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Yıldız YA. Effectiveness of Systemic Inflammation Response Index (SIRI) Neutrophil-Lymphocyte Ratio (NLR), Derived Neutrophil-Lymphocyte Ratio (dNLR), and Systemic Immune Inflammation Index (SII) for predicting prognosis of acute diverticulitis. Updates Surg 2025:10.1007/s13304-025-02241-x. [PMID: 40374971 DOI: 10.1007/s13304-025-02241-x] [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: 01/07/2025] [Accepted: 04/28/2025] [Indexed: 05/18/2025]
Abstract
There are many applications to emergency services due to acute colonic diverticulitis. It is necessary to decide whether these patients are complicated, to quickly predict their prognosis, and to decide whether medical or invasive treatment is necessary. We planned to research effectiveness NLR, NLR, SII, and SIRI values calculated using hemogram data can predict the prognosis of acute diverticulitis. We managed a retrospective scanning with patients who applied with a diagnosis of acute diverticulitis between 06/2020 and 04/2023. Demographic data (age, gender, previous surgery, comorbid diseases), tomographic Hinchey classification, location of diverticulitis, applied treatment, and obtained from blood parameters at presentation to the emergency department WBC, CRP, NLR, dNLR, SII, SIRI parameters were recorded from the electronically registered patient files. According to the Hinchey classification, those with Hinchey 0 and 1a were included in the noncomplicated group A class because they were followed up with outpatient medical follow-up. Those with Hinchey 1b,2,3,4 were included in the complicated GROUP B class. Differences in WBC, CRP, NLR, dNLR, SIRI, SII values between the complicated and noncomplicated groups were evaluated statistically. There were 286 patients with acute diverticulitis on the dates indicated. The number of patients eligible for the study was eighty-two. According to Hinchey's classification, 56 patients had noncomplicated acute diverticulitis (SAD) and 26 patients had complicated diverticulitis (CAD). These diagnoses were given based on tomography findings and clinical evaluations. The hospital stay was longer in the CAD group compared to the SAD group (p < 0.001) statistically significantly. The rate of surgical procedures and percutaneous interventions in the CADs was higher than SADs (p: 0.040) statistically significantly. WBC (white blood cell), NLR, dNLR, SIRI, SII and CRP parameters were higher in CADs than in SADs as statistically significant. Spearman's correlation analysis showed between the Hinchey classification and the NLR, dNLR, SII, SIRI, CRP, WBC parameters with high correlation as positive. Determination of values SIRI (2.42), NLR (3.35), SII (907.44) dNLR (4.63), CRP (15.25) WBC (11.16) and specificity and fractionation of these values ROC analysis was performed for this purpose. Highest AUC (area under the curve) value was found in WBC [0.807 0.703-0.910)], SIRI [0.786 (, 0.681-0.892)], SII [0.767 (0.654-0.880)], NLR [0.740 (0.624-0.854)], dNLR [0.739 (0.625-0.853)]. This study showed that there are SII, SIRI dNLR, NLR, CRP, and WBC values in patients presenting with acute diverticulitis a very high correlation with Hinchey classification in distinguishing complicated and non-complicated acute diverticulitis (p < 0.01). These data were higher in CADs than in SADs statistically significantly. The use of these data can both prevent unnecessary radiation in patients suspected of acute diverticulitis by reducing unnecessary tomography scans and can be valuable in predicting the prognosis of diverticulitis at a low cost.
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Affiliation(s)
- Yasin Alper Yıldız
- Department of General Surgery, Faculty of Medicine 37120, Kastamonu University, Kastamonu, Turkey.
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Thorndal C, Kragsnaes MS, Nilsson AC, Holm DK, dePont Christensen R, Ellingsen T, Kjeldsen J, Bjørsum-Meyer T. Safety and efficacy of faecal microbiota transplantation in patients with acute uncomplicated diverticulitis: study protocol for a randomised placebo-controlled trial. Therap Adv Gastroenterol 2025; 18:17562848241309868. [PMID: 39758967 PMCID: PMC11694295 DOI: 10.1177/17562848241309868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 12/10/2024] [Indexed: 01/07/2025] Open
Abstract
Background Little is known about the involvement of gut microbiota in the disease course of diverticulitis and the potential benefits of manipulating the gut milieu. We propose to conduct a randomised placebo-controlled feasibility trial of faecal microbiota transplantation (FMT) given as capsules to patients with acute uncomplicated diverticulitis. Objectives The objective is primarily to investigate the feasibility of clinical safety, explore efficacy associated with FMT in this patient population, and examine changes in patient-reported quality of life and the composition and function of the gut microbiota. Design Study protocol for a randomised placebo-controlled trial. Methods and analysis Participants with acute, uncomplicated diverticulitis, as confirmed by computed tomography (CT) scan, will be recruited from Odense University Hospital (Denmark) and randomly assigned to either the intervention group or the control group. The intervention group will consist of 20 patients who receive encapsulated FMT. The control group will also consist of 20 patients, receiving placebo capsules. Primary safety endpoint: Patient safety is monitored by (a) the number of re-admissions and (b) the number of adverse events within 3 months of FMT/placebo; Primary efficacy endpoint: Reduction in the proportion of patients treated with antibiotics within 3 months following FMT/placebo; Secondary outcome: Change from baseline to 3 months in the GI-QLI questionnaire. Results will be analysed using an intention-to-treat approach. Adverse events or unintended consequences will be reported. Ethics and discussion This is the first study to investigate the safety and efficacy of FMT in patients with acute uncomplicated diverticulitis. The project has the potential to broaden the knowledge and literature on the role of the intestinal microbiota in diverticulitis, and we believe it will elevate our understanding of cause and effect. Trial registration Informed consent is obtained from all participants. The study is approved by the regional ethics committee (ref. S-20230023) and the Danish Data Protection Agency (ref. 24/2435). The trial was registered on clinicaltrials.gov (NCT06254625) on 10th February 2024.
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Affiliation(s)
- Camilla Thorndal
- Department of Surgery, Odense University Hospital, Baagøes Alle 15, Odense 5000, Denmark
| | - Maja Skov Kragsnaes
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | | | - Rene dePont Christensen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Torkell Ellingsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Jens Kjeldsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastrointestinal Diseases, Odense University Hospital, Odense, Denmark
| | - Thomas Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Luvsandagva B, Bai T, Hou X. The Association of the Presence of Esophageal and Colonic Diverticula with Hiatal Hernia: A Cross-sectional Study. Niger J Clin Pract 2024; 27:1235-1238. [PMID: 39627662 DOI: 10.4103/njcp.njcp_690_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/26/2024] [Indexed: 12/06/2024]
Abstract
OBJECTIVE This study investigates the association between the presence of diverticula in the colon and esophagus and the occurrence of hiatal hernia, seeking to understand potential shared pathophysiological underpinnings and risk factors. METHODS A cross-sectional study was conducted at a tertiary care center, including patients aged ≥18 years who underwent both gastroscopy and colonoscopy over 2 years. Exclusion criteria were prior gastrectomy or colectomy, incomplete medical records, and non-consent. The presence of hiatal hernia, colonic, and esophageal diverticulosis was identified via endoscopy. Logistic regression analysis assessed the associations, adjusting for age and sex. RESULTS Among 3563 participants, males showed a higher prevalence of hiatal hernias compared to females (76.1% vs. 23.9%, P < 0.001). Hiatal hernia patients had a mean age of 51.28 years, slightly higher than those without (49.62 years, P = 0.034). A significant association was found between hiatal hernias and colonic diverticulosis (11.8% vs. 1.8%, P < 0.001), as well as between hiatal hernias and esophageal diverticulosis (2.4% vs. 0.3%, P < 0.001). Adjusted logistic regression revealed a 5-7 times higher likelihood of colonic diverticulosis in patients with hiatal hernias (odds ratio = 5.64, 95% confidence interval: 3.60-8.83; P < 0.001). CONCLUSION The study demonstrates a notable association between hiatal hernias and the presence of both colonic and esophageal diverticula, suggesting common pathophysiological processes. These findings highlight the need for further research into shared risk factors and mechanisms underlying these conditions, potentially guiding improved management strategies for affected patients.
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Affiliation(s)
- B Luvsandagva
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kim KO. Recent updates on classification and unsolved issues of diverticular disease: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:252-260. [PMID: 39209318 PMCID: PMC11534408 DOI: 10.12701/jyms.2024.00542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/26/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024]
Abstract
Recently, a paradigm shift has occurred in the classification of diverticular disease and the understanding of its pathogenesis. Diverticular disease is now defined as a variety of clinically significant conditions such as diverticulitis, diverticular bleeding, symptomatic uncomplicated diverticular disease, and segmental colitis associated with diverticulosis. Low-grade inflammation, visceral hypersensitivity, abnormal intestinal motility, and genetic factors have emerged as the key contributors to the pathogenesis of diverticular disease. Routine antibiotic use is no longer recommended for all cases of diverticulitis, and simple recurrence is not an indication for surgical treatment. Early colonoscopy with proper preparation is recommended for the treatment of diverticular bleeding, although recent studies have not shown significant efficacy in preventing recurrence. The roles of dietary fiber, nonabsorbable antibiotics, 5-aminosalicylates, and probiotics in the prevention of diverticular disease are controversial and require further investigation.
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Affiliation(s)
- Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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Barlas AM, Altıner S, Başpınar A, Aydın SM, Doğanay E, Kaymak Ş, Ünal Y. Predicting complicated acute diverticulitis with the HALP score: A retrospective study. Asian J Surg 2024:S1015-9584(24)02132-8. [PMID: 39332948 DOI: 10.1016/j.asjsur.2024.09.091] [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: 04/02/2024] [Revised: 08/30/2024] [Accepted: 09/12/2024] [Indexed: 09/29/2024] Open
Abstract
OBJECTIVE HALP score is a scoring system consisting of hemoglobin, albumin, lymphocyte and platelet. It is different from other prognostic markers because it provides information about both inflammation and immunonutrition status. This study aims to evaluate the severity of the disease and the level of prognosis in patients diagnosed with acute diverticulitis. MATERIAL METHODS 190 patients diagnosed with acute diverticulitis between January 2017 and June 2023 were included in the study. The patients were divided into two separate groups according to the Hinchey classification. The prognostic effect of inflammatory markers and HALP score was examined. RESULT The median values of C-reactive protein, white blood cell count, neutrophil count, HALP score, and hospitalization duration were significantly higher in patients diagnosed with complicated diverticulitis than in those diagnosed with uncomplicated diverticulitis. (p < 0.001, p = 0.045, p = 0.004, p < 0.001 and p < 0.001, respectively). The distinguishing feature of the HALP score in predicting the complexity of the diagnosis of diverticulitis was evaluated using ROC analysis. Area Under Curve (AUC) value was found to be 0.723 (p < 0.001). According to the ROC curve, the sensitivity and specificity for the cut-off value of HALP score ≤44.1 were 66.7 % and 75.0 %, respectively. CONCLUSION HALP score is an inexpensive parameter that can be used safely to determine the severity and prognosis of acute diverticulitis.
