• diverticulosis
• lower gastrointestinal bleeding
• endoscopy

• Humans
• Male
• Female
• Aged
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/diagnosis
• Retrospective Studies
• Recurrence
• Risk Factors
• Aged, 80 and over
• Middle Aged
• Diverticulum, Colon/complications
• Follow-Up Studies
• Diverticular Diseases/complications

• I01 CX001403 CSRD VA
• P30 DK041301 NIDDK NIH HHS
• P30DK41301 NIDDK NIH HHS
• 5I01CX001403 Veterans Administration Clinical Merit Review Research Grant

• colon
• comorbidity
• diverticular diseases
• diverticulum
• recurrence

• Arterial hypertension
• Diabetes
• Diverticulosis
• Metabolic syndrome
• Obesity

• Humans
• Diverticulum/complications
• Hypertension
• Obesity
• Risk Factors
• Liver Diseases

• Paracelsus Medical University

• colonic diverticular bleeding
• invasive treatment
• right colon
• severity

• DICA classification
• acute diverticulitis
• colonoscopy
• diverticular bleeding
• diverticular disease
• segmental colitis associated with diverticulosis

• Anti-Bacterial Agents/therapeutic use
• Colon
• Diverticulitis/drug therapy
• Humans
• Length of Stay

• distal colon
• diverticulitis
• ethnic disparity
• outcome

• Acute Disease
• Diverticulitis
• Ethnicity
• Female
• Humans
• Male
• Middle Aged
• Minority Groups
• Retrospective Studies

• Chronic constipation
• Rome criteria
• colonic diverticula
• colonoscopy
• constipation scoring system

Diverticulosis of the colon is a common condition in Western countries and most patients will remain asymptomatic, but some will present with symptoms of acute diverticulitis or bleeding. Our understanding of diverticulosis is evolving but is mostly derived from diverticulosis affecting the left-sided colon. In contrast, right-sided colonic diverticulosis (RCD) is more commonly seen in Asian countries but is much less common overall. Based on the marked differences in epidemiology, it is commonly thought that these are 2 distinct disease processes. A review of the literature describing the epidemiology and etiology of RCD was performed, with a comparison to the current understanding of left-sided diverticulosis. RCD is becoming increasingly common. The epidemiology of RCD shows it to be a mostly acquired condition, and not congenital as previously thought. Many factors in the etiology of RCD are similar to that seen in left-sided diverticulosis, with a few variations. It is therefore likely that most cases of RCD represent the same disease process that is seen in the left colon.

• Ascending colon
• Cecum
• Colon
• Diverticulitis
• Diverticulum

Computed tomography colonography (CTC) may be superior to colonoscopy and barium enema for detecting diverticula. However, few studies have used CTC to diagnose diverticula.

To evaluate the current prevalence and distribution of colonic diverticula in Japan using CTC.

This study was conducted as part of the Japanese National Computed Tomographic Colonography Trial, which included 1181 participants from 14 hospitals in Japan. We analyzed the prevalence and distribution of colonic diverticula and their relationships with age and sex. The relationship between the diverticula and the length of the large intestine was also analyzed.

Diverticulosis was present in 48.1% of the participants. The prevalence of diverticulosis was higher in the older participants (P < 0.001 for trend). The diverticula seen in younger participants were predominantly located in the right-sided colon. Older participants had a higher frequency of bilateral type (located in the right- and left-sided colon) diverticulosis (P < 0.001 for trend). The length of the large intestine with multiple diverticula in the sigmoid colon was significantly shorter in those without diverticula (P < 0.001).

The prevalence of colonic diverticulosis in Japan is higher than that previously reported. The prevalence was higher, and the distribution tended to be bilateral in older participants.

