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Völkerer A, Wernly S, Semmler G, Flamm M, Ausserwinkler M, Datz L, Götz N, Hofer H, Aigner E, Datz C, Wernly B. Association between Diverticulosis and Colorectal Neoplasia: Analysis from a Large Austrian Database. J Clin Med 2024; 13:6078. [PMID: 39458031 PMCID: PMC11508311 DOI: 10.3390/jcm13206078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 10/07/2024] [Accepted: 10/10/2024] [Indexed: 10/28/2024] Open
Abstract
Background: Colorectal neoplasia and diverticulosis are common findings on colonoscopies. While adenomas are precursors to colorectal cancer, diverticulosis is usually asymptomatic but can lead to diverticulitis. Despite their prevalence and coexistence, the relationship between these conditions remains unclear. This study investigates whether diverticulosis is associated with adenomas, considering shared risk factors and potential inflammation-driven mechanisms. Methods: We examined 6154 asymptomatic individuals undergoing colorectal cancer screening in Austria. Diverticulosis and colorectal neoplasia were documented during screenings based on macroscopic definitions. Advanced neoplasia was defined as polyps >1 cm or high-grade dysplasia. Associations between diverticulosis and neoplastic findings were assessed using univariate and multivariable logistic regression models. Results: Although the overall incidence of any polypoid lesion was higher in the diverticulosis group (37% vs. 30%), statistical analysis revealed a comparable rate of advanced neoplasms in both groups. Importantly, no significant link between diverticulosis and advanced neoplasms was found (OR 1.125; 95% CI: 0.933 to 1.357, p = 0.218) even after adjusting for confounding factors. In a univariate analysis, a statistically significant association between diverticulosis and the presence of any colorectal polyps was identified (OR 1.388; 95% CI: 1.244-1.549, p < 0.0001). However, after adjusting for confounding factors in model 2 (OR 1.065, 95% CI: 0.942 to 1.204, p = 0.314) and model 3 (OR 1.071, 95% CI: 0.925 to 1.239, p = 0.360), this effect was also not statistically significant. Conclusions: Patients with diverticulosis share demographic and clinical features with those at risk of colorectal neoplasia, such as older age, male gender, and higher cardiometabolic risk. However, diverticulosis does not independently increase the risk of advanced colorectal neoplasia or unspecified polypoid lesions.
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Affiliation(s)
- Andreas Völkerer
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria; (A.V.); (S.W.); (L.D.); (H.H.); (B.W.)
| | - Sarah Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria; (A.V.); (S.W.); (L.D.); (H.H.); (B.W.)
| | - Georg Semmler
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria;
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Mathias Ausserwinkler
- Department of Internal Medicine, Elisabethinen Hospital Klagenfurt, 9020 Klagenfurt, Austria;
- Clinic I for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Leonora Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria; (A.V.); (S.W.); (L.D.); (H.H.); (B.W.)
| | - Nikolaus Götz
- Department of Internal Medicine, General Hospital Sankt Vinzenz, 6511 Zams, Austria;
| | - Hannah Hofer
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria; (A.V.); (S.W.); (L.D.); (H.H.); (B.W.)
| | - Elmar Aigner
- Clinic I for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria; (A.V.); (S.W.); (L.D.); (H.H.); (B.W.)
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria; (A.V.); (S.W.); (L.D.); (H.H.); (B.W.)
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, 5020 Salzburg, Austria;
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McKechnie T, Kazi T, Shi V, Grewal S, Aldarraji A, Brennan K, Patel S, Amin N, Doumouras A, Parpia S, Eskicioglu C, Bhandari M. Preoperative very low-energy diets for obese patients undergoing intra-abdominal colorectal surgery: a retrospective cohort study (RetroPREPARE). Tech Coloproctol 2024; 28:134. [PMID: 39352422 DOI: 10.1007/s10151-024-03015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/30/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND Very low-energy diets (VLEDs) prescribed prior to bariatric surgery have been associated with decreased operative time, technical difficulty, and postoperative morbidity. To date, limited data are available regarding the impact of VLEDs prior to colorectal surgery. We designed this study to determine whether preoperative VLEDs benefit patients with obesity undergoing colorectal surgery. METHODS This is a single-center retrospective cohort study. Individuals undergoing elective colorectal surgery with a body mass index (BMI) of greater than 30 kg/m2 from 2015 to 2022 were included. The exposure of interest was VLEDs for 2-4 weeks immediately prior to surgery. The control group consisted of patients prior to January 2018 who did not receive preoperative VLED. The primary outcome was 30 day postoperative morbidity. Multivariable logistic regression modeling was used to determine associations with 30 day postoperative morbidity. RESULTS Overall, 190 patients were included, 89 patients received VLEDs (median age: 66 years; median BMI: 35.9 kg/m2; 48.3% female) and 101 patients did not receive VLEDs (median age: 68 years; median BMI: 32.1 kg/m2; 44.6% female). One-hundred four (54.7%) patients experienced 30 day postoperative morbidity. Multivariable regression analysis identified three variables associated with postoperative morbidity: VLEDs [odds ratio (OR) 0.22, 95% confidence intervals (CI) 0.08-0.61, P < 0.01], Charlson comorbidity index (OR 1.25, 95% CI 1.03-1.52, P = 0.02), and rectal dissections (OR 2.71, 95% CI 1.30-5.65, P < 0.01). CONCLUSIONS The use of a preoperative VLED was associated with a significant reduction in postoperative morbidity in patients with obesity prior to colorectal surgery. A high-quality randomized controlled trial is required to confirm these findings.
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Affiliation(s)
- T McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| | - T Kazi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - V Shi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - S Grewal
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - A Aldarraji
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - K Brennan
- Division of General Surgery, Department of Surgery, Queen's University, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - S Patel
- Division of General Surgery, Department of Surgery, Queen's University, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - N Amin
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, ON, Canada
| | - A Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, ON, Canada
| | - S Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - C Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, ON, Canada
| | - M Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Shelygin YA, Ivashkin VT, Achkasov SI, Moskalev AI, Тimerbulatov VM, Sazhin AV, Shapovalyants SG, Karpukhin OY, Kostenko NV, Кorotkikh NN, Zarodnyuk IV, Trubacheva JL, Veselov VV, Likutov AA, Kashnikov VN, Frolov SA, Yartsev PA, Loranskaya ID, Vykova BA, Shifrin OS, Poluektova EA, Mamieva ZA, Ulyanin AI, Shkurko TV. CLINICAL GUIDELINES Diverticular disease (57.2, 57.3), adults. KOLOPROKTOLOGIA 2024; 23:10-27. [DOI: 10.33878/2073-7556-2024-23-2-10-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Affiliation(s)
- Yu. A. Shelygin
- Ryzhikh National Medical Research Center of Coloproctology;
Russian Medical Academy of Continuous Professional Education
| | - V. T. Ivashkin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - S. I. Achkasov
- Ryzhikh National Medical Research Center of Coloproctology;
Russian Medical Academy of Continuous Professional Education
| | - A. I. Moskalev
- Ryzhikh National Medical Research Center of Coloproctology
| | | | - A. V. Sazhin
- Pirogov Russian National Research Medical University
| | | | | | | | - N. N. Кorotkikh
- Voronezh State Medical University named after N.N. Burdenko of the Ministry of Health of the Russian Federation
| | | | | | - V. V. Veselov
- Ryzhikh National Medical Research Center of Coloproctology;
Russian Medical Academy of Continuous Professional Education
| | - A. A. Likutov
- Ryzhikh National Medical Research Center of Coloproctology;
Russian Medical Academy of Continuous Professional Education
| | | | - S. A. Frolov
- Ryzhikh National Medical Research Center of Coloproctology;
Pirogov Russian National Research Medical University
| | - P. A. Yartsev
- Sklifosovsky Research Institute for Emergency Medicine of the Moscow Department of Health
| | | | - B. A. Vykova
- Ryzhikh National Medical Research Center of Coloproctology
| | - O. S. Shifrin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. A. Poluektova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Z. A. Mamieva
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. I. Ulyanin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - T. V. Shkurko
- Ryzhikh National Medical Research Center of Coloproctology
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Marasco G, Buttitta F, Cremon C, Barbaro MR, Stanghellini V, Barbara G. The role of microbiota and its modulation in colonic diverticular disease. Neurogastroenterol Motil 2023; 35:e14615. [PMID: 37243442 DOI: 10.1111/nmo.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/06/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Diverticular disease (DD) is a common condition in Western countries. The role of microbiota in the pathogenesis of DD and its related symptoms has been frequently postulated since most complications of this disease are bacteria-driven and most therapies rely on microbiota modulation. Preliminary data showed fecal microbial imbalance in patients with DD, particularly when symptomatic, with an increase of pro-inflammatory and potentially pathogenetic bacteria. In addition, bacterial metabolic markers can mirror specific pathways of the disease and may be even used for monitoring treatment effects. All treatments currently suggested for DD can affect microbiota structure and metabolome compositions. PURPOSE Sparse evidence is available linking gut microbiota perturbations, diverticular disease pathophysiology, and symptom development. We aimed to summarize the available knowledge on gut microbiota evaluation in diverticular disease, with a focus on symptomatic uncomplicated DD, and the relative treatment strategies.
