World J Gastroenterol. 2008 April 21; 14(15): 2411-2413.
Published online 2008 April 21. doi: 10.3748/wjg.14.2411.
Association between colonic polyps and diverticular disease
Tetsuo Hirata, Yuko Kawakami, Nagisa Kinjo, Susumu Arakaki, Tetsu Arakaki, Akira Hokama, Fukunori Kinjo and Jiro Fujita.
Tetsuo Hirata, Akira Hokama, Jiro Fujita, Department of Medicine and Therapeutics, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
Yuko Kawakami, Department of Internal Medicine, Nishinjo Hospital, Okinawa 900-0034, Japan
Susumu Arakaki, Tetsu Arakaki, Department of Coloproctology, Nishinjo Hospital, Okinawa 900-0034, Japan
Nagisa Kinjo, Fukunori Kinjo, Department of Endoscopy, Ryukyu University Hospital, Okinawa 903-0215, Japan
Author contributions: Hirata T, Kawakami Y, Arakaki S, Arakaki T, Kinjo N Hokama A, Kinjo F, and Fujita J designed the research; Hirata T and Kawakami Y performed the research; Hirata T and Fujita J wrote the paper.
Correspondence to: Tetsuo Hirata, Department of Medicine and Therapeutics, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. h400314@med.u-ryukyu.ac.jp
Telephone: +81-98-8951144
Fax: +81-98-8951414
Received December 6, 2007; Revised February 18, 2008;
Abstract
AIM: To evaluate the association between colonic polyps and diverticular disease in Japan.
METHODS: We retrospectively reviewed the medical records of 672 consecutive patients who underwent total colonoscopy between August 2006 and April 2007 at Nishinjo Hospital, Okinawa, Japan. Patients with a history of any of the following were excluded from the study: previous polypectomy, colonic resection, and inflammatory bowel diseases. The association between colonic polyps and diverticular disease was analyzed by logistic regression analysis, adjusted for age and sex.
RESULTS: Prevalence of colonic polyps in all patients with diverticular disease was significantly higher than that in those without diverticular disease (adjusted odds ratio 1.7).
CONCLUSION: Our data showed that patients with diverticular disease have a higher risk of colonic polyps compared to those without.
Keywords: Colonic polyps, Colonic neoplasm, Diverticular disease, Proximal diverticular disease, Colono-scopy
INTRODUCTION
The prevalence of colonic neoplasia and diverticular disease has increased in recent years[15]. Both have common risk factors such as age and a lack of dietary fiber[610]. Despite common epidemiological trends and risk factors, any association between these diseases has not been clarified. Although some data have been reported regarding the association between these diseases in Western countries[1114], there has been no study in Japan. There are differences between diverticular disease in Western countries and that seen in Asia, including Japan[1519]. Diverticular disease of the right colon is rare in Western countries[2022], whereas in Asia, diverticular disease of the right colon is common and has been increasing in recent years[2327].
This study evaluated the association between colonic polyps and diverticular disease in Japanese patients undergoing total colonoscopy.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of consecutive patients who underwent total colonoscopy between August 2006 and April 2007 at Nishinjo Hospital, Okinawa, Japan. The major indications for total colonoscopy were screening examination after hemorrhoidectomy and rectal bleeding. Patients with a history of any of the following were excluded from this study: Previous polypectomy, colonic resection, and inflammatory bowel diseases. The location of diverticula and polyps was classified into three groups: Distal, proximal and bilateral colon. The borderline between the distal and proximal colon was set at the splenic flexure. Diverticular disease was defined as the presence of one or more diverticula, and all polyps were diagnosed as adenoma by histological examination.
Statistical analysis
The chi-square test was used to compare sex and prevalence of colonic polyps, and the t test to compare mean age. Logistic regression analysis was used to examine the association between diverticular disease and colonic polyps, adjusting for age and sex. P < 0.05 was considered statistically significant. All statistical analyses were performed with SPSS 15.0 for Windows.
RESULTS
The present study included 672 consecutive patients. Of these, 165 (24.5%) had diverticular disease and 189 (28.1%) had colonic polyps. The most common segment for diverticular disease was the proximal, followed by the bilateral and distal colon. The most common segment for colonic polyps was the distal, followed by the proximal and bilateral colon (Table 1). Among patients with diverticular disease, none had active segmental colitis.