• Computed tomography colonography
• Diverticulosis
• Diverticular disease
• Colon

• Aged
• Colonography, Computed Tomographic
• Colonoscopy
• Diverticulosis, Colonic/diagnostic imaging
• Diverticulosis, Colonic/epidemiology
• Diverticulum, Colon/diagnostic imaging
• Diverticulum, Colon/epidemiology
• Humans
• Japan/epidemiology
• Prevalence
• Tomography

• Asia
• Singapore
• colon
• colonoscopy
• diverticulosis
• westernization

• Anatomy
• Biopsy
• Colon
• Muscularis propria
• Perforation

Right colonic diverticulitis (RCD) and left colonic diverticulitis (LCD) may have different clinical features due to the different embryologic origins and anatomical locations of each colon. Therefore, we aimed to compare RCD and LCD in terms of the associated clinical features. We retrospectively collected clinical data from patients who were diagnosed with acute colonic diverticulitis based on computed tomography findings between 2011 and 2017. RCD was defined as colonic diverticulitis extending from the caecum to the transverse colon, and LCD was defined as extending from the splenic flexure to the sigmoid colon. These analyses included 667 patients with RCD and 58 patients with LCD. Relative to the patients with LCD, the patients with RCD were younger (P < 0.001), were more likely to be male (P = 0.033), were taller (P < 0.001), had lower body mass index values (P < 0.001), had less advanced modified Hinchey stages (P < 0.001), and had shorter hospital stays (P < 0.001). Having LCD rather than RCD was a predictor of recurrent colonic diverticulitis (P = 0.003). Relative to LCD, RCD occurs at younger ages, is expressed at less advanced modified Hinchey stages, and is associated with lower risks of recurrence.

• colonic diverticula
• colonic diverticular bleeding
• endoscopic hemostasis
• ligation therapy
• stigmata of recent hemorrhage

• acute pancreatitis
• alcohol abuse
• alcohol consumption
• alcohol intoxication
• anxiety
• colonic diverticular disease (cdd)
• depression
• liver cirrhosis
• sleep disorder

• Adult
• Aged
• Alcoholic Intoxication/complications
• Alcoholism/complications
• Comorbidity
• Diverticulosis, Colonic/epidemiology
• Diverticulosis, Colonic/etiology
• Female
• Humans
• Male
• Middle Aged
• Risk Factors
• Sex Factors
• Taiwan/epidemiology

Dietary fiber intake is considered a protective factor for diverticular disease such as diverticulitis. However, evidence for an inverse connection between dietary fiber consumption and asymptomatic colonic diverticulosis is lacking. Specifically, few studies have investigated this subject in Asians with different presentations of diverticulosis. Therefore, we assessed the protective effects of a vegetarian diet for asymptomatic colonic diverticulosis in Buddhist monks who are obligatory vegetarians for spiritual reasons compared with the general population.

A retrospective, cross-sectional, case-control study was conducted in age- and sex-matched Buddhist monks and the general population who underwent colonoscopy for screening at a Korean health promotion center from August 2005 to June 2018. We compared the prevalence of asymptomatic diverticulosis between the 2 groups using a self-administered questionnaire.

In this study, a total of 1,316 individuals were included (Buddhist monks of 658 and general population of 658) with a mean age of 52.6±9.5 years. The prevalence of asymptomatic diverticulosis in Buddhist monks was lower compared with the general population (6.7% [44/658] vs. 10.8% [71/658], P=0.008). Buddhist monks had a higher rate of high body mass index (BMI) and metabolic syndrome. By a multivariate regression analysis model, a nonvegetarian diet (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.21–2.72, P=0.004), old age (OR, 4.53; 95% CI, 1.36–15.12; P=0.014), male sex (OR, 1.91; 95% CI, 1.28–2.85; P=0.002), and a high BMI (OR, 1.50; 95% CI, 1.01–2.23; P=0.047) were independent predictors of asymptomatic diverticulosis. Moreover, a nonvegetarian diet was associated with both right-sided and left-sided diverticulosis.

A nonvegetarian diet may increase a risk of asymptomatic colonic diverticulosis in Asians.