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Affiliation(s)
- Giovanni Marasco
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Francesco Buttitta
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Cesare Cremon
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Vincenzo Stanghellini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Giovanni Barbara
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
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5
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Völkerer A, Wernly S, Semmler G, Flamm M, Aigner E, Datz C, Wernly B. Diverticulosis and cardiometabolic risk factors: a systematic literature review. Int J Colorectal Dis 2023; 38:236. [PMID: 37725283 PMCID: PMC10509050 DOI: 10.1007/s00384-023-04532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND There is a hypothesis of an association between diverticulosis and metabolic syndrome (MS) or its components, but data on this topic are inconsistent, and a systematic review has not been performed. We conducted a systematic review to investigate the possible association between cardiometabolic risk factors and diverticulosis. METHODS A systematic literature search was conducted via PubMed, Cochrane Library, and Web of Science in December 2022 to collect the necessary data. Studies that examined the association between MS or individual metabolic factors and asymptomatic diverticulosis were included in the review. RESULTS Of the potentially relevant articles identified via PubMed (477), Cochrane Library (224), and Web of Science (296), 29 articles met the inclusion criteria and were used for this work. These studies were assessed for study quality using GRADE. Overall, 6 studies were rated as "very low," 19 studies as "low," and 4 studies as "moderate." The data suggest an association between arterial hypertension, obesity, and fatty liver disease in younger patients and diverticulosis. Patient age appears to play an important role in diverticular formation. Data on diabetes mellitus is inconclusive and may require further investigation depending on the location of the diverticula. CONCLUSION Based on the synthesized data, there is an association between arterial hypertension, obesity, and fatty liver disease in younger patients. The formation of diverticula seems to be influenced by age and genetic factors. The study suggests a connection with cardiometabolic risk factors. To gain a better understanding of the role of metabolic risk factors in asymptomatic diverticulosis, targeted studies are necessary based on these findings.
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Affiliation(s)
- Andreas Völkerer
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Sarah Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Georg Semmler
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Elmar Aigner
- Clinic I for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria.
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
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6
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Bowel Movements and Risk of Diverticulitis. Clin Gastroenterol Hepatol 2022; 20:e643. [PMID: 33716142 DOI: 10.1016/j.cgh.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
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7
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Reply. Clin Gastroenterol Hepatol 2022; 20:e643-e644. [PMID: 33839278 DOI: 10.1016/j.cgh.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023]
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8
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Higashimori A, Nakatani M, Jinnai K, Kin D, Maeda N, Nakamura Y, Hashimoto A, Morimoto K, Sasaki E, Fukuda T, Watanabe T, Fujiwara Y. Chronic constipation is negatively associated with colonic diverticula. Scand J Gastroenterol 2021; 56:1264-1270. [PMID: 34411502 DOI: 10.1080/00365521.2021.1961307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Constipation has been considered the key risk factor for diverticulosis occurrence, but the underlying mechanism is unclear. We investigated the factors associated with diverticulosis, focusing on the association of constipation severity with the localization and number of diverticula. MATERIALS AND METHODS We analyzed consecutive patients who underwent colonoscopy between March and December 2019. Chronic constipation was diagnosed as constipation meeting Rome IV criteria or as that requiring laxative therapy for more than 6 months. The degree of constipation was scored using the Constipation Scoring System (CSS). RESULTS We assessed 1014 patients. Multivariate analysis revealed that age, alcohol consumption, and hypertension were positively associated with diverticulosis, whereas chronic constipation was negatively associated with diverticulosis (odds ratio [OR] = 0.74; 95% confidence interval [CI], 0.55-0.99). When assessed according to the location of diverticula, right-sided diverticula were significantly associated with a lower incidence of constipation (OR = 0.94; 95% CI, 0.89-0.98), whereas neither left-sided nor bilateral diverticula was associated with constipation. This negative association of diverticula with constipation was stronger in patients with a high CSS score. In stratified analysis, the number of diverticula decreased with increasing degree of constipation (p for trend <.01), and a high CSS score was associated with a decreased prevalence of ≥3 diverticula (OR = 0.64; 95% CI, 0.44-0.99). CONCLUSIONS Chronic constipation was negatively associated with colonic diverticulosis. The association increased with the degree of constipation and was strong only in cases with right-sided diverticula and those with ≥3 diverticula.
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Affiliation(s)
- Akira Higashimori
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan.,Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masami Nakatani
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Kagami Jinnai
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Daiyu Kin
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Natsumi Maeda
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan.,Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | - Kenichi Morimoto
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Eiji Sasaki
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Takashi Fukuda
- Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan
| | - Toshio Watanabe
- Department of Premier Preventive Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Nutritional Imbalances in Adult Celiac Patients Following a Gluten-Free Diet. Nutrients 2021; 13:nu13082877. [PMID: 34445038 PMCID: PMC8398893 DOI: 10.3390/nu13082877] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
Celiac disease (CD) is a chronic autoimmune disorder of the small intestine, whose only effective treatment is a gluten-free diet (GFD). It is characterized by the atrophy of the intestinal villi that leads to altered nutrient absorption. This study describes the nutritional imbalances which may be found in adults with CD following a GFD. During the first year of treatment, deficiencies will overcome as the intestinal mucosa recovers. Thus, biochemical data will show this progression, together with the decrease in symptoms. In contrast, in the long term, when a strict GFD is followed and mucosal recovery is achieved, analyzing nutrient intake makes more sense. Macronutrient consumption is characterized by its low complex carbohydrate and fiber intakes, and high fat (especially SFA) and sugar intakes. This profile has been related to the consumption of GFP and their nutritional composition, in addition to unbalanced dietary habits. The most notable deficiencies in micronutrients are usually those of iron, calcium and magnesium and vitamin D, E and some of group B. It is necessary to follow up patients with CD and to promote nutritional education among them, since it could help not only to achieve a gluten free but also a balanced diet.
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10
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Functional and anatomical deficits in visceral nociception with age: a mechanism of silent appendicitis in the elderly? Pain 2021; 161:773-786. [PMID: 31790010 DOI: 10.1097/j.pain.0000000000001764] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The ability to sense visceral pain during appendicitis is diminished with age leading to delay in seeking health care and poorer clinical outcomes. To understand the mechanistic basis of this phenomenon, we examined visceral nociception in aged mouse and human tissue. Inflamed and noninflamed appendixes were collected from consenting patients undergoing surgery for the treatment of appendicitis or bowel cancer. Supernatants were generated by incubating samples in buffer and used to stimulate multiunit activity in intestinal preparations, or single-unit activity from teased fibres in colonic preparations, of young and old mice. Changes in afferent innervation with age were determined by measuring the density of calcitonin gene-related peptide-positive afferent fibres and by counting dorsal root ganglia back-labelled by injection of tracer dye into the wall of the colon. Finally, the effect of age on nociceptor function was studied in mouse and human colon. Afferent responses to appendicitis supernatants were greatly impaired in old mice. Further investigation revealed this was due to a marked reduction in the afferent innervation of the bowel and a substantial impairment in the ability of the remaining afferent fibres to transduce noxious stimuli. Translational studies in human tissue demonstrated a significant reduction in the multiunit but not the single-unit colonic mesenteric nerve response to capsaicin with age, indicative of a loss of nociceptor innervation. Our data demonstrate that anatomical and functional deficits in nociception occur with age, underpinning the atypical or silent presentation of appendicitis in the elderly.
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11
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Lim JH, Kim YS, Lee JE, Youn J, Chung GE, Song JH, Yang SY, Kim JS. Dietary pattern and its association with right-colonic diverticulosis. J Gastroenterol Hepatol 2021; 36:144-150. [PMID: 32525584 DOI: 10.1111/jgh.15145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM In East Asia, colonic diverticulosis develops most commonly in the right colon and is known to have different characteristics compared with left-sided one. This study was designed to investigate whether right-colonic diverticulosis is associated with posteriori dietary patterns. METHODS We retrospectively reviewed medical records of prospectively collected cohort that received health check-up in Korea between May 2011 and January 2012. Their anthropometric data, biochemical results, medication history, underlying diseases, colonoscopic findings, and dietary data obtained from semi-quantitative food-frequency questionnaire were analyzed. Three dietary patterns were identified using factor analysis: healthy dietary pattern (vegetables, fish, seaweed, fruits, and beans), meat dietary pattern (red meat, processed meat/fish, fried noodle, poultry, and cephalopods), and snack dietary pattern (bread, sweets, dairy products, nuts, and rice cake). RESULTS Out of the total 1911 patients, 203 (10.6%) had right-colonic diverticulosis, 21 (1.1%) had pan-colonic diverticulosis, and 12 (0.6%) had left-colonic diverticulosis. Among the total, none of the three patterns were associated with right-colonic diverticulosis, under adjustment with age, gender, body mass index, metabolic syndrome, and total energy intake. However, among women, meat dietary pattern was positively associated with right-colonic diverticulosis (odds ratio 1.866, 95% confidence interval: 1.0983-3.173, P = 0.021). CONCLUSION This study demonstrated that meat dietary pattern is positively associated with right-colonic diverticulosis among women.
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Affiliation(s)
- Joo Hyun Lim
- Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Young Sun Kim
- Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, Seoul National University, Seoul, Korea
| | - Jiyoung Youn
- Department of Food and Nutrition, Seoul National University, Seoul, Korea
| | - Goh Eun Chung
- Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Ji Hyun Song
- Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Yang
- Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Joo Sung Kim
- Healthcare System Gangnam Center, Healthcare Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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12
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Coakley KM, Davis BR, Kasten KR. Complicated Diverticular Disease. Clin Colon Rectal Surg 2020; 34:96-103. [PMID: 33642949 DOI: 10.1055/s-0040-1716701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The modern management of colonic diverticular disease involves grouping patients into uncomplicated or complicated diverticulitis, after which the correct treatment paradigm is instituted. Recent controversies suggest overlap in management strategies between these two groups. While most reports still support surgical intervention for the treatment of complicated diverticular disease, more data are forthcoming suggesting complicated diverticulitis does not merit surgical resection in all scenarios. Given the significant risk for complication in surgery for diverticulitis, careful attention should be paid to patient and procedure selection. Here, we define complicated diverticulitis, discuss options for surgical intervention, and explain strategies for avoiding operative pitfalls that result in early and late postoperative complications.
