.
• Prefer vegetables of the easily digestible variety such as tomatoes, carrots and courgettes.
• Wholemeal bread and wholemeal pasta are more suitable for diverticulitis nutrition than white bread.
• If you have diverticulosis, you should avoid hard, pointed and hard-to-digest food components, such as the seeds of apples, pears or melons.
• Wheat or oat bran and ground linseed are also good. Avoid constipating foods such as black tea, chocolate, cocoa, bananas and white flour products.

Allow time for the change to a diet rich in fibre and source material. And above all, stay consistent.

Oesophagus – Jörg Zehetner from ISDE Worldcongress 2018

Jörg Zehetner from the ISDE Worldcongress 2018 in Vienna, Austria
(International Society of the Diseases of the Esophagus)

What is the oesophagus?

Oesophagus is the medical term for the oesophagus. The oesophagus is a muscular tube that pumps our food from the mouth into the stomach. To prevent the oesophagus from being burned all the time by the gastric juice (stomach acid), there is a valve at the end of the oesophagus: the lower oesophageal muscle.

Disorders in the oesophageal area

If the lower oesophageal muscle (this region is also called the cardia) becomes slack, weak or defective, then it is relatively easy for stomach acid to flow back into the oesophagus and cause symptoms such as heartburn, stomach burn, acid regurgitation or burning in the chest area. This backflow of stomach acid into the oesophagus is medically called reflux.

Persistent reflux (chronic reflux) is a risk factor for oesophageal cancer. People often try to get a grip on the problem with acid blockers and diet tips. However, all these methods only alleviate the acute symptoms, not the causes. The mechanical problem – the defective stomach valve – remains. This means that there is still a risk of the disease progressing, which in the final stage can end in oesophageal cancer.

How chronic reflux can be countered

Only an operation, today simply performed as a minimally invasive short procedure, can stop the reflux and thereby reduce the discomfort as well as the risk of cancer to zero.

With such an operation, the mechanical defect in the cardia muscle is repaired so that normal function can be fully restored.

In order to be able to understand the entire pathological course of reflux up to oesophageal cancer, please watch the video that was created in cooperation with Hirslanden, the basis for this video was my idea and my concept.

Hernia surgery at Bern Visceral Surgery Steffen AG

Treat unpleasant tissue breakdowns professionally

The medical term for a hernia is colloquially known as a hernia. This does not mean broken bones, but rather weaknesses in an organic structure that lead to a bulge in the further course. In many cases, organs are pushed or shifted from their original physical position to other areas, which can also be visually recognisable.

Known hernias are, for example, umbilical hernia, incisional hernia, inguinal hernia or hiatal hernia.

In addition to the unpleasant physical sensations and sometimes also cosmetic impairments, a hernia can also lead to disturbances in the respective organ function and even to dramatic courses of disease. Therefore, even smaller or inconspicuous hernias should initially be treated by a specialist.

Complicated hernias require interdisciplinary intervention

Complex hernias are not only associated with the familiar visual appearances, but also with severe pain and, in extreme cases, disruption of the respective organ function. Surgical intervention is urgently required here, but this should rarely be based on the hernia alone, but also on the environmental conditions in the physical surroundings. Finally, it is a question of treating the hernia itself on the one hand, but on the other hand also of recognising the conditions of its development and, if possible, ruling them out for the future.

Our patients in the swiss1chirurgie clinic (Berner Viszeralchirurgie Steffen AG) benefit from the interdisciplinary interaction of medical experts. In our clinic we have all the possibilities to discuss and treat complicated hernias in a multidisciplinary team. In this way, radiologists, physiotherapists, internists and of course the operating surgeons can achieve the best conditions for a successful course of treatment in interdisciplinary work.

Modern surgical planning and surgical experience

Surgical planning using computer tomography (CT) and derived 3D animation is extremely helpful for a promising treatment approach. This gives us clear impressions in the team of how the hernia has formed, what its dimensions are and which surgical method is most promising.

Subsequently, the patients are treated precisely according to the clinical picture. Superfluous interventions are avoided and interventions are always carried out to the extent that exactly fits the picture of the hernia obtained.

Smaller hernias, i.e. tissue openings of up to 2 centimetres, are usually closed directly. Anything above this requires laparoscopic surgery, which also involves the use of nets. These nets securely close the affected hernia and prevent the recurrence of a hernia at the same site to within one percent. Without the use of nets, the risk of recurrence of the fracture was about ten percent with the corresponding need for repeat surgical interventions.

Incidentally, nets are also used almost without exception in high-risk patients, such as overweight people, in order to largely reduce the risk of a new fracture in the same part of the body.

Overall, we thus ensure an extremely professional treatment of hernias, which is associated with the lowest possible risk and the highest degree of quality of life to be gained, especially for our patients.

The surgery team of the swiss1chirurgie clinic (Berner Viszeralchirurgie Steffen AG9 with Dr. Jörg Zehetner and Dr. Rudolf Steffen stands for professional surgery that is first and foremost committed to people.