• Asymptomatic
• Buddhism
• Diet, vegetarian
• Diverticulosis

• Diverticulum
• Fatty liver
• Waist-hip ratio

• Antibiotics
• Conservative management
• Right-sided colonic diverticulitis

A high intake of dietary fibre has been associated with a reduced risk of diverticular disease in several studies; however, the dose–response relationship between fibre intake and diverticular disease risk has varied, and the available studies have not been summarised in a meta-analysis. We conducted a systematic review and meta-analysis of prospective cohort studies to clarify the association between dietary fibre intake, fibre subtypes, and the risk of diverticular disease.

PubMed and Embase databases were searched up to August 9th 2018. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model and nonlinear associations were modelled using fractional polynomial models.

Five prospective cohort studies with 19,282 cases and 865,829 participants were included in the analysis of dietary fibre and diverticular disease risk. The summary RR was 0.74 (95% CI 0.71–0.78, I² = 0%) per 10 g/day. There was no evidence of a nonlinear association between dietary fibre intake and diverticular disease risk, p_nonlinearity = 0.35, and there was a 23%, 41% and 58% reduction in risk for an intake of 20, 30, and 40 g/day, respectively, compared to 7.5 g/day. There was no evidence of publication bias with Egger’s test, p = 0.58 and the association persisted in subgroup and sensitivity analyses. The summary RR per 10 g/day was 0.74 (95% CI 0.67–0.81, I² = 60%, n = 4) for cereal fibre, 0.56 (95% CI 0.37–0.84, I² = 73%, n = 2) for fruit fibre, and 0.80 (95% CI 0.45–1.44, I² = 87%, n = 2) for vegetable fibre.

These results suggest that a high fibre intake may reduce the risk of diverticular disease and individuals consuming 30 g of fibre per day have a 41% reduction in risk compared to persons with a low fibre intake. Further studies are needed on fibre types and risk of diverticular disease and diverticulitis.

The online version of this article (10.1007/s00394-019-01967-w) contains supplementary material, which is available to authorized users.

• Diverticular disease
• Fibre
• Meta-analysis
• Systematic review

• Diverticular bleeding
• Diverticulitis
• Diverticulosis
• East
• West

• BRAF
• Colon
• Colorectal carcinoma
• Ethnicity
• KRAS
• Microsatellite instability

• Adult
• Aged
• Aged, 80 and over
• China/epidemiology
• Diverticulosis, Colonic/epidemiology
• Diverticulosis, Colonic/etiology
• Diverticulosis, Colonic/pathology
• Female
• Humans
• Male
• Middle Aged
• Odds Ratio
• Population Surveillance
• Prevalence
• Risk Factors
• Sex Factors
• Urban Population
• Young Adult

We conducted a systematic review and meta-analysis of prospective studies of the association between body mass index (BMI) and physical activity and diverticular disease risk.

PubMed and Embase databases were searched up to February 7, 2017. Summary relative risks and 95% confidence intervals (95% CIs) were calculated using a random effects model and nonlinear associations were modeled using fractional polynomial models.

Six cohort studies of BMI and diverticular disease risk (28,915 cases, 1,636,777 participants) and five cohort studies of physical activity and diverticular disease risk (2080 cases, 147,869 participants) were included. The summary relative risk (RR) of incident diverticular disease for a 5 unit BMI increment was 1.28 (95% CI: 1.18–1.40, I² = 77%, n = 6) for diverticular disease, 1.31 (95% CI: 1.09–1.56, I² = 74%, n = 2) for diverticulitis, and 1.20 (95% CI: 1.04–1.40, I² = 56%, n = 3) for diverticular disease complications. There was no evidence of a nonlinear association between BMI and diverticular disease risk (p_nonlinearity = 0.22), and risk increased even within the normal weight range. Compared to a BMI of 20, the summary RR for a BMI of 22.5, 25.0, 27.5, 30.0, 32.5, 35.0, 37.5, and 40.0 was 1.15 (1.07–1.23), 1.31 (1.17–1.47), 1.50 (1.31–1.71), 1.71 (1.52–1.94), 1.96 (1.77–2.18), 2.26 (2.00–2.54), 2.60 (2.11–3.21), and 3.01 (2.06–4.39), respectively. The summary RR was 0.76 (95% CI: 0.63–0.93, I² = 54%, n = 5) for high vs. low physical activity and 0.74 (95% CI: 0.57–0.97, I² = 39.5%, p_{heterogeneity} = 0.20, n = 2) for high vs. low vigorous physical activity.