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Affiliation(s)
- Kathleen M Coakley
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Bradley R Davis
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Kevin R Kasten
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
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Patel K, Krishna SG, Porter K, Stanich PP, Mumtaz K, Conwell DL, Clinton SK, Hussan H. Diverticulitis in Morbidly Obese Adults: A Rise in Hospitalizations with Worse Outcomes According to National US Data. Dig Dis Sci 2020; 65:2644-2653. [PMID: 31900720 DOI: 10.1007/s10620-019-06002-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 12/05/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Obesity is a known risk factor for diverticulitis. Our objective was to examine the less investigated impact of morbid obesity (MO) on admissions and clinical course of diverticulitis in a US representative database. METHODS We retrospectively queried the 2010-2014 Nationwide Readmission Database to compare diverticulitis hospitalizations in 48,651 MO and 841,381 non-obese patients. Outcomes of mortality, clinical course, surgical events, and readmissions were compared using multivariable and propensity-score-matched analyses. RESULTS The number of MO patients admitted with diverticulitis increased annually from 7570 in 2010 to 11,935 in 2014, while the total number of patients admitted with diverticulitis decreased (p = 0.003). Multivariable analysis demonstrates that MO was associated with increased mortality (adjusted odds ratio [aOR] 1.54; 95% confidence internal [CI]: 1.16, 2.05), intensive care admissions (aOR = 1.92; 95% CI: 1.61, 2.31), emergent surgery (aOR = 1.20; 95% CI: 1.11, 1.30), colectomy (aOR = 1.13; 95% CI: 1.08, 1.18), open laparotomy (aOR = 1.28; 95% CI: 1.21, 1.34), and colostomy (aOR = 1.34; 95% CI: 1.25, 1.43). Additionally, MO was associated with higher risk for multiple readmissions for diverticulitis within 30 days (aOR = 1.45; 95% CI: 1.08, 1.96) and 6 months (aOR = 1.21; 95% CI: 1.03, 1.42). A one-to-one matched propensity-score analysis confirmed our multivariable analysis findings. CONCLUSIONS Analysis of national data demonstrates an increasing trend of MO patients' admissions for diverticulitis, with a presentation at a younger age. Furthermore, MO is associated with an increased risk of adverse outcomes and readmissions of diverticulitis. Future strategies are needed to ameliorate these outcomes.
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Affiliation(s)
- Kishan Patel
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Peter P Stanich
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Steven K Clinton
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Hisham Hussan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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14
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Bae HJ, Kim ST, Hong SG, Lee H, Choi HS, Cho YK, Kim TH, Chung SH. Risk Factors for Asymptomatic Colon Diverticulosis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 74:142-148. [PMID: 31554029 DOI: 10.4166/kjg.2019.74.3.142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/24/2019] [Accepted: 06/30/2019] [Indexed: 12/23/2022]
Abstract
Backgrounds/Aims The etiology of colon diverticulosis is related to a range of genetic, biological, and environmental factors, but the risk factors for asymptomatic diverticulosis of the colon are unclear. This study examined the risk factors for asymptomatic colon diverticulosis. Methods This retrospective study included examinees who underwent a colonoscopy for screening at the health check-up center of SAM Hospital between January 2016 and December 2016. The examinees with colon diverticulosis found by colonoscopy were compared with those without diverticulosis. The comparison factors were age, gender, alcohol consumption, smoking status, medical history, lipid profile, body mass index, visceral fat area, waist-hip ratio, and severity of a fatty liver. Results This study included 937 examinees and the overall prevalence of diverticulosis was 8.1% (76/937). Fatty liver was found in 69.7% (53/76) in cases of colon diverticulosis and 50.3% (433/861) in the control group (p=0.001). The average waist-hip ratio was 0.92±0.051 in colon diverticulosis and 0.90±0.052 in the control group (p=0.052). Multivariate analysis revealed the waist-hip ratio (OR=1.035, 95% CI 1.000-1.070, p=0.043), moderate fatty liver (OR=2.238, 95% CI 1.026-4.882, p=0.043), and severe fatty liver (OR=5.519, 95% CI 1.236-21.803, p=0.025) to be associated with an increased risk of asymptomatic colon diverticulosis. Conclusions The waist-hip ratio, moderate fatty liver, and severe fatty liver are risk factors for asymptomatic colon diverticulosis. Central obesity, which can be estimated by the waist-hip ratio, and fatty liver might affect the pathogenesis of asymptomatic colon diverticulosis.
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Affiliation(s)
- Hyun Jin Bae
- Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea.,Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Taek Kim
- Department of Radiology, Anyang SAM Hospital, Anyang, Korea
| | - Seung Goun Hong
- Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
| | - Hyunjeong Lee
- Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
| | - Hyo Sun Choi
- Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
| | - Yoo-Kyung Cho
- Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
| | - Sook Hee Chung
- Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
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15
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Barbaro MR, Cremon C, Fuschi D, Scaioli E, Veneziano A, Marasco G, Festi D, Stanghellini V, Barbara G. Nerve fiber overgrowth in patients with symptomatic diverticular disease. Neurogastroenterol Motil 2019; 31:e13575. [PMID: 30838745 DOI: 10.1111/nmo.13575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/10/2019] [Accepted: 02/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colonic diverticulosis is a common condition in industrialized countries. Up to 25% of patients with diverticula develop symptoms, a condition termed symptomatic uncomplicated diverticular disease (SUDD). The aim of the present study was to characterize neuroimmune interactions and nerve fiber plasticity in the colonic mucosa of patients with diverticula. METHODS Controls, patients with diverticulosis and with SUDD were enrolled in the study. Mucosal biopsies were obtained close to diverticula (diverticular region) and in a normal mucosa (distant site), corresponding to sigmoid and descending colon in the controls. Quantitative immunohistochemistry was used to assess mast cells, T cells, macrophages, nerve fibers, and neuronal outgrowth (growth-associated protein 43, GAP43+fibers). KEY RESULTS No difference emerged in mast cells and T cells among the three groups. Macrophages were increased in patients with SUDD and diverticulosis as compared to controls. Nerve fibers were enhanced in patients with SUDD and diverticulosis in comparison with controls in the diverticular region. GAP43+ fibers were increased only in patients with SUDD as compared to controls and to patients with diverticulosis in the diverticular region. In patients with SUDD, GAP43 density was increased in the diverticular region compared to distant site. Macrophages close to GAP43+ fibers were increased in the diverticular region of patients with SUDD. Significant correlations were found between GAP43+ fibers and immune cells. CONCLUSIONS AND INFERENCES Patients with diverticula are characterized by increased macrophage counts, while nerve fiber sprouting is increased only in the diverticular region of patients with SUDD suggesting a role in symptom generation.
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Affiliation(s)
- Maria Raffaella Barbaro
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Daniele Fuschi
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Alberto Veneziano
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vincenzo Stanghellini
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences and Center for Applied Biomedical Research (CRBA), Alma Mater Studiorum - University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
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Murray KA, Hoad CL, Garratt J, Kaviani M, Marciani L, Smith JK, Siegmund B, Gowland PA, Humes DJ, Spiller RC. A pilot study of visceral fat and its association with adipokines, stool calprotectin and symptoms in patients with diverticulosis. PLoS One 2019; 14:e0216528. [PMID: 31067253 PMCID: PMC6505945 DOI: 10.1371/journal.pone.0216528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/18/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Complications of diverticular disease are increasingly common, possibly linked to increasing obesity. Visceral fat could contribute to the development of symptomatic diverticular disease through its pro-inflammatory effects. OBJECTIVE The study had 2 aims. A) to develop a semi-automated algorithm to measure abdominal adipose tissue from 2-echo magnetic resonance imaging (MRI) data; B) to use this to determine if visceral fat was associated with bowel symptoms and inflammatory markers in patients with symptomatic and asymptomatic diverticular disease. DESIGN An observational study measuring visceral fat using MRI together with serum adiponectin, leptin, stool calprotectin and patient-reported somatisation and bowel habit. SETTING Medical and imaging research centres of a university hospital. PARTICIPANTS MRI scans were performed on 55 patients after an overnight fast measuring abdominal subcutaneous and visceral adipose tissue volumes together with small bowel water content (SBWC). Blood and stool samples were collected and patients kept a 2 week stool diary and completed a somatisation questionnaire. MAIN OUTCOME MEASURES Difference in the volume of visceral fat between symptomatic and asymptomatic patients. RESULTS There were no significant differences in visceral (p = 0.98) or subcutaneous adipose (p = 0.60) tissue between symptomatic and asymptomatic patients. However measured fat volumes were associated with serum adipokines. Adiponectin showed an inverse correlation with visceral adipose tissue (VAT) (Spearman ρ = -0.5, p = 0.0003), which correlated negatively with SBWC (ρ = -0.3, p = 0.05). Leptin correlated positively with subcutaneous adipose tissue (ρ = 0.8, p < 0.0001). Overweight patients (BMI > 25 kgm-2) showed a moderate correlation between calprotectin and VAT (ρ = 0.3, p = 0.05). Somatization scores were significantly higher in symptomatic patients (p < 0.0003). CONCLUSIONS Increasing visceral fat is associated with lower serum adiponectin and increased faecal calprotectin suggesting a pro-inflammatory effect which may predispose to the development of complications of diverticulosis.