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Affiliation(s)
- Aziz Mutlu Barlas
- Ankara Training and Research Hospital, Department of General Surgery, Ankara, Turkey.
| | - Saygın Altıner
- Ankara Training and Research Hospital, Department of General Surgery, Ankara, Turkey.
| | - Abdurrahman Başpınar
- Ankara Training and Research Hospital, Department of General Surgery, Ankara, Turkey.
| | - Seyit Murat Aydın
- Ankara Training and Research Hospital, Department of General Surgery, Ankara, Turkey.
| | - Enes Doğanay
- Ankara Training and Research Hospital, Department of General Surgery, Ankara, Turkey.
| | - Şahin Kaymak
- University of Health Scienece Gülhane Medical, School Department of General Surgery, Ankara, Turkey.
| | - Yılmaz Ünal
- Ankara Training and Research Hospital, Department of General Surgery, Ankara, Turkey.
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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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Delveus H, Lanzing G, Sahli H, Rönnow CF, Dahlbäck C, Buchwald P. Diverticulosis and risk of diverticulitis in 10 years; a Swedish retrospective observational study. Scand J Gastroenterol 2024; 59:433-436. [PMID: 38206087 DOI: 10.1080/00365521.2023.2301345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Diverticulosis is a common condition and is thought to be increasing in the Western population. Several studies have attempted to estimate the prevalence of diverticulosis and it's inflamed state, diverticulitis, with results varying depending on study population and methodology, The aim of this study was to investigate the prevalence of diverticulosis in patients undergoing colonoscopy at a Swedish academic referral centre and to study the incidence of diverticulitis in a 10-year follow-up. METHODS All patients who had undergone colonoscopy at the Endoscopy unit, Skåne University Hospital, Sweden, during 01 January 2010 through 31 December 2011 were identified. The colonoscopy referrals, colonoscopy reports, and medical records until 14 June 2022 were reviewed. RESULTS In all, 2648 patients were included in the study, whereof 910 patients had reported diverticulosis (34.4%). During the 10-year follow-up, the overall incidence of computed tomography verified diverticulitis was 4.4%, and 0.6% for patients with and without diverticulosis at index colonoscopy, respectively. Of the 50 patients that developed diverticulitis, 21 were complicated and 29 uncomplicated. CONCLUSION Diverticulosis is a common condition in the population, although most patients will not develop diverticulitis.
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Affiliation(s)
- Hugo Delveus
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Gustav Lanzing
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Hannah Sahli
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Carl-Fredrik Rönnow
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Endoscopy, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Dahlbäck
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Pamela Buchwald
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
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Serrano González J, Román García de León L, Galindo Jara P, Lucena de la Poza JL, Sánchez Movilla A, Colao García L, García Schiever JG, Varillas Delgado D. Non-antibiotic treatment of uncomplicated acute diverticulitis is applicable and safe in our environment. A prospective multicenter study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:140-147. [PMID: 37929981 DOI: 10.17235/reed.2023.9737/2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
INTRODUCTION acute diverticulitis is one of the most frequent underlying causes behind individuals attending the Emergency Room with abdominal pain. The most widespread therapy for acute uncomplicated diverticulitis includes outpatient treatment with antibiotics; however, several publications indicate that patients can also be successfully treated without antibiotics. The results of the implementation of this more recent protocol in two hospitals in Madrid are presented. METHODS an observational prospective study was performed. Participants were patients diagnosed with uncomplicated acute diverticulitis at two hospitals in Madrid, Hospital Universitario de Torrejón and Hospital Universitario Puerta de Hierro Majadahonda, between December 2018 and August 2021, treated on an outpatient basis without antibiotic therapy. The study group was compared with a control group, composed of patients diagnosed with uncomplicated acute diverticulitis and treated with outpatient antibiotic therapy at Hospital Universitario Puerta de Hierro between March 2015 and March 2018. RESULTS three hundred and sixty-one patients were included, 182 in the study group and 179 in the control group. Diverticulitis was persistent in 19 patients (10.4 %) in the study group, who were not treated with antibiotics, and in five patients (2.8 %) in the control group, treated with outpatient antibiotic therapy (p = 0.004). Recurrences occurred in 23 patients (12.6 %) in the study group, and in 53 patients (29.6 %) in the control group (p < 0.0001). The analysis of the complications found no significant differences between both groups (p = 0.109). No urgent surgical intervention or mortality was recorded in the study group. CONCLUSIONS in our environment, symptomatic non-antibiotic treatment of uncomplicated acute diverticulitis cases is safe, without showing a higher rate of complications. Although, there seems to be a worse initial symptom control.
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Vagios I, Vailas M, Vergadis C, Schizas D. Transverse colon diverticulitis mimicking acute appendicitis. BMJ Case Rep 2024; 17:e254703. [PMID: 38296506 PMCID: PMC10831436 DOI: 10.1136/bcr-2023-254703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
Diverticulitis in a solitary transverse colon diverticulum is uncommon, with only a handful of cases documented in the literature. There are various clinical manifestations of the disease, which make clinical and radiological diagnosis rather challenging. Herein, we present a case of a premenopausal female patient in her late 40s who presented to the emergency department, complaining of right lower quadrant abdominal pain, nausea, anorexia and fever. Following clinical, biochemical and radiological tests, the patient was prepared for surgical operation, with the presumed diagnosis of acute appendicitis. An appendicectomy was planned via a McBurney incision. Notably, no inflammation of the appendix was discovered. However, on further exploration, an inflammatory mass was identified in the transverse colon, which was subsequently excised and sent for histological examination. The histology results confirmed the presence of a ruptured solitary transverse colon diverticulum, accompanied by an adjacent mesenteric abscess. The patient's postoperative recovery was uneventful.
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Affiliation(s)
- Ilias Vagios
- 1st Surgical Department, Laiko General Hospital, Athens, Attica, Greece
| | - Michail Vailas
- 1st Surgical Department, Laiko General Hospital, Athens, Attica, Greece
| | - Chrysovalantis Vergadis
- Radiology, Division of Interventional Radiology, Laiko General Hospital, Athens, Attica, Greece
| | - Dimitrios Schizas
- 1st Surgical Department, Laiko General Hospital, Athens, Attica, Greece
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Agnes AL, Agnes A, Di Grezia M, Giambusso M, Savia E, Grieco M, Cozza V, Magalini S, Sganga G. Management of acute diverticulitis in Stage 0-IIb: indications and risk factors for failure of conservative treatment in a series of 187 patients. Sci Rep 2024; 14:1501. [PMID: 38233497 PMCID: PMC10794215 DOI: 10.1038/s41598-024-51526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024] Open
Abstract
Left-sided acute diverticulitis in WSES Stage 0-IIb preferentially undergoes conservative management. However, there is limited understanding of the risk factors for failure of this approach. The aim of this study was to investigate the factors associated with the decision to perform conservative treatment as well as the predictors of its failure. We included patients with a diagnosis of WSES diverticulitis CT-driven classification Stage 0-IIb treated in the Emergency Surgery Unit of the Agostino Gemelli University Hospital Foundation between 2014 and 2020. The endpoints were the comparison between the characteristics and clinical outcomes of acute diverticulitis patients undergoing conservative versus operative treatment. We also identified predictors of conservative treatment failure. A set of multivariable backward logistic analyses were conducted for this purpose. The study included 187 patients. The choice for operative versus conservative treatment was associated with clinical presentation, older age, higher WSES grade, and previous conservative treatment. There were 21% who failed conservative treatment. Of those, major morbidity and mortality rates were 17.9% and 7.1%, respectively. A previously failed conservative treatment as well as a greater WSES grade and a lower hemoglobin value were significantly associated with failure of conservative treatment. WSES classification and hemoglobin value at admission were the best predictors of failure of conservative treatment. Patients failing conservative treatment had non-negligible morbidity and mortality. These results promote the consideration of a combined approach including baseline patients' characteristics, radiologic features, and laboratory biomarkers to predict conservative treatment failure and therefore optimize treatment of acute diverticulitis.
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Affiliation(s)
- Amedea L Agnes
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy
| | - Annamaria Agnes
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy.
- Gemelli University Hospital Foundation and IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Marta Di Grezia
- Gemelli University Hospital Foundation and IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Mauro Giambusso
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy
| | - Eleonora Savia
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy
| | - Michele Grieco
- S. Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | - Valerio Cozza
- Gemelli University Hospital Foundation and IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Sabina Magalini
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy
- Gemelli University Hospital Foundation and IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Gabriele Sganga
- Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168, Rome, Italy
- Gemelli University Hospital Foundation and IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
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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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Soliman MG, Mansour HA, Hassan WA, Shawky E. Impact of Oral Probiotics in Amelioration of Immunological and Inflammatory Responses on Experimentally Induced Acute Diverticulitis. Probiotics Antimicrob Proteins 2023; 15:1113-1123. [PMID: 35838945 PMCID: PMC10491525 DOI: 10.1007/s12602-022-09969-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 12/17/2022]
Abstract
Acute diverticulitis is inflammation of a colon diverticulum; it represents a major cause of morbidity and mortality. The alteration of gut microbiota contributes to the promotion of inflammation and the development of acute diverticulitis disease. Probiotics can modify the gut microbiota, so they are considered a promising option for managing diverticulitis disease. This study aimed to investigate the potential protective effect of probiotics, alone or in combination with amoxicillin, on the experimentally induced model of acute diverticulitis disease. Forty-two rats were divided into seven groups as follows: control group: received water and food only; DSS group: received 3% dextran sulfate sodium (DSS) daily for 7 days; LPS group: injected with lipopolysaccharide (LPS) enema at the dose of (4 mg/kg); probiotics group: treated with probiotics (Lactobacillus acidophilus and Bifidobacterium lactis) each of which (4 × 108 CFU suspended in 2 ml distilled water) orally for 7 days; DSS/LPS group: received DSS and LPS; DSS/LPS treated with probiotics group; DSS/LPS treated with probiotics and amoxicillin group. The results revealed that both treatments (probiotics and probiotics-amoxicillin) attenuated DSS/LPS-induced diverticulitis, by restoring the colonic antioxidant status, ameliorating inflammation (significantly reduced TNF-α, interleukins, interferon-γ, myeloperoxidase activity, and C-reactive protein), decreasing apoptosis (through downregulating caspase-3), and reduction of the colon aerobic bacterial count. These probiotic strains were effective in preventing the development of the experimentally induced acute diverticulitis through the anti-inflammatory and immunomodulatory effects and have affected gut microbiota, so they can be considered a potential option in treating acute diverticulitis disease.