These results suggest that even moderate increases in BMI may increase the risk of diverticular disease as well as diverticular disease complications and that a higher level of physical activity may reduce the risk.

The online version of this article (doi:10.1007/s00394-017-1443-x) contains supplementary material, which is available to authorized users.

• Body mass index
• Diverticular disease
• Meta-analysis
• Physical activity
• Systematic review

• Body Mass Index
• Diverticular Diseases/complications
• Diverticular Diseases/epidemiology
• Exercise
• Humans
• Incidence
• Obesity/complications
• Obesity/epidemiology
• Risk Factors
• Sensitivity and Specificity
• Waist Circumference
• Waist-Hip Ratio

• the Liaison Committee between the Central Norway Regional Health Authority (RHA) and the Norwegian University of Science and Technology (NTNU)
• the Imperial College National Institute of Health Research (NIHR) Biomedical Research Centre (BRC)

• Diverticulitis
• classification
• colonic-disorders
• emergency
• epidemiology
• pathophysiology
• prevention
• severity

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Cross-Sectional Studies
• Diverticulitis, Colonic/complications
• Diverticulitis, Colonic/diagnosis
• Diverticulitis, Colonic/epidemiology
• Female
• Humans
• Japan/epidemiology
• Logistic Models
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Risk Factors

• Adult
• Age Factors
• Aged
• Cohort Studies
• Comorbidity
• Databases, Factual
• Diverticulosis, Colonic/diagnosis
• Diverticulosis, Colonic/epidemiology
• Erectile Dysfunction/diagnosis
• Erectile Dysfunction/epidemiology
• Humans
• Incidence
• Male
• Middle Aged
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Taiwan/epidemiology

Diverticula of the colon are pseudodiverticula defined by multiple outpouchings of the mucosal and submucosal layers penetrating through weak spots of the muscle coat along intramural blood vessels. A complete prolapse consists of a diverticular opening, a narrowed neck, and a thinned diverticular dome underneath the serosal covering. The susceptibility of diverticula to inflammation is explained by local ischemia, translocation of pathogens due to retained stool, stercoral trauma by fecaliths, and microperforations. Local inflammation may lead to phlegmonous diverticulitis, paracolic/mesocolic abscess, bowel perforation, peritonitis, fistula formation, and stenotic strictures. Diverticular bleeding is due to an asymmetric rupture of distended vasa recta at the diverticular dome and not primarily linked to inflammation. Structural and functional changes of the bowel wall in diverticular disease comprise: i) Altered amount, composition, and metabolism of connective tissue; ii) Enteric myopathy with muscular thickening, deranged architecture, and altered myofilament composition; iii) Enteric neuropathy with hypoganglionosis, neurotransmitter imbalance, deficiency of neurotrophic factors and nerve fiber remodeling; and iv) Disturbed intestinal motility both in vivo (increased intraluminal pressure, motility index, high-amplitude propagated contractions) and in vitro (altered spontaneous and pharmacologically triggered contractility). Besides established etiologic factors, recent studies suggest that novel pathophysiologic concepts should be considered in the pathogenesis of diverticular disease.