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Affiliation(s)
- Kathryn A. Murray
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
- Trinity Medical Sciences University, Ratho Mill, Kingstown, St. Vincent, West Indies
| | - Caroline L. Hoad
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Jill Garratt
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Mehri Kaviani
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Luca Marciani
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Jan K. Smith
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Britta Siegmund
- Gastroenterology, Rheumatology, Infectious Diseases, Charité –Universitätsmedizin, Berlin, Germany
| | - Penny A. Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - David J. Humes
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Robin C. Spiller
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
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Abstract
INTRODUCTION Diverticulitis is a significant cause of morbidity among older women, and little attention has been paid to understanding its etiology. We have shown that menopausal hormone therapy (MHT) is associated with the risk of inflammatory bowel disease. In this study, we prospectively examined the association between MHT and the risk of incident diverticulitis. METHODS We studied 65,367 postmenopausal women enrolled in the Nurses' Health Study who provided detailed information on hormone use and other medical and lifestyle factors biennially, and on diet every 4 years. Between 2008 and 2014, participants reported any episodes of diverticulitis that required antibiotics and the date of occurrence. We used Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Over 24 years encompassing 1,297,165 person-years of follow-up, we documented 5,425 incident cases of diverticulitis. We observed an increased risk of diverticulitis among both current (HR 1.28; 95% CI 1.18-1.39) and past (HR 1.35; 95% CI 1.25-1.45) MHT users compared to never users. The increased risk was observed among participants using estrogen only (HR 1.30; 95% CI 1.20-1.41) and those using combined estrogen and progesterone (HR 1.31; 95% CI 1.21-1.42) compared to nonusers. The risk did not increase with longer duration of use (P-trend = 0.76). The association between MHT and diverticulitis was not modified by age, body mass index, past oral contraceptive use, or fiber intake (all P-interaction >0.11). CONCLUSIONS Menopausal hormone therapy was associated with an increased risk of diverticulitis. Further studies are needed to understand the potential mechanisms that may underlie this association.
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18
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Irritable bowel syndrome and colonic diverticular disease: overlapping symptoms and overlapping therapeutic approaches. Curr Opin Gastroenterol 2019; 35:27-33. [PMID: 30407258 DOI: 10.1097/mog.0000000000000499] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Irritable bowel syndrome (IBS) is a common symptomatic disorder in the Western world and colonic diverticula are also prevalent; however, relationships between IBS-type symptoms and diverticula have been a source of much debate. Our goal was to reassess these relationships in the light of new data. RECENT FINDINGS On removing from consideration clinical scenarios which are directly related to diverticula (i.e., diverticulitis, diverticular hemorrhage, and complications of diverticulitis, such as stricture and fistula), relationships between IBS and diverticula can be seen to revolve around a number of questions. First, are IBS and symptomatic uncomplicated diverticular disease (SUDD) the same condition? Or, in other words is SUDD no more than IBS in an individual who just happens to have diverticula? Although coincident IBS and diverticula inevitably do occur there is some evidence to indicate that SUDD may be somewhat distinctive with SUDD being characterized by more frequent and severe pain. Second, and analogous to interactions between IBS and inflammatory bowel disease or celiac disease, can an episode of acute diverticulitis lead to the de novo development of IBS? There is now epidemiological and pathophysiological evidence to support this occurrence. SUMMARY Although relationships between uncomplicated diverticular disease and IBS have been reexamined their status remains unclear. As yet, however, none of the newer concepts related to this relationship have led to new therapeutic approaches in IBS or diverticular disease.
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Liu Y, Zhao J, Liao D, Wang G, Gregersen H. Stress-strain analysis of duodenal contractility in response to flow and ramp distension in rabbits fed low-fiber diet. Neurogastroenterol Motil 2019; 31:e13476. [PMID: 30246440 DOI: 10.1111/nmo.13476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previously we demonstrated that low-fiber diet in rabbits affects the passive mechanomorphological properties in the small intestine, resulting in reduced intestinal wall thickness and collagen content, as well as intestinal wall softening. The aim of the present study was to evaluate the contractility in rabbits on long-term low-fiber diet and specifically to compare the contraction threshold, the frequency, and the amplitude of flow-induced and distension-induced contractions in the duodenum between rabbits on normal diet and on long-term low-fiber diet. METHODS Ten rabbits were fed a low-fiber diet for 5 months (Intervention group), and five rabbits were fed normal diet (Control group). The duodenal segments were used for determination of mechanical parameters for analyses of contractility. The duodenal experiments were carried out in organ baths containing physiological Krebs solution. Pressure and diameter changes induced by contractions in response to flow and ramp distension were measured. The frequencies and amplitude of contractions were analyzed. Distension-induced contraction thresholds and maximum contraction amplitude of flow-induced contractions were calculated in terms of mechanical stress and strain. Multiple linear regression analyses were applied to study dependencies between contractility parameters and wall thickness, wall area, and muscle layer thickness. KEY RESULTS During distension, the pressure, stress, and strain thresholds for induction of phasic contraction were biggest in the Intervention Group (P < 0.05). In addition, the contraction frequencies during flow-induced contraction were highest in the Intervention Group (P < 0.05), whereas the maximum contraction amplitudes in terms of pressure, diameter, stress, and strain were lowest in the Intervention Group (P < 0.05). The contraction thresholds and contraction frequencies were negatively associated with the wall thickness, wall area, and muscle layer thickness, whereas maximum contraction amplitudes were positively associated with the wall thickness, wall area, and muscle layer thickness. CONCLUSIONS AND INFERENCES Duodenal contractility in rabbits fed with long-term low-fiber diet exhibited low contraction amplitudes and high contraction thresholds and frequencies. The changes were associated with the low-fiber diet-induced histomorphological remodeling. Studies on detailed structural and functional diet-induced changes in smooth muscle and intestinal nerves are needed for better understanding the remodeling mechanisms.
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Affiliation(s)
- Yue Liu
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College of Chongqing University, Chongqing, China.,GIOME Academia, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Zhuhai Da Hengqin Technology Development Co. Ltd., Zhuhai, China
| | - Jingbo Zhao
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College of Chongqing University, Chongqing, China.,GIOME Academia, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Mech-Sense, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Donghua Liao
- GIOME Academia, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Guixue Wang
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College of Chongqing University, Chongqing, China
| | - Hans Gregersen
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College of Chongqing University, Chongqing, China.,GIOME, Department of Surgery, Chinese University of Hong Kong, Hong Kong SAR, China
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Dreher ML. Whole Fruits and Fruit Fiber Emerging Health Effects. Nutrients 2018; 10:E1833. [PMID: 30487459 PMCID: PMC6315720 DOI: 10.3390/nu10121833] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
Less than 10% of most Western populations consume adequate levels of whole fruits and dietary fiber with typical intake being about half of the recommended levels. Evidence of the beneficial health effects of consuming adequate levels of whole fruits has been steadily growing, especially regarding their bioactive fiber prebiotic effects and role in improved weight control, wellness and healthy aging. The primary aim of this narrative review article is to examine the increasing number of health benefits which are associated with the adequate intake of whole fruits, especially fruit fiber, throughout the human lifecycle. These potential health benefits include: protecting colonic gastrointestinal health (e.g., constipation, irritable bowel syndrome, inflammatory bowel diseases, and diverticular disease); promoting long-term weight management; reducing risk of cardiovascular disease, type 2 diabetes and metabolic syndrome; defending against colorectal and lung cancers; improving odds of successful aging; reducing the severity of asthma and chronic obstructive pulmonary disease; enhancing psychological well-being and lowering the risk of depression; contributing to higher bone mineral density in children and adults; reducing risk of seborrheic dermatitis; and helping to attenuate autism spectrum disorder severity. Low whole fruit intake represents a potentially more serious global population health threat than previously recognized, especially in light of the emerging research on whole fruit and fruit fiber health benefits.
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Affiliation(s)
- Mark L Dreher
- Nutrition Science Solutions, LLC, Wimberley, 78676 TX, USA.
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21
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Teixeira C, Trabulo D, Ribeiro S, Martins CR, Alves AL, Cremers I, Oliveira AP. Colonic diverticulosis and the metabolic syndrome: an association? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 109:768-771. [PMID: 28776378 DOI: 10.17235/reed.2017.5009/2017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Colonic diverticulosis (CD) is related to advanced age and a lack of dietary fiber. Recently, several studies have shown that metabolic syndrome (MS) is also implicated in the etiopathogenesis of CD. This study aimed to assess the association between MS, obesity and CD. METHODS This was a prospective study of a one-year duration. The MS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). Demographic data, risk factors for MS and endoscopic findings of patients who underwent a total colonoscopy in the department were collected. Obesity was defined as a body mass index ≥ 30 kg/m2. Informed consent was obtained. The local Ethics Committee and National Data Protection Committee approved the study. Statistical analysis was performed with SPSS 21 and statistical significance was defined as p < 0.05. RESULTS The study included 203 patients, 95 males with a mean age of 65.5 years. CD was diagnosed in 30.5% of patients. Univariate analysis showed that age, hypertension, increased waist circumference and hyperlipidemia were associated with colonic diverticulosis. There was no association with gender, obesity or type 2 diabetes mellitus. Multivariate analysis showed that age and a greater waist circumference increased the risk of diverticulosis. Age-adjusted analysis showed that MS was associated with diverticulosis. The prevalence of adenoma in patients with CD was similar to that in patients without CD. CONCLUSION In this series, MS was significantly associated with CD. The identification of risk groups is important since diverticulosis can have serious and potentially fatal complications. To our knowledge, this is the first Southern European prospective study evaluating the association between MS and CD.