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Affiliation(s)
- Maha G Soliman
- Department of Zoology, Faculty of Science, Al-Azhar University, Cairo, Egypt
| | - Hanaa A Mansour
- Department of Pharmacology, National Organization for Drug Control and Research (NODCAR), Giza, Egypt
| | - Wedad A Hassan
- Department of Pharmacology, National Organization for Drug Control and Research (NODCAR), Giza, Egypt
| | - Eman Shawky
- Department of Zoology, Faculty of Science, Al-Azhar University, Cairo, Egypt.
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13
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Guo X, Patel B, Han L, Van Alstine WG, Noblet JN, Chambers SD, Kassab GS. Novel patch biomaterial treatment for colon diverticulosis in swine model. Front Bioeng Biotechnol 2023; 11:1215362. [PMID: 37588135 PMCID: PMC10425590 DOI: 10.3389/fbioe.2023.1215362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
Current leading managements for diverticular disease cannot prevent the recurrence of diverticulitis, bleeding and/or other complications. There is an immediate need for developing new minimal invasive therapeutic strategies to prevent and treat this disease. Through a biomechanical analysis of porcine colon with diverticular lesions, we proposed a novel adhesive patch concept aiming at mechanical reconstruction of the diseased colon wall. This study aims to evaluate the surgical feasibility (safety and efficacy) of pulmonary visceral pleura (PVP) patch therapy using a pig model of diverticulosis. Six female Yucatan miniature pigs underwent collagenase injection (CI) for the development of diverticular lesions. The lesions in each animal either received patch implantation (treated group, n = 40 for 6 pigs) or left intact (untreated group, n = 44 for 6 pigs). The normal colonic wall in each animal received patch implantation at two spots to serve as control (n = 12 for 6 pigs). After 3 months of observation, the performance and safety of the patch treatment were evaluated through macroscopic and histological examination. We found that 95% of pouch-like herniation of the mucosa was prevented from the colon wall with the treatment. The pouch diameter was significantly reduced in the treated group as compared to the untreated group (p < 0.001). The patch application caused a significant increase in the levels of collagen of the colon tissue as compared to the untreated and control groups (p < 0.001). No difference was found in the lymphocyte and macrophage inflammatory infiltrate between the groups. Our results suggest that patch treatment efficiently inhibits the diverticular pouch deformation and promotes the healing of the colon wall with a normal inflammatory response, which may minimize the risk of diverticulosis reoccurrence and complications over time.
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Affiliation(s)
- Xiaomei Guo
- California Medical Innovations Institute Inc, San Diego, CA, United States
| | - Bhavesh Patel
- California Medical Innovations Institute Inc, San Diego, CA, United States
| | - Ling Han
- California Medical Innovations Institute Inc, San Diego, CA, United States
| | | | | | | | - Ghassan S. Kassab
- California Medical Innovations Institute Inc, San Diego, CA, United States
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14
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Venezia L, Buonocore MR, Barbuscio I, Bortoluzzi F, Monica F, Manfredi G, Anderloni A, Stasi E. Choosing Wisely in Gastroenterology: five new recommendations from the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO). Eur J Gastroenterol Hepatol 2023; 35:728-733. [PMID: 37272504 DOI: 10.1097/meg.0000000000002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND 'Choosing Wisely' is an international campaign against inappropriateness in medical practices that aims to promote a rational and evidence-based use of resources. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) joined the Campaign in 2017 releasing five recommendations. AIMS To identify five new recommendations for a correct, evidence-based approach to the management of gastrointestinal diseases. METHODS All AIGO members were asked to identify practices or interventions that, even though diffuse in clinical practice, do not provide benefit for patients. The proposed items were then revised, divided by topic and ranked. After a systematic review of the literature for each item, five new recommendations were identified. RESULTS The five recommendations are: do not request surveillance investigations for patients with pancreatic cysts who are poor surgical candidates, irrespective of cysts nature and characteristics; do not request esophagogastroduodenoscopy in patients with recent onset of upper gastrointestinal symptoms younger than 50 years, without alarm features; do not request surveillance colonoscopy for asymptomatic colonic diverticular disease without changes in symptoms; do not perform food intolerance tests except for those scientifically validated; do not prescribe proton pump inhibitors to patients with liver cirrhosis, outside of established indications. CONCLUSION The Choosing Wisely recommendations will reduce unnecessary testing and treatments, increasing patient safety and overall healthcare quality.
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Affiliation(s)
- Ludovica Venezia
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria 'Maggiore della Carità', Novara
| | | | | | | | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, Academic Hospital Cattinara, Trieste
| | - Guido Manfredi
- Gastroenterology and Endoscopy Department, ASST Crema 'Maggiore' Hospital, Crema
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Matteo, Pavia
| | - Elisa Stasi
- Gastroenterology, Digestive Endoscopy, 'Vito Fazzi' Hospital, Lecce, Italy
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Sabo CM, Ismaiel M, Ismaiel A, Leucuta DC, Popa SL, Grad S, Dumitrascu DL. Do Colonic Mucosal Tumor Necrosis Factor Alpha Levels Play a Role in Diverticular Disease? A Systematic Review and Meta-Analysis. Int J Mol Sci 2023; 24:9934. [PMID: 37373082 PMCID: PMC10298590 DOI: 10.3390/ijms24129934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Diverticular disease (DD) is the most frequent condition in the Western world that affects the colon. Although chronic mild inflammatory processes have recently been proposed as a central factor in DD, limited information is currently available regarding the role of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α). Therefore, we conducted a systematic review and meta-analysis aiming to assess the mucosal TNF-α levels in DD. We conducted a systematic literature search using PubMed, Embase, and Scopus to identify observational studies assessing the TNF-α levels in DD. Full-text articles that satisfied our inclusion and exclusion criteria were included, and a quality assessment was performed using the Newcastle-Ottawa Scale (NOS). The principal summary outcome was the mean difference (MD). The results were reported as MD (95% confidence interval (CI)). A total of 12 articles involving 883 subjects were included in the qualitative synthesis, out of which 6 studies were included in our quantitative synthesis. We did not observe statistical significance related to the mucosal TNF-α levels in symptomatic uncomplicated diverticular disease (SUDD) vs. the controls (0.517 (95% CI -1.148-2.182)), and symptomatic vs. asymptomatic DD patients (0.657 (95% CI -0.883-2.196)). However, the TNF-α levels were found to be significantly increased in DD compared to irritable bowel disease (IBS) patients (27.368 (95% CI 23.744-30.992)), and segmental colitis associated with diverticulosis (SCAD) vs. IBS patients (25.303 (95% CI 19.823-30.784)). Between SUDD and the controls, as well as symptomatic and asymptomatic DD, there were no significant differences in the mucosal TNF-α levels. However, the TNF-α levels were considerably higher in DD and SCAD patients than IBS patients. Our findings suggest that TNF-α may play a key role in the pathogenesis of DD in specific subgroups and could potentially be a target for future therapies.
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Affiliation(s)
- Cristina Maria Sabo
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (C.M.S.); (S.-L.P.); (S.G.); (D.L.D.)
| | - Mohamed Ismaiel
- Department of General Surgery, Altnagelvin Hospital, Londonderry BT47 6LS, UK;
| | - Abdulrahman Ismaiel
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (C.M.S.); (S.-L.P.); (S.G.); (D.L.D.)
| | - Daniel-Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Stefan-Lucian Popa
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (C.M.S.); (S.-L.P.); (S.G.); (D.L.D.)
| | - Simona Grad
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (C.M.S.); (S.-L.P.); (S.G.); (D.L.D.)
| | - Dan L. Dumitrascu
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (C.M.S.); (S.-L.P.); (S.G.); (D.L.D.)
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16
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Waser A, Balaphas A, Uhe I, Toso C, Buchs NC, Ris F, Meyer J. Incidence of diverticulitis recurrence after sigmoid colectomy: a retrospective cohort study from a tertiary center and systematic review. Int J Colorectal Dis 2023; 38:157. [PMID: 37261498 PMCID: PMC10235134 DOI: 10.1007/s00384-023-04454-1] [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: 05/25/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Our aim was to determine the incidence of diverticulitis recurrence after sigmoid colectomy for diverticular disease. METHODS Consecutive patients who benefited from sigmoid colectomy for diverticular disease from January 2007 to June 2021 were identified based on operative codes. Recurrent episodes were identified based on hospitalization codes and reviewed. Survival analysis was performed and was reported using a Kaplan-Meier curve. Follow-up was censored for last hospital visit and diverticulitis recurrence. The systematic review of the literature was performed according to the PRISMA statement. Medline, Embase, CENTRAL, and Web of Science were searched for studies reporting on the incidence of diverticulitis after sigmoid colectomy. The review was registered into PROSPERO (CRD42021237003, 25/06/2021). RESULTS One thousand three-hundred and fifty-six patients benefited from sigmoid colectomy. Four hundred and three were excluded, leaving 953 patients for inclusion. The mean age at time of sigmoid colectomy was 64.0 + / - 14.7 years. Four hundred and fifty-eight patients (48.1%) were males. Six hundred and twenty-two sigmoid colectomies (65.3%) were performed in the elective setting and 331 (34.7%) as emergency surgery. The mean duration of follow-up was 4.8 + / - 4.1 years. During this period, 10 patients (1.1%) developed reccurent diverticulitis. Nine of these episodes were classified as Hinchey 1a, and one as Hinchey 1b. The incidence of diverticulitis recurrence (95% CI) was as follows: at 1 year: 0.37% (0.12-1.13%), at 5 years: 1.07% (0.50-2.28%), at 10 years: 2.14% (1.07-4.25%) and at 15 years: 2.14% (1.07-4.25%). Risk factors for recurrence could not be assessed by logistic regression due to the low number of incidental cases. The systematic review of the literature identified 15 observational studies reporting on the incidence of diverticulitis recurrence after sigmoid colectomy, which ranged from 0 to 15% for a follow-up period ranging between 2 months and over 10 years. CONCLUSION The incidence of diverticulitis recurrence after sigmoid colectomy is of 2.14% at 15 years, and is mostly composed of Hinchey 1a episodes. The incidences reported in the literature are heterogeneous.