Table 1
Table 1
Number of patients with diverticular disease and colonic polyps by colon segment n (%)
Table 2 summarizes the demographic features of patients with or without diverticular disease. The mean age of patients with diverticular disease was significantly higher than that of patients without diverticular disease (P < 0.001). There were significantly more males in those patients with diverticular disease than those without (P = 0.008). The prevalence of colonic polyps in patients with or without diverticular disease was significantly different at 43% and 23.2%, respectively.
Table 2
Table 2
Comparison of demographic features between patients with or without diverticular disease
Using logistic regression analysis adjusted for age and sex, we calculated the adjusted odds ratio (OR) for colonic polyps (Table 3). This confirmed that the prevalence of colonic polyps in all patients with diverticular disease or those with diverticular disease in the proximal colon was significantly higher than that in patients without diverticular disease (adjusted OR 1.7 and 1.9, respectively).
Table 3
Table 3
Association between colonic polyps and diverticular disease adjusted for age and sex by logistic regression analysis
DISCUSSION
Colonic neoplasia and diverticular disease have common epidemiological trends and risk factors such as age and a lack of dietary fiber[67]. However, little is known about any association between these diseases. Morini and others found an increased risk for sigmoid colon adenoma in Italian patients with diverticular disease, in a prospective study[28]. Kieff and others have reported an increased risk for distal neoplasia in women in the USA with extensive distal diverticulosis, in a cross-sectional study[29]. Although the sample size and distribution of patients included in the present study might inadequately reflect the general population of Japan, our data showed a 1.7-fold increased risk for colonic polyps in patients with diverticular disease, as compared to those without. In addition, although the prevalence of colonic polyps in patients with diverticular disease in the proximal colon and that in patients without was significantly different, the prevalence of colonic polyps in patients with diverticular disease in the distal or bilateral colon and that in patients without diverticular disease was not significantly different. This observation may be the result of the limited number of patients with diverticular disease in the distal and bilateral colon. However, this result was similar to a previous study in Korea, in which patients with proximal diverticular disease had a higher risk of any proximal neoplasia than did other patients[30]. Diverticular disease of the proximal colon is rare in Western countries, whereas in Asia including Japan, diverticular disease of the proximal colon is relatively common[16172324]. These results suggest that, regardless of the segment with diverticular disease or race, patients with diverticular disease have a higher risk of colonic neoplasia.
In conclusion, our data showed patients with diverticular disease have a higher risk of colonic polyps compared to those without (OR 1.7). This finding needs to be taken into account in surveillance for colonic neoplasia. However, further research is needed to clarify the mechanism of the association between these diseases.
COMMENTS
Background
Prevalences of colonic neoplasia and diverticular disease have increased in recent years. Both colonic neoplasia and diverticular disease have common risk factors such as age and a lack of dietary fiber. Despite common epidemiological trends and risk factors, any association between these diseases has not been clarified.
Research frontiers
There is an increasing body of epidemiological evidence regarding an association between diverticular disease and colonic polyps.
Innovations and breakthroughs
This study clarified the strong association between diverticular disease and colonic polyps. Moreover, this study suggested that regardless of the segment with diverticular disease or race, patients with diverticular disease have a higher risk of colonic neoplasia.
Applications
These results need to be taken into account in surveillance for colonic neoplasia.
Peer review
It is interesting that in the authors’ series there were similar associations between left and right sided diverticulosis and polyps.
Footnotes
Peer reviewers: Francesco Costa, Dipartimento di Medicina Interna - U.O. di Gastroenterologia, Università di Pisa-Via Roma, 67-56122-Pisa, Italy; Francis Seow-Choen, Seow-Choen Colorectal Centre, Mt Elizabeth Medical Centre, Singapore, 3 Mt Elizabeth Medical Centre #09-10, 228510, Singapore; Marc Basson, Chief of Surgery, John D. Dingell VA Medical Center, 4646 John R. Street, Detroit, MI 48301, USA
S- Editor Li DL L- Editor Kerr C E- Editor Lu W
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