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Affiliation(s)
| | - Daniel Trabulo
- Gastroenterology, Centro Hospitalar de Setúbal, Portugal
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Abstract
Acute diverticulitis is a common condition that has been increasing in incidence in the United States. It is associated with increasing age, but the pathophysiology of acute diverticulitis is still being elucidated. It is now believed to have a significant contribution from inflammatory processes rather than being a strictly infectious process. There are still many questions to be answered regarding the optimal management of acute diverticulitis because recent studies have challenged traditional practices, such as the routine use of antibiotics, surgical technique, and dietary restrictions for prevention of recurrence.
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Elisei W, Tursi A. The Pathophysiology of Colonic Diverticulosis: Inflammation versus Constipation? Inflamm Intest Dis 2018; 3:55-60. [PMID: 30733948 DOI: 10.1159/000489173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/12/2018] [Indexed: 12/18/2022] Open
Abstract
Background Diverticulosis of the colon is the most common anatomic alteration of the human colon, but the pathophysiologic mechanisms of its occurrence are not completely understood. Summary Constipation has been considered the key factor for diverticulosis occurrence. However, several fine papers questioned this pathogenetic hypothesis, showing on the contrary an inverse relationship between low number of bowel movements and diverticulosis occurrence. In the last years, several papers have showed the role of low-grade inflammation in the occurrence of symptoms in people having diverticulosis, as well as its role on symptom persistence following acute diverticulitis, even if the evidence available is not so strong. Although the trigger of this low-grade inflammation is currently under debate, some preliminary evidence found colonic dysbiosis linked to symptom occurrence in those patients. Key Messages Constipation no longer seems the leading cause for diverticulosis occurrence, while low-grade inflammation could play a role in symptom occurrence.
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Affiliation(s)
- Walter Elisei
- Gastroenterology Unit, ASL Roma 6, Albano Laziale, Italy
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Carabotti M, Annibale B. Treatment of diverticular disease: an update on latest evidence and clinical implications. Drugs Context 2018; 7:212526. [PMID: 29623099 PMCID: PMC5866096 DOI: 10.7573/dic.212526] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Diverticular disease (DD) is a common condition, especially in Western countries. In about 80% of patients, colonic diverticula remain asymptomatic (diverticulosis), while approximately 20% of patients may develop abdominal symptoms (symptomatic uncomplicated diverticular disease, SUDD) and, eventually complications as acute diverticulitis (AD). The management of this condition has been improved, and in the last five years European countries and the USA have published guidelines and recommendations. SCOPE To summarize the latest evidence and clinical implication in treatment of DD focusing the attention either on the treatment of diverticulosis, SUDD and AD together with the primary and secondary prevention of diverticulitis. FINDINGS The present review was based on the latest evidence in the treatment of DD in the last 10 years. In the last 5 years, six countries issued guidelines on DD with differences regarding covered topics and recommendations regarding treatments. At present there is a lack of rationale for drug use in patients with asymptomatic diverticulosis, but there are limited indications to suggest an increase in dietary fibre to reduce risk of DD. To achieve symptomatic relief in SUDD patients, several therapeutic strategies with fibre, probiotics, rifaximin and mesalazine have been proposed even if a standard therapeutic approach remained to be defined. Agreement has been reached for the management of AD, since recent guidelines showed that antibiotics can be used selectively, rather than routinely in uncomplicated AD, although use of antibiotics remained crucial in the management of complicated cases. With regard to treatment for the primary and secondary prevention of AD, the efficacy of rifaximin and mesalazine has been proposed although with discordant recommendations among guidelines. CONCLUSION Treatment of DD represented an important challenge in clinical practice, especially concerning management of SUDD and the primary and secondary prevention of AD.
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Affiliation(s)
- Marilia Carabotti
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, University Hospital Sant'Andrea, Sapienza, Rome
| | - Bruno Annibale
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, University Hospital Sant'Andrea, Sapienza, Rome
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Yamada E, Kuriyama H, Uchida E, Murata Y, Hata Y, Tagri M, Isozaki Y, Oyamada H, Ozawa Y, Ito T, Mizuki A, Inamori M, Manabe N, Haruma K, Nakajima A. Association between endoscopic findings related to colonic diverticula and bowel habits: A multicenter study in Japan. J Gastroenterol Hepatol 2017; 32:1938-1942. [PMID: 28425144 DOI: 10.1111/jgh.13805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/08/2017] [Accepted: 04/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Few studies have shown the associations between colonic diverticula and endoscopic findings such as location, inflammation, number of diverticula, sigmoid colon rigidity, and bowel habits. METHODS Japanese subjects who underwent total colonoscopies at six centers in Japan from November 2015 to October 2016 were analyzed. Bowel habits were evaluated using the Gastrointestinal Symptom Rating Scale. Location and number of diverticula, inflammation, and sigmoid colon rigidity were evaluated from endoscopy results. RESULTS A total of 762 subjects (486 men and 276 women [ratio, 1.76:1]) whose mean age was 65.5 ± 11.4 years were evaluated. In multivariate analysis, presence of constipation was associated with a significantly lower likelihood of left-sided colonic diverticula (odds ratio = 0.40, 95% confidence interval 0.20-0.82, P = 0.012), whereas right-sided and bilateral-sided colonic diverticula, multiple colonic diverticula, inflammation findings, and sigmoid colon rigidity were not related to bowel habits. CONCLUSIONS Among endoscopic findings related to colonic diverticula and bowel habits, only left-sided colonic diverticula were inversely associated with constipation, whereas inflammation findings, multiple diverticula, and sigmoid colon rigidity were not related to bowel habits. However, the association of inflammation findings with colonic diverticula and bowel habits should be further studied. Investigation of changes in left-sided colonic diverticula may lead to new treatments for constipation.
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Affiliation(s)
- Eiji Yamada
- Gastroenterology Division, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan
| | - Hitoshi Kuriyama
- Gastroenterology Division, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Eri Uchida
- Gastroenterology Division, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Yoriko Murata
- Gastroenterology Division, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Yasuo Hata
- Gastroenterology Division, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Masataka Tagri
- Department of Biostatistics and Epidemiology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yutaka Isozaki
- Department of Gastroenterology, Matsushita Memorial Hospital, Osaka, Japan
| | - Hirokazu Oyamada
- Department of Gastroenterology, Matsushita Memorial Hospital, Osaka, Japan
| | - Yukihiro Ozawa
- Department of Surgery, Miura City Hospital, Miura, Japan
| | - Takafumi Ito
- Department of Internal Medicine, Keiyu Hospital, Yokohama, Japan
| | - Akira Mizuki
- Department of Internal Medicine, Keiyu Hospital, Yokohama, Japan
| | - Masahiko Inamori
- Department of Medical Education, Yokohama City University School of Medicine, Yokohama, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Kawasaki Medical School, Kurashiki, Japan
| | - Ken Haruma
- Department of Gastroenterology, Kawasaki Medical School, Kurashiki, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
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Liu Y, Zhao J, Liao D, Wang G, Gregersen H. Intestinal Mechanomorphological Remodeling Induced by Long-Term Low-Fiber Diet in Rabbits. Ann Biomed Eng 2017; 45:2867-2878. [DOI: 10.1007/s10439-017-1922-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 09/11/2017] [Indexed: 12/23/2022]
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Turco F, Andreozzi P, Palumbo I, Zito FP, Cargiolli M, Fiore W, Gennarelli N, De Palma GD, Sarnelli G, Cuomo R. Bacterial stimuli activate nitric oxide colonic mucosal production in diverticular disease. Protective effects of L. casei DG® ( Lactobacillus paracasei CNCM I-1572). United European Gastroenterol J 2017; 5:715-724. [PMID: 28815036 PMCID: PMC5548353 DOI: 10.1177/2050640616684398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/13/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Micro-inflammation and changes in gut microbiota may play a role in the pathogenesis of diverticular disease (DD). OBJECTIVE The objective of this article is to evaluate the expression of nitric oxide (NO)-related mediators and S100B in colonic mucosa of patients with DD in an ex vivo model of bacterial infection. METHODS Intestinal biopsies obtained from patients with diverticulosis, symptomatic uncomplicated diverticular disease (SUDD) and SUDD with previous acute diverticulitis (SUDD+AD) were stimulated with the probiotic L. casei DG® (LCDG) and/or the pathogen enteroinvasive Escherichia coli (EIEC). S100B, NO release and iNOS expression were then evaluated. RESULTS Basal iNOS expression was significantly increased in SUDD and SUDD+AD patients. Basal NO expression was significantly increased in SUDD+AD. No differences in S100B release were found. In all groups, iNOS expression was significantly increased by EIEC and reduced by LCDG. In all groups, except for SUDD+AD, EIEC significantly increased NO release, whereas no increase was observed when LCDG was added to biopsies. EIEC did not induce significant changes in S100B release. CONCLUSIONS Colonic mucosa of patients with DD is characterized by a different reactivity toward pathogenic stimuli. LCDG plays a role in counteracting the pro-inflammatory effects exerted by EIEC, suggesting a beneficial role of this probiotic in DD.