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Affiliation(s)
- Alexia Waser
- Medical School, University of Geneva, Geneva, Switzerland
| | - Alexandre Balaphas
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Isabelle Uhe
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicolas C Buchs
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Ris
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Jeremy Meyer
- Medical School, University of Geneva, Geneva, Switzerland.
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland.
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17
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Piccin A, Gulotta M, di Bella S, Martingano P, Crocè LS, Giuffrè M. Diverticular Disease and Rifaximin: An Evidence-Based Review. Antibiotics (Basel) 2023; 12:antibiotics12030443. [PMID: 36978310 PMCID: PMC10044695 DOI: 10.3390/antibiotics12030443] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
There have been considerable advances in the treatment of diverticular disease in recent years. Antibiotics are frequently used to treat symptoms and prevent complications. Rifaximin, a non-absorbable antibiotic, is a common therapeutic choice for symptomatic diverticular disease in various countries, including Italy. Because of its low systemic absorption and high concentration in stools, it is an excellent medicine for targeting the gastrointestinal tract, where it has a beneficial effect in addition to its antibacterial properties. Current evidence shows that cyclical rifaximin usage in conjunction with a high-fiber diet is safe and effective for treating symptomatic uncomplicated diverticular disease, while the cost-effectiveness of long-term treatment is unknown. The use of rifaximin to prevent recurrent diverticulitis is promising, but further studies are needed to confirm its therapeutic benefit. Unfortunately, there is no available evidence on the efficacy of rifaximin treatment for acute uncomplicated diverticulitis.
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Affiliation(s)
- Anna Piccin
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Marco Gulotta
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Stefano di Bella
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Infectious Disease Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Paola Martingano
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Lory Saveria Crocè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Liver Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Mauro Giuffrè
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT 06510, USA
- Correspondence:
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18
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Protective effects of amoxicillin and probiotics on colon disorders in an experimental model of acute diverticulitis disease. Inflammopharmacology 2022; 30:2153-2165. [PMID: 36318434 DOI: 10.1007/s10787-022-01093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
AbstractAcute diverticulitis disease is associated with inflammation and infection in the colon diverticula and may lead to severe morbidity. This study aimed to evaluate and compare the protective effects of amoxicillin antibiotic, either alone or in combination with probiotics (Lactobacillus acidophilus and Bifidobacterium lactis), in a rat model of acute diverticulitis disease. Acute diverticulitis was induced, in albino rats, by adding 3% weight/volume of dextran sulfate sodium (DSS) to the rats’ drinking water; daily for 7 days, in addition to injecting lipopolysaccharide (LPS) enema (4 mg/kg). The impact of treatments was assessed by measuring the physiological and immunological parameters and evaluating colon macroscopic and microscopic lesions. The results showed that both treatments (especially probiotics with amoxicillin) alleviated the adverse effects of DSS and LPS. This was obvious through the modulation of the rats’ body weight and the colon weight-to-length ratio. Also, there was a significant (p < 0.001) decrease in the colon macroscopic lesion score. The pro-inflammatory cytokines [(TNF)-α, (IL)-1β, (IFN)-γ, and (IL)-18]; in the colon tissue; were significantly (p < 0.001) decreased. Also, both treatments significantly ameliorated the elevation of myeloperoxidase activity and C-reactive protein levels, in addition to improving the histopathological alterations in the colon tissue. In conclusion, amoxicillin and probiotics–amoxicillin were effective in preventing the development of experimentally induced acute diverticulitis, through their anti-inflammatory and immunomodulatory effects. Furthermore, this study has explored the role of probiotics in preventing DSS/LPS-induced acute diverticulitis, so it can be applied as a promising treatment option for acute diverticulitis disease.
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19
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Lactobacillus paracasei CNCM I 1572: A Promising Candidate for Management of Colonic Diverticular Disease. J Clin Med 2022; 11:jcm11071916. [PMID: 35407527 PMCID: PMC8999804 DOI: 10.3390/jcm11071916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023] Open
Abstract
Diverticular disease (DD) is a common gastrointestinal condition. Patients with DD experience a huge variety of chronic nonspecific symptoms, including abdominal pain, bloating, and altered bowel habits. They are also at risk of complications such as acute diverticulitis, abscess formation, hemorrhage, and perforation. Intestinal dysbiosis and chronic inflammation have recently been recognized as potential key factors contributing to disease progression. Probiotics, due to their ability to modify colonic microbiota balance and to their immunomodulatory effects, could present a promising treatment option for patients with DD. Lactobacillus paracasei CNCM I 1572 (LCDG) is a probiotic strain with the capacity to rebalance gut microbiota and to decrease intestinal inflammation. This review summarizes the available clinical data on the use of LCDG in subjects with colonic DD.
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20
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DeLong CG, Scow JS, Morrell DJ, Knoedler JJ, Alli VV, Winder JS, Pauli EM. Endoscopic management of colovesical and colovaginal fistulas with over-the-scope clips: A single-institution case series. Colorectal Dis 2022; 24:314-321. [PMID: 34762356 DOI: 10.1111/codi.15987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 12/09/2022]
Abstract
AIM Conventional surgical management of colovesical and colovaginal fistulas can be morbid and is contraindicated in many patients. Our aim in this work is to evaluate our experience in the management of colovesical and colovaginal fistulas with endoscopic over-the-scope (OTS) clips. METHOD A retrospective review of all patients who underwent attempted endoscopic OTS clip management of colovesical and colovaginal fistulas between 2013 and 2020 was performed. Preoperative risk factors, operative details and postoperative outcomes are reported. RESULTS Ten patients were identified. Fistula types were: colovesical (five), rectovesical (two), colovaginal (two) and rectovaginal (one). The aetiology of the fistula was diverticular disease in seven (70%) cases and surgical complication of pelvic surgery in three (30%). The mean defect age was 157 ± 98 days, the mean defect diameter was 4.5 mm (range 2-10 mm) and the mean fistula length was 15 mm (range 2-25 mm). In nine (90%) cases, fistula identification and cannulation were performed through the nonenteric lumen of the fistula. Initial management with an OTS clip was technically successful in eight (80%) patients. Of the eight patients who underwent OTS clip placement, long-term success (mean follow-up 218 days, range 25-673 days) was achieved after initial intervention in four (50%) patients. One patient underwent serial OTS clip procedures and achieved long-term success after four interventions; three patients have not undergone a repeat procedure after initial failure. CONCLUSION Endoscopic management of colovesical and colovaginal fistulas with OTS clips offers a promising therapeutic option for patients with contraindications to conventional surgical management. Immediate technical success and long-term success rates are similar to other gastrointestinal tract applications of OTS clips.
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Affiliation(s)
- Colin G DeLong
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jeffrey S Scow
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - David J Morrell
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - John J Knoedler
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Vamsi V Alli
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Joshua S Winder
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Eric M Pauli
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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21
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Yan Y, Wu JS, Pan S. Age, alcohol, sex, and metabolic factors as risk factors for colonic diverticulosis. World J Clin Cases 2022; 10:136-142. [PMID: 35071513 PMCID: PMC8727266 DOI: 10.12998/wjcc.v10.i1.136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/28/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The pathogenesis of colonic diverticulosis is not well understood. Moreover, only a few studies on colonic diverticulosis have been reported in mainland China.
AIM To evaluate the prevalence of and risk factors for asymptomatic colorectal diverticulosis in Eastern China.
METHODS From August 2016 to July 2020, 6180 asymptomatic individuals were enrolled in this cross-sectional study. These individuals had undergone physical examinations, laboratory testing, and colonoscopy. Data regarding the baseline characteristics and their general health status were obtained through interviews.
RESULTS The prevalence of colonic diverticulosis was 7.3% (449/6180). Colonic diverticulosis was detected predominantly on the right side of the colon (88.4%). Logistic regression analysis revealed that an age ≥ 60 years (adjusted odds ratio [OR] 2.149, 95% confidence interval [CI] 1.511-3.057, P < 0.001), male sex (adjusted OR: 1.878, 95%CI: 1.373-2.568, P < 0.001), obesity (adjusted OR: 1.446, 95%CI: 1.100-1.902, P = 0.008), alcohol intake (adjusted OR: 1.518, 95%CI: 1.213-1.901, P < 0.001), hypertension (adjusted OR: 1.454, 95%CI: 1.181-1.789, P < 0.001), hypertriglyceridemia (adjusted OR: 1.287, 95%CI: 1.032-1.607, P = 0.025), and hyperuricemia (adjusted OR: 1.570, 95%CI: 1.257-1.961, P < 0.001) significantly increased the risk of colonic diverticulosis.
CONCLUSION Advanced age, male sex, alcohol intake, obesity, and other metabolic-related factors, such as hypertension, hypertriglyceridemia, and hyperuricemia, were independent risk factors for colonic diverticulosis. Understanding the true prevalence of colonic diverticulosis and its associated risk factors will aid in its prevention and treatment.