• Connective tissue
• Diverticular disease
• Enteric musculature
• Enteric nervous system
• Intestinal motility

• colorectal diverticulosis
• asymptomatic
• colonoscopy
• health check-up

• Adenomatous Polyps/epidemiology
• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Alcoholism/epidemiology
• Asymptomatic Diseases/epidemiology
• Colonoscopy
• Colorectal Neoplasms/epidemiology
• Diverticulosis, Colonic/diagnosis
• Diverticulosis, Colonic/epidemiology
• Diverticulum/diagnosis
• Diverticulum/epidemiology
• Female
• Humans
• Male
• Middle Aged
• Prevalence
• Rectal Diseases/diagnosis
• Rectal Diseases/epidemiology
• Risk Factors
• Taiwan/epidemiology
• Young Adult

• diverticulosis
• prevalence
• vietnamese
• complications

• Age Factors
• Aged
• Asian
• Boston/epidemiology
• Colonoscopy
• Diverticulosis, Colonic/ethnology
• Diverticulosis, Colonic/pathology
• Female
• Humans
• Male
• Middle Aged
• Prevalence
• Retrospective Studies
• Risk Factors
• Sex Factors
• Vietnam/ethnology
• White People

• Adolescent
• Adult
• Aged
• Anti-Bacterial Agents/therapeutic use
• Diverticulitis, Colonic/diagnostic imaging
• Diverticulitis, Colonic/drug therapy
• Diverticulitis, Colonic/surgery
• Female
• Humans
• Male
• Middle Aged
• Radiography
• Recurrence
• Retrospective Studies
• Risk Factors
• Treatment Outcome
• Ultrasonography
• Young Adult

AIM: To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.

METHODS: The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed. The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology. Right-sided diverticula were classified as those arising from the cecum, ascending colon, and transverse colon, and those from the descending colon, sigmoid colon, and rectum were classified as left-sided diverticulosis. To assess the changing trend of occurrence of diverticulosis, data were compared with two previous studies of 51 patients.

RESULTS: The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001, (27.5% vs 48.1%, P < 0.05). Moreover, no differences in gender, body mass index, multiplicity of the diverticula, fever, or leukocytosis were noted between patients with right-sided and left-sided disease. However, patients with right-sided disease were significantly younger (50.9 year vs 64.0 year, P < 0.01). Furthermore, left-sided disease was significantly associated with a higher incidence of complicated diverticulitis (89.2% vs 57.5%, P < 0.01), combined resection due to extensive inflammation (21.6% vs 5.0%, P < 0.05), operative complications (51.4% vs 27.5%, P < 0.05), and in-hospital mortality (10.8% vs 0%, P < 0.05), along with longer post-operative hospitalization duration (21.3 ± 10.2 d vs 10.6 ± 8.1 d, P < 0.05).

CONCLUSION: Compared with right-sided diverticular disease, the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.

• Colonic diverticulosis
• Diverticular bleeding
• Diverticulitis
• Poor surgical outcome
• Left-sided diverticulitis

• Adult
• Aged
• Aged, 80 and over
• Colectomy/adverse effects
• Colectomy/mortality
• Colon/pathology
• Colon/surgery
• Diverticulitis, Colonic/diagnosis
• Diverticulitis, Colonic/mortality
• Diverticulitis, Colonic/surgery
• Diverticulosis, Colonic/diagnosis
• Diverticulosis, Colonic/mortality
• Diverticulosis, Colonic/surgery
• Diverticulum, Colon/diagnosis
• Diverticulum, Colon/mortality
• Diverticulum, Colon/surgery
• Female
• Hospital Mortality
• Humans
• Incidence
• Length of Stay
• Male
• Middle Aged
• Postoperative Complications/mortality
• Postoperative Complications/therapy
• Republic of Korea/epidemiology
• Retrospective Studies
• Risk Factors
• Tertiary Care Centers
• Time Factors
• Treatment Outcome
• Young Adult