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Affiliation(s)
- Fabio Turco
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Paolo Andreozzi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Ilaria Palumbo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Francesco Paolo Zito
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Martina Cargiolli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | | | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | | | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Rosario Cuomo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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Aune D, Sen A, Leitzmann MF, Tonstad S, Norat T, Vatten LJ. Tobacco smoking and the risk of diverticular disease - a systematic review and meta-analysis of prospective studies. Colorectal Dis 2017; 19:621-633. [PMID: 28556447 DOI: 10.1111/codi.13748] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/22/2016] [Indexed: 02/08/2023]
Abstract
AIM This systematic review and meta-analysis aimed to clarify whether tobacco smoking is associated with an increased risk of diverticular disease. METHOD The PubMed and Embase databases were searched for studies of smoking and diverticular disease up to 19 February 2016. Prospective studies that reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of diverticular disease associated with current or previous smoking were included. Summary RRs were estimated using a random effects model. RESULTS We identified five prospective studies which comprised 6076 cases of incident diverticular disease (diverticulosis and diverticulitis) among 385 291 participants and three studies with 1118 cases of complications related to diverticular disease (abscess or perforation) among 292 965. The summary RR for incident diverticular disease was 1.36 (95% CI 1.15-1.61, I2 = 84%, n = 4) for current smokers, 1.17 (95% CI 1.05-1.31, I2 = 49%, n = 4) for former smokers and 1.29 (95% CI 1.16-1.44, I2 = 62%, n = 5) for ever smokers. The summary RR was 1.11 (95% CI 0.99-1.25, I2 = 82%, n = 4) per 10 cigarettes per day. Although there was some indication of nonlinearity there was a dose-dependent positive association with increasing number of cigarettes smoked per day. There was some evidence that smoking also increases the risk of complications of diverticular disease, but the number of studies was small. CONCLUSION The current meta-analysis provides evidence that tobacco smoking is associated with an increased incidence of diverticular disease and related complications.
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Affiliation(s)
- D Aune
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK.,Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Bjørknes University College, Oslo, Norway
| | - A Sen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - M F Leitzmann
- Department of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Regensburg, Germany
| | - S Tonstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - T Norat
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - L J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Barbara G, Scaioli E, Barbaro MR, Biagi E, Laghi L, Cremon C, Marasco G, Colecchia A, Picone G, Salfi N, Capozzi F, Brigidi P, Festi D. Gut microbiota, metabolome and immune signatures in patients with uncomplicated diverticular disease. Gut 2017; 66:1252-1261. [PMID: 27618836 DOI: 10.1136/gutjnl-2016-312377] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/19/2016] [Accepted: 08/20/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The engagement of the gut microbiota in the development of symptoms and complications of diverticular disease has been frequently hypothesised. Our aim was to explore colonic immunocytes, gut microbiota and the metabolome in patients with diverticular disease in a descriptive, cross-sectional, pilot study. DESIGN Following colonoscopy with biopsy and questionnaire phenotyping, patients were classified into diverticulosis or symptomatic uncomplicated diverticular disease; asymptomatic subjects served as controls. Mucosal immunocytes, in the diverticular region and in unaffected sites, were quantified with immunohistochemistry. Mucosa and faecal microbiota were analysed by the phylogenetic platform high taxonomic fingerprint (HTF)-Microbi.Array, while the metabolome was assessed by 1H nuclear magnetic resonance. RESULTS Compared with controls, patients with diverticula, regardless of symptoms, had a >70% increase in colonic macrophages. Their faecal microbiota showed depletion of Clostridium cluster IV. Clostridium cluster IX, Fusobacterium and Lactobacillaceae were reduced in symptomatic versus asymptomatic patients. A negative correlation was found between macrophages and mucosal Clostridium cluster IV and Akkermansia. Urinary and faecal metabolome changes in diverticular disease involved the hippurate and kynurenine pathways. Six urinary molecules allowed to discriminate diverticular disease and control groups with >95% accuracy. CONCLUSIONS Patients with colonic diverticular disease show depletion of microbiota members with anti-inflammatory activity associated with mucosal macrophage infiltration. Metabolome profiles were linked to inflammatory pathways and gut neuromotor dysfunction and showed the ability to discriminate diverticular subgroups and controls. These data pave the way for further large-scale studies specifically aimed at identifying microbiota signatures with a potential diagnostic value in patients with diverticular disease.
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Affiliation(s)
- Giovanni Barbara
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Eleonora Scaioli
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Raffaella Barbaro
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elena Biagi
- Department of Pharmacy and Biotechnology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Laghi
- Department of Agri-Food Sciences and Technologies, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Colecchia
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Gianfranco Picone
- Department of Agri-Food Sciences and Technologies, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nunzio Salfi
- Pathology Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Capozzi
- Department of Agri-Food Sciences and Technologies, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Patrizia Brigidi
- Department of Pharmacy and Biotechnology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Cuomo R, Barbara G, Annibale B. Rifaximin and diverticular disease: Position paper of the Italian Society of Gastroenterology (SIGE). Dig Liver Dis 2017; 49:595-603. [PMID: 28215517 DOI: 10.1016/j.dld.2017.01.164] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 02/08/2023]
Abstract
Management of diverticular disease has significantly improved in the last decade. Antibiotic treatment is used for symptom relief and prevention of complications. In Italy, the non-absorbable antibiotic rifaximin is one of the most frequently used drugs, and it is perceived as the reference drug to treat symptomatic diverticular disease. Its non-systemic absorption and high faecal concentrations have oriented rifaximin use to the gastrointestinal tract, where rifaximin exerts eubiotic effects representing an additional value to its antibiotic activity. This position paper was commissioned by the Italian Society of Gastroenterology governing board for a panel of experts (RC, GB, BA) to highlight the indications for treatment of diverticular disease. There is a lack of rationale for drug use for the primary prevention of diverticulitis in patients with diverticulosis; thus, rifaximin use should be avoided. The cyclic use of rifaximin, in association with high-fibre intake, is safe and useful for the treatment of symptomatic uncomplicated diverticular disease, even if the cost-efficacy of long-term treatment remains to be determined. The use of rifaximin in the prevention of diverticulitis recurrence is promising, but the low therapeutic advantage needs to be verified. No evidence is available on the efficacy of rifaximin treatment on acute uncomplicated diverticulitis.
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Affiliation(s)
- Rosario Cuomo
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Bruno Annibale
- Medical-Surgical Science and Translational Medicine Department, Sapienza University, Rome, Italy.
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Valdovinos MA, Montijo E, Abreu AT, Heller S, González-Garay A, Bacarreza D, Bielsa-Fernández M, Bojórquez-Ramos MC, Bosques-Padilla F, Burguete-García AI, Carmona-Sánchez R, Consuelo-Sánchez A, Coss-Adame E, Chávez-Barrera JA, de Ariño M, Flores-Calderón J, Gómez-Escudero O, González-Huezo MS, Icaza-Chávez ME, Larrosa-Haro A, Morales-Arámbula M, Murata C, Ramírez-Mayans JA, Remes-Troche JM, Rizo-Robles T, Peláez-Luna M, Toro-Monjaraz EM, Torre A, Urquidi-Rivera ME, Vázquez R, Yamamoto-Furusho JK, Guarner F. The Mexican consensus on probiotics in gastroenterology. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2017; 82:156-178. [PMID: 28104319 DOI: 10.1016/j.rgmx.2016.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/17/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. AIM To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology. MATERIALS AND METHODS Controlled clinical trials, meta-analyses, and systematic reviews published up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases, humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologists treating adult patients and 14 pediatric gastroenterologists formulated statements that were voted on until agreement>70% was reached. The level of evidence based on the GRADE system was evaluated for each statement. RESULTS AND CONCLUSIONS Eleven statements on the general concepts of probiotics and 27 statements on the use of probiotics in gastrointestinal diseases in both adults and children were formulated. The consensus group recommends the use of probiotics under the following clinical conditions: the prevention of diarrhea associated with antibiotics, the treatment of acute infectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enterocolitis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief from irritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis and pouchitis, and the treatment of covert and overt hepatic encephalopathy.