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Affiliation(s)
- Ye Yan
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Jian-Sheng Wu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Shuang Pan
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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22
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Biondo S, Bordin D, Golda T. Treatment for Uncomplicated Acute Diverticulitis. COLONIC DIVERTICULAR DISEASE 2022:273-289. [DOI: https:/doi.org/10.1007/978-3-030-93761-4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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23
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Sabo CM, Dumitrascu DL, Bjarnason I. Symptomatic Uncomplicated Diverticular Disease. COLONIC DIVERTICULAR DISEASE 2022:87-97. [DOI: 10.1007/978-3-030-93761-4_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Kruis W, Bafutto M. Anti-inflammatory Agents. COLONIC DIVERTICULAR DISEASE 2022:235-244. [DOI: 10.1007/978-3-030-93761-4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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25
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Brandimarte MA, Di Rosa E, Paglione L, Di Paolo C. Burden of Diverticulosis and Diverticular Disease. COLONIC DIVERTICULAR DISEASE 2022:13-21. [DOI: 10.1007/978-3-030-93761-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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26
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Biondo S, Bordin D, Golda T. Treatment for Uncomplicated Acute Diverticulitis. COLONIC DIVERTICULAR DISEASE 2022:273-289. [DOI: 10.1007/978-3-030-93761-4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Papa A, Vetrone LM, Nakajima A, Yamada E. Prevalence of Diverticulosis and Diverticular Disease. COLONIC DIVERTICULAR DISEASE 2022:3-12. [DOI: 10.1007/978-3-030-93761-4_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Educational Case: Diverticulosis. Acad Pathol 2022; 9:100014. [PMID: 35600744 PMCID: PMC9115725 DOI: 10.1016/j.acpath.2022.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/12/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
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Piccioni A, Franza L, Vaccaro V, Saviano A, Zanza C, Candelli M, Covino M, Franceschi F, Ojetti V. Microbiota and Probiotics: The Role of Limosilactobacillus Reuteri in Diverticulitis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:802. [PMID: 34441008 PMCID: PMC8398895 DOI: 10.3390/medicina57080802] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 02/05/2023]
Abstract
The microbiota is the set of commensal microorganisms, residing in the organism, helping proper functioning of organs and systems. The role that the microbiota plays in maintaining the health of vertebrates is widely accepted, particularly in the gastrointestinal system, where it is fundamental for immunity, development, and conversion of nutrients. Dysbiosis is an alteration of the microbiota which refers to a disturbed balance, which can cause a number of pathologies. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. In particular, Lactobacilli are a group of Gram-positive bacteria, which are able to produce lactic acid through glucose metabolism. They are present in different microenvironments, ranging from the vagina, to the mouth, to different tracts of the small intestine. In the present review, we will discuss the use of Limosilactobacillus in human health in general and more specifically in diverticulitis. In particular we analyze the role of Limosilactobacillus reuteri and its anti-inflammatory action. For this review, articles were identified using the electronic PubMed database through a comprehensive search, conducted by combining key terms such as "diverticulitis", "Limosilactobacillus reuteri", "human health and disease", "probiotics". We selected all the articles published in the last 10 years and screened 1017 papers. Articles referenced in the screened papers were evaluated if considered interesting for our topic. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. The importance of probiotics in treating diverticular disease and acute diverticulitis can be further understood if taking into consideration some pathophysiological aspects, associated to the microbiota. L. reuteri plays an important role in human health and disease. The effectiveness of L. reuteri in stimulating a correct bowl motility partly explains its effectiveness in treating diverticulitis. The most important action of L. reuteri is probably its immunomodulating activity. Levels of IL-6, IL-8, and Tumor necrosis factor (TNF-alpha) are reduced after supplementation with different strands of Lactobacilli, while T-regulatory cells increase in number and activity. Anyway, new mechanisms of action of probiotics come to light from the many investigations currently taking place in numerous centres around the world and to improve how exactly probiotic administration could make the difference in the management of diverticular disease and acute diverticulitis.
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Affiliation(s)
- Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (M.C.); (M.C.); (F.F.)
| | - Laura Franza
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
| | - Vanessa Vaccaro
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
| | - Angela Saviano
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
| | - Christian Zanza
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
| | - Marcello Candelli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (M.C.); (M.C.); (F.F.)
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (M.C.); (M.C.); (F.F.)
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (M.C.); (M.C.); (F.F.)
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
| | - Veronica Ojetti
- Emergency Department, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (L.F.); (V.V.); (A.S.); (C.Z.); (V.O.)
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Saavedra-Perez D, Curbelo-Peña Y, Sampson-Davila J, Albertos S, Serrano A, Ibañez L, Errando X, Perez X. Management of symptomatic uncomplicated diverticular colon disease: A systematic review of diagnosis and treatment. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 44:497-518. [PMID: 33647346 DOI: 10.1016/j.gastrohep.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/28/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
Symptomatic uncomplicated diverticular colon disease (SUDCD) is a highly prevalent disease in our setting, which significantly affects the quality of life of patients. Recent changes in understanding the natural history of this disease and technological and pharmacological advances have increased the available options for both diagnosis and treatment. However, consensus regarding the use of these options is scarce and sometimes lacks scientific evidence. The objective of this systematic review is to clarify the existing scientific evidence and analyse the use of the different diagnostic and therapeutic options for SUDCD, comparing their advantages and disadvantages, to finally suggest a diagnostic-therapeutic algorithm for this pathology and, at the same time, propose new research questions.
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Affiliation(s)
- David Saavedra-Perez
- Servicio de Cirugía General y Digestiva, Consorci Sanitari Alt Penedes-Garraf, Barcelona, España.
| | - Yuhamy Curbelo-Peña
- Servicio de Cirugía General y Digestiva, Consorci Sanitari Alt Penedes-Garraf, Barcelona, España
| | - Jaime Sampson-Davila
- Servicio de Cirugía General y Digestiva, Consorci Sanitari Alt Penedes-Garraf, Barcelona, España
| | - Sonia Albertos
- Servicio de Digestología, Consorci Sanitari Alt Penedes-Garraf, Barcelona, España
| | - Alejandro Serrano
- Servicio de Cirugía General y Digestiva, Consorci Sanitari Alt Penedes-Garraf, Barcelona, España
| | - Luis Ibañez
- Servicio de Cirugía General y Digestiva, Consorci Sanitari Alt Penedes-Garraf, Barcelona, España
| | - Xavier Errando
- Servicio de Cirugía General y Digestiva, Consorci Sanitari Alt Penedes-Garraf, Barcelona, España
| | - Xavier Perez
- Servicio de Cirugía General y Digestiva, Consorci Sanitari Alt Penedes-Garraf, Barcelona, España
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Abstract
Diverticulosis is an anatomic change in the colon that is characterized by outpouching of the mucosa and submucosa through the muscularis. Its prevalence increases with age so most of the elderly patients have this condition. Although diverticulosis is common, diverticular disease, in which there are clinical sequelae, is rare. This collective term includes diverticulitis, diverticular hemorrhage and less well-defined entities such as segmental colitis associated with diverticulosis, and symptomatic uncomplicated diverticular disease. Diverticulitis presents as acute lower abdominal pain, and initial management traditionally includes antibiotics, with surgery reserved for complicated disease, although newer evidence questions the optimal role and timing of both interventions.
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Affiliation(s)
- David Wan
- Division of Gastroenterology and Hepatology, Joan & Sanford I. Weill Department of Medicine, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY 10021, USA
| | - Tibor Krisko
- Division of Gastroenterology and Hepatology, Joan & Sanford I. Weill Department of Medicine, Weill Cornell Medicine, 413 East 69th Street, BRB 650, New York, NY 10021, USA.
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Covino M, Papa V, Tursi A, Simeoni B, Lopetuso LR, Vetrone LM, Franceschi F, Rapaccini G, Gasbarrini A, Papa A. Development and Validation of Predictive Assessment of Complicated Diverticulitis Score. J Pers Med 2021; 11:jpm11020080. [PMID: 33572940 PMCID: PMC7911244 DOI: 10.3390/jpm11020080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
The prevalence of acute diverticulitis (AD) has progressively increased in recent decades, with correspondingly greater morbidity and mortality. The aim of the study is to develop a predictive score to identify patients with the highest risk of complicated AD. The clinical records of 1089 patients referred to the emergency department (ED) over a five-year period were reviewed. In multivariate analysis, male sex (p < 0.001), constipation (p = 0.002), hemoglobin < 11.9 g/dL (p < 0.001), C reactive protein > 80 mg/L (p < 0.001), severe obesity (p = 0.049), and no proton pump inhibitor treatment (p = 0.003) were independently associated with complicated AD. The predictive assessment of complicated (PACO)-diverticulitis (D) score, including these six variables, was applied to the retrospective cohort and then validated prospectively in a cohort including 282 patients. It categorized patients into three risk classes for complicated AD. The PACO-D score showed fair discrimination for complicated AD with an area under the receiver operating characteristic curve of 0.674 and 0.648, in the retrospective and prospective cohorts, respectively. The PACO-D score could be a practical clinical tool to identify patients at highest risk for complicated AD referred to the ED so that appropriate diagnostic and therapeutic resources could be appropriately allocated. Further external validation is needed to confirm these results.
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Affiliation(s)
- Marcello Covino
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (M.C.); (B.S.); (F.F.)
- Facoltà di Medicina e Chirurgia, Università Cattolica del S. Cuore, L.go A. Gemelli 8, 00168 Rome, Italy; (V.P.); (L.M.V.); (G.R.); (A.G.)
| | - Valerio Papa
- Facoltà di Medicina e Chirurgia, Università Cattolica del S. Cuore, L.go A. Gemelli 8, 00168 Rome, Italy; (V.P.); (L.M.V.); (G.R.); (A.G.)
- Digestive Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Antonio Tursi
- Territorial Gastroenterology Service, Azienda Sanitaria Locale Barletta-Andria-Trani, 70031 Andria, Italy;
| | - Benedetta Simeoni
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (M.C.); (B.S.); (F.F.)
| | - Loris Riccardo Lopetuso
- Department of Medicine and Ageing Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
- Center for Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Lorenzo Maria Vetrone
- Facoltà di Medicina e Chirurgia, Università Cattolica del S. Cuore, L.go A. Gemelli 8, 00168 Rome, Italy; (V.P.); (L.M.V.); (G.R.); (A.G.)
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (M.C.); (B.S.); (F.F.)