Colonic diverticula are located predominantly on the right side in Asia and on the left side in Europe and the United States. Factors associated with uncomplicated colonic diverticulosis and its distribution pattern have been unknown. Our aims are to investigate the prevalence and risk factors for uncomplicated colonic diverticulosis. We conducted a prospective cross-sectional study in adults who underwent colonoscopy. Alcohol, alcohol related flushing, smoking, medications, and comorbidities were assessed by interview on the colonoscopy day. Alcohol consumption was categorized as nondrinker, light (1–180 g/week), moderate (181–360 g/week), and heavy (≥361 g/week). Smoking index was defined as the number of cigarettes per day multiplied by the number of smoking years and categorized as nonsmoker, <400, 400–799, and ≥800. A total of 2,164 consecutive patients were enrolled. Overall, 542 patients (25.1%) had uncomplicated colonic diverticulosis located on the right side (50%), bilaterally (29%), and on the left side (21%). Univariate analysis revealed age, male, smoking index, alcohol consumption, aspirin use, anticoagulants use, corticosteroid use, hypertension, and atherosclerotic disease as factors significantly associated with diverticulosis. Alcohol related flushing was not associated with the disease. Multivariate analysis showed increasing age (P<0.01), increasing alcohol consumption (P<0.01) and smoking (P<0.01), and atherosclerotic disease (P<0.01) as significantly associated factors. Alcohol and smoking were associated with right-sided and bilateral diverticula. In conclusion, one in four Japanese adults have colonic diverticulosis (50% right-sided). Age, alcohol consumption, and smoking were found to be significant risk factors for uncomplicated colonic diverticulosis, particularly right-sided and bilateral.

• Adult
• Aged
• Alcohol Drinking/adverse effects
• Colonoscopy
• Comorbidity
• Cross-Sectional Studies
• Diverticulum, Colon/diagnosis
• Diverticulum, Colon/epidemiology
• Female
• Humans
• Japan/epidemiology
• Male
• Middle Aged
• Prevalence
• Prospective Studies
• Risk Factors
• Smoking/adverse effects

Left-sided diverticulitis is increasing in Japan, and many studies report that left-sided diverticulitis is more likely to be severe. Therefore, it is important to identify the features and risk factors for left-sided diverticulitis. We hypothesized that left-sided diverticulitis in Japan is related to obesity and conducted a study of the features and risk factors for this disorder in Japan.

Right-sided diverticulitis and left-sided diverticulitis patients (total of 215) were compared with respect to background, particularly obesity-related factors to identify risk factors for diverticulitis.

There were 166 (77.2%) right-sided diverticulitis patients and 49 (22.8%) left-sided diverticulitis patients. The proportions of obese patients (body mass index ≥25 kg/m², p=0.0349), viscerally obese patients (visceral fat area ≥100 cm², p=0.0019), patients of mean age (p=0.0003), and elderly patients (age ≥65 years, p=0.0177) were significantly higher in the left-sided-diverticulitis group than in the right-sided-diverticulitis group. The proportion of viscerally obese patients was significantly higher in the left-sided-diverticulitis group than in the left-sided-diverticulosis group (p=0.0390).

This study showed that obesity, particularly visceral obesity, was a risk factor for left-sided diverticulitis in Japan.

• Diverticulitis
• Epidemiology
• Obesity
• Risk

• Anti-Bacterial Agents/therapeutic use
• Diverticulitis/drug therapy
• Humans
• Intestine, Large
• Randomized Controlled Trials as Topic

• cardiovascular risk factor
• colonic diverticulum
• diabetes

• Administration, Oral
• Aged
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Biopsy, Needle
• Confidence Intervals
• Diverticulitis, Colonic/drug therapy
• Diverticulitis, Colonic/mortality
• Diverticulitis, Colonic/prevention & control
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Long-Term Care
• Male
• Mesalamine/adverse effects
• Mesalamine/therapeutic use
• Middle Aged
• Prospective Studies
• Risk Assessment
• Secondary Prevention
• Severity of Illness Index
• Statistics, Nonparametric
• Survival Rate
• Treatment Outcome