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Affiliation(s)
- M A Valdovinos
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
| | - E Montijo
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - A T Abreu
- Servicio de Gastroendoscopia, Hospital Regional n.(o) 2 con Unidad de Medicina de Atención Ambulatoria, IMSS, Ciudad de México, México
| | - S Heller
- Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México
| | - A González-Garay
- Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, México
| | - D Bacarreza
- Hospital Infantil de las Californias, Tijuana, BC, México
| | - M Bielsa-Fernández
- Unidad de Pacientes en Estudio, Universidad Autónoma de Guadalajara, Zapopan, Jalisco, México
| | - M C Bojórquez-Ramos
- UMAE Hospital de Pediatría, Centro Médico Nacional de Occidente, IMSS, , Guadalajara, Jalisco, México
| | - F Bosques-Padilla
- Departamento de Medicina Interna, División de Gastroenterología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - A I Burguete-García
- Departamento de Epidemiología Genética e Infecciones, CISEI, INSP, Cuernavaca, Mor., México
| | | | - A Consuelo-Sánchez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - E Coss-Adame
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - J A Chávez-Barrera
- Departamento de Gastroenterología Pediátrica, UMAE Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, IMSS, Ciudad de México, México
| | - M de Ariño
- Servicio de Gastroenterología, Hospital Español, Ciudad de México, México
| | - J Flores-Calderón
- Departamento de Gastroenterología y Endoscopia, UMAE Hospital de Pediatría Dr. Silvestre Frenk Freund, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - O Gómez-Escudero
- Clínica de Gastroenterología, Endoscopia Digestiva y Motilidad Gastrointestinal, Hospital Ángeles Puebla, Puebla, México
| | - M S González-Huezo
- Departamento de Gastroenterología, Centro Médico Issemym, Metepec, Estado de México, México
| | | | - A Larrosa-Haro
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | | | - C Murata
- Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, México
| | - J A Ramírez-Mayans
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - J M Remes-Troche
- Laboratorio de Motilidad y Fisiología Digestiva, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana (UV), Veracruz, México
| | - T Rizo-Robles
- Servicio de Gastroenterología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Ciudad de México, México
| | - M Peláez-Luna
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - E M Toro-Monjaraz
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - A Torre
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - M E Urquidi-Rivera
- Servicio de Gastroenterología Pediátrica y Endoscopia, Hospital Regional ISSSTE, Monterrey, N.L., México
| | - R Vázquez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - J K Yamamoto-Furusho
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - F Guarner
- Servicio de Aparato Digestivo, Hospital Vall d'Hebrón, Barcelona, España
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Valdovinos M, Montijo E, Abreu A, Heller S, González-Garay A, Bacarreza D, Bielsa-Fernández M, Bojórquez-Ramos M, Bosques-Padilla F, Burguete-García A, Carmona-Sánchez R, Consuelo-Sánchez A, Coss-Adame E, Chávez-Barrera J, de Ariño M, Flores-Calderón J, Gómez-Escudero O, González-Huezo M, Icaza-Chávez M, Larrosa-Haro A, Morales-Arámbula M, Murata C, Ramírez-Mayans J, Remes-Troche J, Rizo-Robles T, Peláez-Luna M, Toro-Monjaraz E, Torre A, Urquidi-Rivera M, Vázquez R, Yamamoto-Furusho J, Guarner F. The Mexican consensus on probiotics in gastroenterology. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Liu Y, Zhao J, Liao D, Bao L, Gregersen H. Low-residue diet fed to rabbits induces histomorphological and biomechanical remodeling of small intestine. Neurogastroenterol Motil 2017; 29. [PMID: 27790839 DOI: 10.1111/nmo.12983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/27/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The composition of ingested food is important for the gut microbiome and intestinal homeostasis. We have previously demonstrated that the structure and mechanical properties in the small intestine remodel significantly during fasting. However, it is not clear to what extent the intestinal mechanical properties changes when the composition of food is changed. This study aimed to investigate the passive biomechanical properties and intestinal tissue remodeling in rabbits fed a low-residue diet. METHODS New Zealand rabbits (control group n=6, intervention group n=7) were studied. Segments from duodenum, jejunum and ileum were excised. The intestinal diameter and length were obtained from digitized images of the segments at preselected luminal pressure levels and at no-load and zero-stress states. Circumferential and longitudinal stresses (force per area) and strains (deformation) were computed from the length, diameter and pressure data referenced to the zero-stress state geometry. Histomorphometric data were also obtained. KEY RESULTS The wet weight-per-unit length, wall thickness and wall area decreased in the intervention group (P<.05, P<.01). Histological measurement confirmed that the wall thickness decreased in all three segments, which was primarily due to mucosal thinning (P<.05). The opening angle tended to increase in all segments in the intervention group. Significant difference between the two groups was found for the jejunum (P<.05). Feeding the low-residue diet shifted the circumferential stress-strain curves in the intervention group to the right, indicating intestinal wall softening. CONCLUSIONS & INFERENCES Low-residue diet in rabbits for 1 month induces location-dependent histomorphometric and biomechanical remodeling of the intestine.
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Affiliation(s)
- Y Liu
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, China.,GIOME Academia, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - J Zhao
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, China.,GIOME Academia, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - D Liao
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, China.,GIOME Academia, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - L Bao
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, China
| | - H Gregersen
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College, Chongqing University, Chongqing, China
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Jamal Talabani A, Lydersen S, Ness-Jensen E, Endreseth BH, Edna TH. Risk factors of admission for acute colonic diverticulitis in a population-based cohort study: The North Trondelag Health Study, Norway. World J Gastroenterol 2016; 22:10663-10672. [PMID: 28082819 PMCID: PMC5192278 DOI: 10.3748/wjg.v22.i48.10663] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/20/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess risk factors of hospital admission for acute colonic diverticulitis.
METHODS The study was conducted as part of the second wave of the population-based North Trondelag Health Study (HUNT2), performed in North Trondelag County, Norway, 1995 to 1997. The study consisted of 42570 participants (65.1% from HUNT2) who were followed up from 1998 to 2012. Of these, 22436 (52.7%) were females. The cases were defined as those 358 participants admitted with acute colonic diverticulitis during follow-up. The remaining participants were used as controls. Univariable and multivariable Cox regression analyses was used for each sex separately after multiple imputation to calculate HR.
RESULTS Multivariable Cox regression analyses showed that increasing age increased the risk of admission for acute colonic diverticulitis: Comparing with ages < 50 years, females with age 50-70 years had HR = 3.42, P < 0.001 and age > 70 years, HR = 6.19, P < 0.001. In males the corresponding values were HR = 1.85, P = 0.004 and 2.56, P < 0.001. In patients with obesity (body mass index ≥ 30) the HR = 2.06, P < 0.001 in females and HR = 2.58, P < 0.001 in males. In females, present (HR = 2.11, P < 0.001) or previous (HR = 1.65, P = 0.007) cigarette smoking increased the risk of admission. In males, breathlessness (HR = 2.57, P < 0.001) and living in rural areas (HR = 1.74, P = 0.007) increased the risk. Level of education, physical activity, constipation and type of bread eaten showed no association with admission for acute colonic diverticulitis.
CONCLUSION The risk of hospital admission for acute colonic diverticulitis increased with increasing age, in obese individuals, in ever cigarette smoking females and in males living in rural areas.
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Søreide K, Boermeester MA, Humes DJ, Velmahos GC. Acute colonic diverticulitis: modern understanding of pathomechanisms, risk factors, disease burden and severity. Scand J Gastroenterol 2016; 51:1416-1422. [PMID: 27539786 DOI: 10.1080/00365521.2016.1218536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Conservative, non-antibiotic and non-surgical management of acute diverticulitis is currently being investigated. To better inform clinical decisions, better understanding of disease mechanisms, disease burden and severity is needed. METHODS Literature search of risk factors, pathophysiology, epidemiology and disease burden/severity reported over the last decade. RESULTS Acute diverticulitis is a common disease and has a high disease burden. Incidence of hospital admissions is reported around 71 per 100,000 population, with reported increase in several subpopulations over the last decades. The incidence is likely to increase further with the aging populations. Risk factors for left-sided acute diverticulitis include dietary, anthropometric and lifestyle factors. Disease mechanisms are still poorly understood, but a distinction between inflammation and infection is emerging. The integrative and complex role of the gut microbiota has become an interesting factor for both understanding the disease as well as a potential target for intervention using probiotics. Mild, self-limiting events are increasingly reported from studies of successful non-antibiotic management in a considerable number of cases. Risk markers of progression to or presence of severe, complicated disease are needed for better disease stratification. Current risk stratification by clinical, imaging or endoscopic means is imperfect and needs validation. Long-term results from minimal-invasive and comparative surgical trials may better help inform clinicians and patients. CONCLUSIONS Over- and under-treatment as well as over- and under-diagnosis of severity is likely to continue in clinical practice due to lack of reliable, robust and universal severity and classification systems. Better understanding of pathophysiology is needed.
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Affiliation(s)
- Kjetil Søreide
- a Department of Gastrointestinal Surgery , Stavanger University Hospital , Stavanger , Norway.,b Department of Clinical Medicine , University of Bergen , Bergen , Norway
| | - Marja A Boermeester
- c Department of Surgery , Academic Medical Center , Amsterdam , the Netherlands
| | - David J Humes
- d Division of Epidemiology and Public Health , School of Community Health Sciences, University of Nottingham , Nottingham , UK
| | - George C Velmahos
- e Division of Trauma Emergency Surgery and Surgical Critical Care , Massachusetts General Hospital , Boston , MA , USA.,f Harvard Medical School , Boston , MA , USA
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Cassieri C, Pica R, Avallone EV, Zippi M, Crispino P, De Nitto D, Paoluzi P, Brandimarte G, Lecca PG, Elisei W, Picchio M, Tursi A. Prevalence of Colonic Diverticulosis in Patients Affected by Ulcerative Colitis: A Prospective Study. J Clin Gastroenterol 2016; 50 Suppl 1:S33-S35. [PMID: 27622358 DOI: 10.1097/mcg.0000000000000631] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diverticulosis of the colon is an acquired condition that results from herniation of the mucosa and submucosa through defects in the muscular layer. The true prevalence of colonic diverticulosis is difficult to measure because most individuals are asymptomatic. In particularly, in literature, there are few studies about the prevalence of colonic diverticulosis in patients affected by ulcerative colitis (UC). GOALS To investigate the prevalence of colonic diverticulosis in UC and in adult patients referred in a single center. STUDY Consecutive patients, referred to our institution to undergo a colonoscopy for colorectal cancer screening and/or for UC assessment, between January 1, 2014 and December 31, 2014, were studied. RESULTS Six hundred five consecutive patients were studied: 438 (72.4%) due to colorectal cancer screening (group A) and 167 (27.6%) for UC assessment (group B). Prevalence of colonic diverticulosis was higher in group A than group B (27.8% vs. 10.8%, P<0.0001). Female gender in patients with colonic diverticulosis was higher in group A than group B (55.7% vs. 22.2%, P=0.0106). Sigma and left colon was mainly involved in group A than group B (97.6% vs. 66.7%, P=0.0001), whereas in group B the right colon was mainly involved in group B versus group A (22.2% vs. 0.8%, P=0.0009). CONCLUSIONS Prevalence of colonic diverticulosis was significantly lower in patients with UC than in control group. UC may, therefore, be a protective factor for colonic diverticulosis occurrence.