- Facoltà di Medicina e Chirurgia, Università Cattolica del S. Cuore, L.go A. Gemelli 8, 00168 Rome, Italy; (V.P.); (L.M.V.); (G.R.); (A.G.)
| | - Gianludovico Rapaccini
- Facoltà di Medicina e Chirurgia, Università Cattolica del S. Cuore, L.go A. Gemelli 8, 00168 Rome, Italy; (V.P.); (L.M.V.); (G.R.); (A.G.)
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Facoltà di Medicina e Chirurgia, Università Cattolica del S. Cuore, L.go A. Gemelli 8, 00168 Rome, Italy; (V.P.); (L.M.V.); (G.R.); (A.G.)
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Alfredo Papa
- Facoltà di Medicina e Chirurgia, Università Cattolica del S. Cuore, L.go A. Gemelli 8, 00168 Rome, Italy; (V.P.); (L.M.V.); (G.R.); (A.G.)
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-063-0151
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Viscido A, Ciccone F, Vernia F, Gabrieli D, Capannolo A, Stefanelli G, Necozione S, Valerii G, Ashktorab H, Latella G. Association of Colonic Diverticula with Colorectal Adenomas and Cancer. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57020108. [PMID: 33504050 PMCID: PMC7910864 DOI: 10.3390/medicina57020108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Conflicting evidence is reported regarding any association between colonic diverticula with colorectal adenomas or cancer. The present study aimed to evaluate, in a cohort of Caucasian patients, the association between colonic diverticula and colorectal polyps and cancer. Materials and Methods: All consecutive patients undergoing colonoscopy at our institution were included in the study. The presence and location of diverticula, polyps, and cancers were recorded. Histologically, polyps were classified as adenoma (with low or high dysplasia), hyperplastic, or inflammatory. The relative risk of the association of polyps and cancer with diverticula was assessed. Multiple logistic regression analyses, including age, sex, family history for colorectal cancer (CRC), and family history for diverticula, were carried out. Results: During the study period, 1490 patients were enrolled; 37.2% (n = 555) showed colonic diverticula or polyps or CRC (308 males, mean age 66 years). Particularly, 12.3% (n = 183) patients presented only diverticula, 13.7% (n = 204) only polyps or cancer, 11.3% (n = 168) both diseases, and 62.7% (n = 935) neither diverticula nor polyps and cancer. A total of 38 patients presented colorectal cancer, 17 of which had also diverticula. A significant increase in relative risk (RR 2.81, 95% CI 2.27-3.47, p < 0.0001) of colorectal adenoma and cancer in patients with colonic diverticula was found. At multivariate analysis, only diverticula resulted to be significantly associated with colorectal adenomas and cancer (Odds Ratio, OR 3.86, 95% CI 2.90-5.14, p < 0.0001). Conclusions: A significant association of colonic diverticula with colorectal adenoma or cancer was found. This implies that patients with colonic diverticula require a vigilant follow-up procedure for the prevention of colorectal cancer from those applicable to the general population.
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Affiliation(s)
- Angelo Viscido
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.V.); (F.V.); (A.C.); (G.S.)
| | - Fabiana Ciccone
- Gastroenterology Unit, Giuseppe Mazzini Hospital, 64100 Teramo, Italy; (F.C.); (D.G.); (G.V.)
| | - Filippo Vernia
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.V.); (F.V.); (A.C.); (G.S.)
| | - Dolores Gabrieli
- Gastroenterology Unit, Giuseppe Mazzini Hospital, 64100 Teramo, Italy; (F.C.); (D.G.); (G.V.)
| | - Annalisa Capannolo
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.V.); (F.V.); (A.C.); (G.S.)
| | - Gianpiero Stefanelli
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.V.); (F.V.); (A.C.); (G.S.)
| | - Stefano Necozione
- Epidemiology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Giorgio Valerii
- Gastroenterology Unit, Giuseppe Mazzini Hospital, 64100 Teramo, Italy; (F.C.); (D.G.); (G.V.)
| | - Hassan Ashktorab
- Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC 20059, USA;
| | - Giovanni Latella
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.V.); (F.V.); (A.C.); (G.S.)
- Correspondence: ; Tel.: +39-0862-434735; Fax: +39-0862-433425
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Giacosa A, Riva A, Petrangolini G, Allegrini P, Fazia T, Bernardinelli L, Gasparri C, Faliva MA, Peroni G, Perna S, Rondanelli M. Symptomatic uncomplicated diverticular disease management: an innovative food-grade formulation of Curcuma longa and Boswellia serrata extracts. Drugs Context 2021; 9:dic-2020-9-2. [PMID: 33408751 PMCID: PMC7747791 DOI: 10.7573/dic.2020-9-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background The treatment of symptomatic uncomplicated colonic diverticular disease (SUDD) is still under debate, and new data show a pathogenic role of dysbiosis and low-grade inflammation in intestinal mucosa. Recent research has highlighted the anti-inflammatory effects of botanical extracts such as Curcuma longa L. and Boswellia serrata Roxb. ex Colebr. The aim of this work is to investigate the potential role of a new delivery formulation of the association of curcumin and boswellia phytosome extracts (CBP) in SUDD. Methods In a 30-day one-group longitudinal explanatory study, patients (men and women) were treated with an innovative association of CBP standardized extracts, 500 mg bid. Results Treatment of SUDD with the association of CBP was followed by a significant decrease in abdominal pain (p<0.0001). The study group showed that CBP supplementation was efficacious within 10 days and that efficacy was maintained almost constant until the 30th day of intervention. Conclusion A phytosome of curcumin and boswellia extracts may be useful for the relief of SUDD pain. However, controlled studies should be performed for final conclusions to be drawn.
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Affiliation(s)
- Attilio Giacosa
- Gastroenterology Unit, Policlinico di Monza, Monza, 20900 Italy.,CDI (Centro Diagnostico Italiano), Milan, 20147 Italy
| | - Antonella Riva
- Research and Development Unit, Indena SpA, Milan, 20139 Italy
| | | | | | - Teresa Fazia
- Department of Brain and Behavioral Science, University of Pavia, Pavia, 27100 Italy
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Science, University of Pavia, Pavia, 27100 Italy
| | - Clara Gasparri
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona "Istituto Santa Margherita", University of Pavia, Pavia, 27100 Italy
| | - Milena Anna Faliva
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona "Istituto Santa Margherita", University of Pavia, Pavia, 27100 Italy
| | - Gabriella Peroni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona "Istituto Santa Margherita", University of Pavia, Pavia, 27100 Italy
| | - Simone Perna
- Department of Biology, University of Bahrain, College of Science, Sakhir Campus P. O. Box, 32038 Kingdom of Bahrain
| | - Mariangela Rondanelli
- IRCCS Mondino Foundation, Pavia, 27100 Italy.,Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, Pavia, 27100 Italy
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Hutchison LC. Pharmacology of Aging. GERIATRIC GASTROENTEROLOGY 2021:249-277. [DOI: 10.1007/978-3-030-30192-7_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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The Effects of Diverticulum Localization and Hinchey Classification on Recurrence and Complications in Acute Colonic Diverticulitis. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:451-456. [PMID: 33364886 PMCID: PMC7751249 DOI: 10.14744/semb.2020.03453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023]
Abstract
Objectives: Diverticular disease of the colon is a pathology that arises from outward ballooning of the mucosa due to some weakness in the muscle layer. Diverticular disease may range from symptomatic uncomplicated diverticular disease to symptomatic disease with complications, such as acute diverticulitis or diverticular bleeding. Acute colonic diverticulitis occurs in about 10- 25% of patients. Methods: In this study, 134 patients who were admitted to our emergency clinic with complaints of abdominal pain between 2016-2019 and hospitalized with the diagnosis of acute diverticulitis were included. Patients’ sex, age, presence of additional disease, increase in leukocyte and C-reactive protein (CRP), localization of diverticulitis, Hinchey classification, mean length of hospital stay and treatment were evaluated. The effects of these parameters on complications and recurrence were statistically analyzed. Results: The length of hospital stay was statistically significantly associated positively with the Hinchey classification (p<0.001). While 18 patients who were medically treated developed recurrence later, and this rate was statistically significant (p<0.001). When one of the factors, localization, which may play a role in the severity of the disease and recurrence are examined, was evaluated concerning its results in our study, we found that rectosigmoid location is an important factor for recurrence. We found that the localization in the colon and the severity of the disease were effective in the prognosis of acute diverticulitis. Conclusion: We believe that localization and the severity of the disease should be taken into consideration when planning surgery in these patients.
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Lauro A, Pozzi E, Vaccari S, Cervellera M, Tonini V. Drains, Germs, or Steel: Multidisciplinary Management of Acute Colonic Diverticulitis. Dig Dis Sci 2020; 65:3463-3476. [PMID: 32980955 DOI: 10.1007/s10620-020-06621-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 02/05/2023]
Abstract
The medical and surgical management of uncomplicated diverticulitis has changed over the last several years. Although immunocompetent patients or those without comorbidities can be treated with antibiotics as an outpatient, the efficacy of high-fiber intake or drugs such as mesalamine or rifaximin is not yet clearly established in the treatment of acute episodes and in the prevention of recurrences. On the other hand, the choice between antibiotic treatment and percutaneous drainage is not always obvious in diverticulitis complicated by abscess formation, especially for larger abscesses; although the results of studies comparing the two approaches remain controversial, surgery must be pursued for abscesses > 8 cm. For emergency surgery, the debate is still ongoing regarding laparoscopic lavage and surgical resection followed by primary anastomosis, since for both approaches the published reports are not in agreement regarding possible benefits. Therefore, these approaches are recommended only for selected patients under the care of experienced surgeons. Also, the contribution of elective surgery toward the overall approach has been revised; currently, it is reserved primarily for patients with a high risk of recurrence and whenever more conservative treatments were not effective.
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Affiliation(s)
- Augusto Lauro
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - Eleonora Pozzi
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - Samuele Vaccari
- Department of Surgical Sciences, Umberto I University Hospital - La Sapienza, Rome, Italy.
| | - Maurizio Cervellera
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
| | - Valeria Tonini
- Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy
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Guimarães MAL, Barbosa LER. Safety and effectiveness of laparoscopic peritoneal lavage in Hinchey III diverticulitis. JOURNAL OF COLOPROCTOLOGY 2020; 40:300-308. [DOI: 10.1016/j.jcol.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Abstract
Introduction The management of Hinchey III diverticulitis has been subject to investigation over the years. Hartmann's procedure is widely referred as the standard treatment. However, this option is associated with relevant morbidity and mortality which motivated the arise of alternative interventions such as the laparoscopic peritoneal lavage.
Aim The aim of this review is to synthesize the evidence on the safety and effectiveness of laparoscopic peritoneal lavage in the management of diverticulitis with generalized purulent peritonitis in comparison to resection procedures.
Materials and methods The bibliographic research was conducted using the electronic database Medline from Pubmed. Of the 358 articles identified, our criterious selection resulted in a total of 27 articles for review.
Results Overall, laparoscopic lavage revealed low mortality rates with no remarkable differences between procedures. The non-randomized studies tended to show lower recurrence and morbidity rates comparatively to the latest RCTs, in the lavage groups, however, no significant differences have been found.
Discussion and conclusion In this review, laparoscopic peritoneal lavage proved to be safe and comparatively effective, although not superior to resection, reaching mixed results. We believe it can be applied as a damage control operation to treat or as a bridge to elective resection. Still, more studies are needed to determine indications and factors for the success of laparoscopic lavage.
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Affiliation(s)
| | - Laura Elisabete Ribeiro Barbosa
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
- Centro Hospitalar São João, Serviço de Cirurgia Geral, Porto, Portugal
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Tursi A, Violi A, Cambie' G, Franceschi M, Baldassarre G, Rodriguez KI, Miraglia C, Brandimarte G, Elisei W, Picchio M, Di Mario F. Risk factors for endoscopic severity of diverticular disease of the colon and its outcome: a real-life case-control study. Eur J Gastroenterol Hepatol 2020; 32:1123-1129. [PMID: 32483087 DOI: 10.1097/meg.0000000000001787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Diverticular disease is an increasing global problem. AIMS To assess the factors associated with the severity of diverticular disease and its outcome, analyzing a real-life population. METHODS A cohort of patients, submitted to colonoscopy from 1 January 2012 to 30 April 2018 was revised. The endoscopic severity of diverticular disease was scored according to the Diverticular Inflammation and Complications Assessment (DICA) classification. RESULTS A cohort of 11 086 patients was identified during the study period, 5635 with diverticulitis and 5451 without diverticulosis. Blood hypertension, diabetes and angiotensin receptor blocker users occurred more frequently in the study group, while the prevalence of colorectal cancer (CRC) was significantly lower. Age >70 years, BMI >30 and blood hypertension were factors independently related to the presence of diverticulosis, while diabetes and CRC were significantly associated with the absence of diverticulosis. Female sex, age, smoke, appendectomy, proton-pump inhibitors and acetyl-salicylic acid use were directly related to the severity of diverticular disease, while CRC and colonic polyp occurrence were inversely related to the severity of diverticular disease, significantly. Female sex, age >70 years and smoke were significantly related to the severity of diverticular disease. CRC and colonic polyps were significantly less in DICA 3 patients. DICA 3 patients were more often symptomatic, at higher risk of hospital admission, longer hospital stay and higher mean costs. CONCLUSIONS Several factors are associated with the severity of diverticular disease according to the DICA classification. The DICA classification is also predictive of the outcome of the disease in terms of hospital admission, stay and costs.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria (BT)
| | - Alessandra Violi
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma
| | - Ginevra Cambie'
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma
| | | | | | | | - Chiara Miraglia
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma
| | | | | | - Marcello Picchio
- Division of Surgery, 'P. Colombo' Hospital, Velletri, Rome, Italy
| | - Francesco Di Mario
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma
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Keady C, Hechtl D, Joyce M. When the bowel meets the bladder: Optimal management of colorectal pathology with urological involvement. World J Gastrointest Surg 2020; 12:208-225. [PMID: 32551027 PMCID: PMC7289647 DOI: 10.4240/wjgs.v12.i5.208] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/10/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
Fistulae between the gastrointestinal and urinary systems are rare but becoming increasingly more common in current surgical practice. They are a heterogeneous group of pathological entities that are uncommon complications of both benign and malignant processes. As the incidence of complicated diverticular disease and colorectal malignancy increases, so too does the extent of fistulous connections between the gastrointestinal and urinary systems. These complex problems will be more common as a factor of an aging population with increased life expectancy. Diverticular disease is the most commonly encountered aetiology, accounting for up to 80% of cases, followed by colorectal malignancy in up to 20%. A high index of suspicion is required in order to make the diagnosis, with ever improving imaging techniques playing an important role in the diagnostic algorithm. Management strategies vary, with most surgeons now advocating for a single-stage approach to enterovesical fistulae, particularly in the elective setting. Concomitant bladder management techniques are also disputed. Traditionally, open techniques were the standard; however, increased experience and advances in surgical technology have contributed to refined and improved laparoscopic management. Unfortunately, due to the relative rarity of these entities, no randomised studies have been performed to ascertain the most appropriate management strategy. Rectourinary fistulae have dramatically increased in incidence with advances in the non-operative management of prostate cancer. With radiotherapy being a major contributing factor in the development of these complex fistulae, optimum surgical approach and exposure has changed accordingly to optimise their management. Conservative management in the form of diversion therapy is effective in temporising the situation and allowing for the diversion of faecal contents if there is associated soiling, macerated tissues or associated co-morbidities. One may plan for definitive surgical intervention at a later stage. Less contaminated cases with no fibrosis may proceed directly to definitive surgery if the appropriate expertise is available. An abdominal approach with direct repair and omentum interposition between the repaired tissues has been well described. In low lying fistulae, a transperineal approach with the patient in a prone-jack knife position provides optimum exposure and allows for the use of interposition muscle grafts. According to recent literature, it offers a high success rate in complex cases.
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Affiliation(s)
- Conor Keady
- Department of Colorectal Surgery, Galway University Hospital, Galway H91 YR71, Ireland
| | - Daniel Hechtl
- Department of Colorectal Surgery, Galway University Hospital, Galway H91 YR71, Ireland
| | - Myles Joyce
- Department of Colorectal Surgery, Galway University Hospital, Galway H91 YR71, Ireland
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Marchante IS, Mohedas RC. Enfermedad diverticular del intestino grueso. MEDICINE - PROGRAMA DE FORMACIÓN MÉDICA CONTINUADA ACREDITADO 2020; 13:434-440. [DOI: 10.1016/j.med.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Tursi A, Scarpignato C, Strate LL, Lanas A, Kruis W, Lahat A, Danese S. Colonic diverticular disease. Nat Rev Dis Primers 2020; 6:20. [PMID: 32218442 PMCID: PMC7486966 DOI: 10.1038/s41572-020-0153-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
Diverticula are outpouchings of the intestinal wall and are common anatomical alterations detected in the human colon. Colonic diverticulosis (the presence of diverticula in the colon; referred to as diverticulosis) remains asymptomatic in most individuals but ~25% of individuals will develop symptomatic diverticulosis, termed colonic diverticular disease (also known as diverticular disease). Diverticular disease can range in severity from symptomatic uncomplicated diverticular disease (SUDD) to symptomatic disease with complications such as acute diverticulitis or diverticular haemorrhage. Since the early 2000s, a greater understanding of the pathophysiology of diverticulosis and diverticular disease, which encompasses genetic alterations, chronic low-grade inflammation and gut dysbiosis, has led to improvements in diagnosis and management. Diagnosis of diverticular disease relies on imaging approaches, such as ultrasonography, CT and MRI, as biomarkers alone are insufficient to establish a diagnosis despite their role in determining disease severity and progression as well as in differential diagnosis. Treatments for diverticular disease include dietary fibre, pharmacological treatments such as antibiotics (rifaximin), anti-inflammatory drugs (mesalazine) and probiotics, alone or in combination, and eventually surgery. Despite being effective in treating primary disease, their effectiveness in primary and secondary prevention of complications is still uncertain.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, Azienda Sanitaria Locale Barletta-Andria-Trani, Andria, Italy.
| | - Carmelo Scarpignato
- Faculty of Health Sciences, LUdeS Lugano Campus, Lugano, Switzerland
- United Campus of Malta, Birkirkara, Msida, Malta
| | - Lisa L Strate
- Division of Gastroenterology, Department of Medicine, Harborview Medical Center, University of Washington Medical School, Seattle, WA, USA
| | - Angel Lanas
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, University of Zaragoza, IIS Aragón (CIBERehd), Zaragoza, Spain
| | | | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center - IRCCS -, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Park JH, Park HC, Lee BH. One-day versus four-day antibiotic treatment for acute right colonic uncomplicated diverticulitis: A randomized clinical trial. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 30:605-610. [PMID: 31290747 DOI: 10.5152/tjg.2019.17775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS Currently, right colonic uncomplicated diverticulitis is typically treated with antibiotic therapy. However, the optimal duration of treatment is unknown. The aim of the present study was to compare the treatment failure rates between 1- and 4-day antibiotic treatment protocols. MATERIALS AND METHODS A prospective randomized study in adults presenting with uncomplicated diverticulitis at the first episode from July 2011 to June 2014 was performed. Patients were randomized to receive intravenous antibiotics for 1 day (1-day group) or intravenous and oral antibiotics for 4 days (4-day group). All patients received cefmetazole and metronidazole. Treatment failure was defined as readmission within 30 days and disease recurrence during the follow-up period. RESULTS Overall, 87 and 89 patients were randomized to the 1-day and 4-day groups, respectively. All patients were successfully treated initially. The hospital length of stay was shorter in the 1-day group than in the 4-day group (3.1 vs. 3.8 days, respectively; p<0.001). After discharge, there were no significant differences between the groups in treatment failure (15/87, 17.2% vs. 19/89, 21.3%; p=0.493). In each group, there were readmission within 30 days (9.2% vs. 12.4%; p=0.502) and recurrence over a median follow-up period of 32 months (10.3% vs. 9.0%; p=0.762). In 34 patients who experienced treatment failure, 6 required surgery. CONCLUSION Single-day antibiotic treatment is as effective as 4-day therapy for the prevention of readmission and recurrence in patients with right colonic uncomplicated diverticulitis.