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Affiliation(s)
- Claudio Cassieri
- *Department of Internal Medicine and Medical Specialties, "Sapienza" University †Division of Internal Medicine and Gastroenterology, "Cristo Re" Hospital, GIOMI Group ‡Division of Gastroenterology, ASL Roma H, Albano Laziale §Division of Surgery, "P. Colombo" Hospital, Velletri, Rome ∥Gastroenterology Service, ASL BAT, Andria, BT, Italy
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Abstract
Diverticular disease (DD) is a widespread condition, however limited evidences are available about its management and complications. In the last years, an Italian Consensus Conference promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) and a Guideline, by Italian Society of Colorectal Surgery (SICCR) were published. The aim of the Consensus was to provide clinical recommendation for appropriate definition, diagnosis, and management of DD, in particular 4 areas of interest were identified, namely: (i) definition and epidemiology, (ii) pathophysiology, (iii) diagnosis, and (iv) medical and surgical treatment. A total of 55 statements graded according to different level of evidence and strength of recommendation were approved. However, if we consider the grade of recommendation, their strength remains suboptimal, with only 3 statements with grade of evidence A in the area of diagnosis. The Clinical guidelines by SICCR focus mainly on acute diverticulitis, and surgical treatment of complicated DD. One of the main topic analyzed, is represented by the management of the acute uncomplicated diverticulitis, in particular about the use of antibiotics and need of hospitalization. Despite the presence of many recent European and western country guidelines, there is a lack of robust data on epidemiology, risk factors, and medical and surgical management of DD, calling the need of further studies aimed to obtain an evidence-based approach in this condition.
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Affiliation(s)
- Bruno Annibale
- Departments of *Medical and Surgical Sciences and Traslational Medicine †Internal Medicine and Medical Specialties, University Sapienza, Roma ‡Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
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Scaioli E, Colecchia A, Marasco G, Schiumerini R, Festi D. Pathophysiology and Therapeutic Strategies for Symptomatic Uncomplicated Diverticular Disease of the Colon. Dig Dis Sci 2016; 61:673-683. [PMID: 26458921 DOI: 10.1007/s10620-015-3925-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/05/2015] [Indexed: 12/12/2022]
Abstract
Colonic diverticulosis imposes a significant burden on industrialized societies. The current accepted causes of diverticula formation include low fiber content in the western diet with decreased intestinal content and size of the lumen, leading to the transmission of muscular contraction pressure to the wall of the colon, inducing the formation of diverticula usually at the weakest point of the wall where penetration of the blood vessels occurs. Approximately 20 % of the patients with colonic diverticulosis develop abdominal symptoms (i.e., abdominal pain and discomfort, bloating, constipation, and diarrhea), a condition which is defined as symptomatic uncomplicated diverticular disease (SUDD). The pathogenesis of SUDD symptoms remains uncertain and even less is known about how to adequately manage bowel symptoms. Recently, low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors leading to symptom development, thus changing and improving the therapeutic approach. In this review, a comprehensive search of the literature regarding on SUDD pathogenetic hypotheses and pharmacological strategies was carried out. The pathogenesis of SUDD, although not completely clarified, seems to be related to an interaction between colonic microbiota alterations, and immune, enteric nerve, and muscular system dysfunction (Cuomo et al. in United Eur Gastroenterol J 2:413-442, 2014). Greater understanding of the inflammatory pathways and gut microbiota composition in subjects affected by SUDD has increased therapeutic options, including the use of gut-directed antibiotics, mesalazine, and probiotics (Bianchi et al. in Aliment Pharmacol Ther 33:902-910, 2011; Comparato et al. in Dig Dis Sci 52:2934-2941, 2007; Tursi et al. in Aliment Pharmacol Ther 38:741-751, 2013); however, more research is necessary to validate the safety, effectiveness, and cost-effectiveness of these interventions.
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Affiliation(s)
- Eleonora Scaioli
- Department of Medical and Surgical Science, Policlinico S.Orsola, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Antonio Colecchia
- Department of Medical and Surgical Science, Policlinico S.Orsola, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Giovanni Marasco
- Department of Medical and Surgical Science, Policlinico S.Orsola, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Ramona Schiumerini
- Department of Medical and Surgical Science, Policlinico S.Orsola, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Davide Festi
- Department of Medical and Surgical Science, Policlinico S.Orsola, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
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Dore MP, Pes GM, Marras G, Soro S, Rocchi C, Loria MF, Bassotti G. Risk factors associated with colonic diverticulosis among patients from a defined geographic area. Tech Coloproctol 2016; 20:177-183. [PMID: 26568053 DOI: 10.1007/s10151-015-1401-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/26/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Only a few data regarding colonic diverticulosis are available in Italy. We examined the frequency of colonic diverticulosis and its associations with risk factors in a homogeneous Northern Sardinian population undergoing colonoscopy for any reason in the last decades. METHODS This was a retrospective single-center study. Medical records of patients undergoing colonoscopy for any indication between 1995 and 2013 were reviewed. Demographic information including age, gender, geographic area (urban, rural), marital status, smoking habit, occupation, body mass index, and comorbidities were collected. Presence, number, and extension of diverticula were assessed by colonoscopy. The diagnosis of diverticulosis was defined by the presence of more than five diverticula. RESULTS A total of 4458 records were collected (39.8 % males). Analysis by birth cohorts showed a significant progressive age-related increase in the prevalence of diverticulosis. The average prevalence was 18.9 % without significant variation across the 19-year observation period. In 101 (12.1 %) subjects diverticula were single or few. Seventy-one percent of diverticula were located predominantly in the left side, 2 % in the right side, and 14.3 % were spread throughout the colon. There was a significant association with obesity but not with smoking habits, marital status, or urban versus rural environment. A strong association was observed between the presence of diverticulosis and cardiovascular and other gastrointestinal and lung disease (p < 0.0001). These associations were also confirmed by the logistic regression analysis. CONCLUSIONS In this endoscopic study, colonic diverticulosis in Northern Sardinia showed prevalence similar to other series in Western countries, and it was predominantly left sided and age related.
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Affiliation(s)
- M P Dore
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
- Baylor College of Medicine, Houston, TX, USA
| | - G M Pes
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - G Marras
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - S Soro
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - C Rocchi
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - M F Loria
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - G Bassotti
- Department of Medicine, University of Perugia, Perugia, Italy.
- Clinica di Gastroenterologia ed Epatologia, Ospedale Santa Maria della Misericordia, Piazzale Menghini, 1, 06156, San Sisto, Perugia, Italy.
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Higher Mortality in Surgically Managed Diverticulitis is Associated with Asian Ethnicity and Right-Sided Disease. Dis Colon Rectum 2016; 59:216-23. [PMID: 26855396 DOI: 10.1097/dcr.0000000000000526] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although right-sided diverticulitis is perceived to have a higher incidence among Asians and infrequently requires surgical management in comparison with sigmoid diverticulitis, it is unknown whether differences in outcomes are due to ethnic disparity or disease pathophysiology. OBJECTIVE The aim of this study was to determine the surgical outcomes for Asian and non-Asian patients with diverticulitis who underwent colectomy. DESIGN Patients identifiable by ethnicity in the Nationwide Inpatient Sample with diverticulitis and colectomy between 2004 and 2010 were included. Univariate comparisons were made between Asian and non-Asian patients by using t tests for continuous variables and χ tests for categorical variables. Propensity score matching analysis was performed to compare Asian patients with otherwise similar non-Asian patients. PATIENTS Included were 58,142 non-Asian and 335 Asian patients with diverticulitis who underwent a colectomy. MAIN OUTCOME MEASURES The primary outcomes were in-hospital mortality, hospital length of stay, and total costs. RESULTS Asian patients were younger (56.1 vs. 59.2 years, p < 0.0001), were more likely to undergo a right colectomy (22.7% vs. 4.1%, p < 0.0001), and were more likely to have emergent/urgent surgery than the non-Asian patients (67.1% vs. 49.8%, p < 0.0001). Without controlling for patient/disease factors, there were statistically significant differences in mortality (non-Asian 2.2% vs. Asian 4.2%; p = 0.014), length of stay (non-Asian 8.9 vs. Asian 9.8 days; p = 0.0166), and costs (non-Asian $18,783 vs. Asian $21,901; p = 0.001). Propensity score matching comparing 333 non-Asian patients with 333 similar Asian patients showed that, whereas differences in cost and length of stay became insignificant, the difference in mortality remained statistically significant. LIMITATIONS The ethnicity variable was not uniformly collected by all states within the Nationwide Inpatient Sample database. CONCLUSIONS Among patients undergoing a colectomy for diverticulitis, a higher mortality was observed in Asian patients and right-sided disease. Future longitudinal studies comparing the natural history and outcomes of management between right- and left-sided diverticulitis are necessary to investigate whether a true ethnic disparity exists.
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Left Colon Diverticulitis Presenting as Perforated Lumbar Abscess: A Case Report and Review of the Current Literature. Case Rep Gastrointest Med 2015; 2015:414905. [PMID: 26881151 PMCID: PMC4736197 DOI: 10.1155/2015/414905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/20/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022] Open
Abstract
Diverticular perforation is a common complication of diverticulitis and can lead to the creation of abscesses. The presence of such abscesses on the abdominal wall is rare and can lead to misdiagnosis. We present the case of a patient with abdominal pain and the formation of a large left lumbar abscess due to perforation of a diverticulum of the left colon and our surgical treatment of choice with favorable results.
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