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Affiliation(s)
- Jung Ho Park
- Department of Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Hyoung Chul Park
- Department of Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Bong Hwa Lee
- Department of Surgery, Hallym University College of Medicine, Anyang, Korea
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Abu Baker F, Z'cruz De La Garza JA, Mari A, Zeina AR, Bishara A, Gal O, Kopelman Y. Colorectal Cancer and Polyps in Diverticulosis Patients: A 10-Year Retrospective Study in 13680 Patients. Gastroenterol Res Pract 2019; 2019:2507848. [PMID: 31871446 PMCID: PMC6913345 DOI: 10.1155/2019/2507848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/07/2019] [Accepted: 10/29/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Shared by certain epidemiological and etiological characteristics, diverticulosis and colorectal cancer (CRC) as well as colonic polyps has long been linked. This association was studied in several heterogeneous studies but has reported inconsistent results. Clarifying the association is clinically relevant for endoscopist awareness and potential modification of screening and surveillance intervals for diverticulosis patients. METHODS In this retrospective single-center study, patients diagnosed with diverticulosis on colonoscopy over a 10-year period were included. Each diverticulosis patient was matched with 1 control by age, gender, setting (inpatient/outpatient), and procedure's indication. CRC and polyp detection rates were recorded and compared between the groups before and after adjustment for bowel preparation quality and exam completion. CRC location was recorded and compared between groups. RESULTS A cohort of 13680 patients (6840 patients with diverticulosis and 6840 matched controls) was included. Diverticulosis was located mainly to the sigmoid and left colon (94.4%). The CRC diagnosis rate was lower in the diverticulosis group (2% vs. 4.5%, odds ratio = 0.472, P < 0.001, and 95%CI = 0.382-0.584). Moreover, location of CRC was unrelated to diverticulosis location, as more CRCs in the diverticulosis group were located proximal to the splenic flexure as compared to the control group (42.5% vs 29.5%, respectively; P = 0.007). Diverticulosis, however, was associated with an increased polyp detection rate compared to controls (30.5% vs. 25.5%; odds ratio = 1.2, P < 0.001, and 95%CI = 1.11-1.299). CONCLUSION We demonstrated that diverticulosis was not associated with an increased risk for CRC. A possible increased polyp detection rate, however, warrants further evaluation in large prospective studies.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Affiliated to the Technion Faculty of Medicine, Hadera, Haifa, Israel
| | | | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital, Affiliated to the Faculty of Medicine, Bar Ilan University, Israel
| | - Abdel-Rauf Zeina
- Department of Radiology, Hillel Yaffe Medical Center, Affiliated to the Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amani Bishara
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Affiliated to the Technion Faculty of Medicine, Hadera, Haifa, Israel
| | - Oren Gal
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Affiliated to the Technion Faculty of Medicine, Hadera, Haifa, Israel
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Affiliated to the Technion Faculty of Medicine, Hadera, Haifa, Israel
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Zullo A, Gatta L, Vassallo R, Francesco VD, Manta R, Monica F, Fiorini G, Vaira D. Paradigm shift: the Copernican revolution in diverticular disease. Ann Gastroenterol 2019; 32:541-553. [PMID: 31700230 PMCID: PMC6826076 DOI: 10.20524/aog.2019.0410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022] Open
Abstract
Diverticular disease (DD) is an umbrella definition that includes different clinical conditions ranging from diverticulosis to severe and potentially life-threatening complications. In the last decade, new concepts regarding pathogenetic alterations have been developed, while the diagnostic, clinical and therapeutic approaches to the management of DD patients have changed. The protective role of dietary factors (i.e., fiber) has been questioned, whilst some drugs widely used in clinical practice have been found to have a deleterious effect. The use of antibiotics in all patients with acute uncomplicated diverticulitis was reconsidered, as well as the need for a surgical approach in these patients. Conflicting recommendations in different guidelines were proposed for the treatment of symptomatic uncomplicated DD. An endoscopic classification of DD was introduced, and a "curative" endoscopic approach has been pioneered. Based on these observations, which together amount to a kind of "Copernican revolution" in the management of DD patients, we performed a comprehensive and critical reappraisal of the proposed modifications, aiming to discriminate between certainties and doubts on this issue.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome (Angelo Zullo)
| | - Luigi Gatta
- Gastroenterology and Endoscopy Unit, Versilia Hospital, Lido di Camaiore (Luigi Gatta)
| | - Roberto Vassallo
- Gastroenterology and Digestive Endoscopy; “Buccheri la Ferla, Fatebenefratelli”, Hospital, Palermo (Roberto Vassallo)
| | - Vincenzo De Francesco
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia (Vincenzo De Francesco)
| | - Raffaele Manta
- Gastroenterology and Digestive Endoscopy, “Generale” Hospital, Perugia (Raffaele Manta)
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, Academic Hospital Cattinara, Trieste (Fabio Monica)
| | - Giulia Fiorini
- Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna (Giulia Fiorini, Dino Vaira), Italy
| | - Dino Vaira
- Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna (Giulia Fiorini, Dino Vaira), Italy
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Choe EK, Lee JE, Chung SJ, Yang SY, Kim YS, Shin ES, Choi SH, Bae JH. Genome-wide association study of right-sided colonic diverticulosis in a Korean population. Sci Rep 2019; 9:7360. [PMID: 31089239 PMCID: PMC6517584 DOI: 10.1038/s41598-019-43692-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 04/27/2019] [Indexed: 02/06/2023] Open
Abstract
Diverticulosis results from complex interactions related to aging, environmental factors and genetic predisposition. Despite epidemiologic evidence of genetic risk factors, there has been no attempt to identify genes that confer susceptibility to colonic diverticulosis. We performed the first genome-wide association study (GWAS) on susceptibility to diverticulosis in a Korean population. A GWAS was carried out in 7,948 healthy individuals: 893 patients and 1,075 controls comprised the test set, and 346 patients and 305 controls comprised the replication set. Diverticulosis was diagnosed by colonoscopy during comprehensive medical check-ups, and single-nucleotide polymorphisms (SNPs) related to diverticulosis were detected with the Affymetrix Axiom KORV1.1-96 Array. In all, 9 SNPs were identified in three SNP aggregates in the test set (P < 10−3, within 200 kb) after adjusting for sex. All the SNPs were replicated in the replication set (P < 0.05). Three SNPs were near the WNT4 gene, four near the RHOU gene, and two in the OAS1/3 genes. The top SNP associated with right-sided colonic diverticulosis was rs22538787, located near the WNT4 gene [combined set, P-value = 3.128 × 10−6, odds ratio = 1.415 (95% confidence interval: 1.223–1.637)]. These 9 novel SNP alleles associated with the WNT4, RHOU, and OAS1/3 genes are possibly involved in the underlying genetic susceptibility to right-sided diverticulosis. Our results provide basic knowledge about the development of diverticulosis in an Asian population.
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Affiliation(s)
- Eun Kyung Choe
- Department of Surgery, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | | | - Su Jin Chung
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam, Seoul, Korea
| | - Sun Young Yang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam, Seoul, Korea
| | - Young Sun Kim
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam, Seoul, Korea
| | | | - Seung Ho Choi
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam, Seoul, Korea
| | - Jung Ho Bae
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam, Seoul, Korea.
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48
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Golovanova EV. Cyclic rifaximin and soluble dietary fiber therapy for symptomatic diverticular disease: effective prevention of complications. MEDICAL COUNCIL 2019:98-107. [DOI: 10.21518/2079-701x-2019-3-98-107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
The article discusses the current issues of managing patients with colonic diverticular disease. The prevalence of pathology is steadily increasing, which is due to the more frequent diagnosis of the disease and the increase in life expectancy of the population. Meanwhile, the wrong approaches to the management of this category of patients can result in the development of serious complications that often result in fatal outcomes. The paper presents data on the efficacy of rifaximin therapy of colonic diverticular disease, including using cyclic courses that significantly reduce the risk of complications. Particular attention is paid to the role of dietary fiber in the prevention of the inflammation development in the diverticular disease, including dietary fiber combined with rifaximin.
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Affiliation(s)
- E. V. Golovanova
- Federal State Budgetary Educational Institution of the Higher Education «Moscow State University of Medicine and Dentistry named after A.I. Yevdokimov» of the Ministry of Healthcare of the Russian Federation
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Rottier SJ, de Jonge J, Dreuning LC, van Pelt J, van Geloven AAW, Beele XDY, Huisman PM, Deurholt WY, Rottier CA, Boermeester MA, Schreurs WH. Prevalence of alpha-1-antitrypsin deficiency carriers in a population with and without colonic diverticula. A multicentre prospective case-control study: the ALADDIN study. Int J Colorectal Dis 2019; 34:933-938. [PMID: 30767045 DOI: 10.1007/s00384-019-03248-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE The underling pathophysiological mechanisms that cause the formation of colonic diverticula (diverticulosis) remain unclear. Connective tissue changes due to ageing that cause changes in collagen structure of the colonic wall is one theory. Alpha-1-antitrypsin (A1AT) is a protease inhibitor known to protect connective tissue in other organs. Associations between (carriers of) A1AT deficiency and the development of colonic diverticula will be the main focus of this study. METHODS A multicentre prospective case-controlled study. In total, 230 patients ≥ 60 years with acute abdominal pain undergoing an abdominal computed tomography (CT) will be included. The research group consists of patients with diverticulosis and/or diverticulitis; controls are patients without diverticula (0 to ≤ 5 diverticula). Genotype analysis for A1AT deficiency will be performed. RATIONALE Hypothetically, connective tissue changes, in particular related to (carriers of) A1AT deficiency, can contribute to the development of diverticula and diverticulitis. We expect to find a higher prevalence of A1AT carriers in patients with diverticulosis compared to patients without diverticulosis. Having diverticulosis does not affect the general health of these individuals per se, when asymptomatic. Once an association is found, present findings can be the basis for a second study to assess the risk of developing acute diverticulitis and its disease course in carriers of A1AT deficiency. Because a large cohort is needed in the latter, we shall first perform a pilot study to investigate the likelihood of the primary hypothesis. TRIAL REGISTRATION Netherlands Trial register, NTR6251, NL55016.094.15.
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Affiliation(s)
- S J Rottier
- Department of Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar/Den Helder, Netherlands.
- Department of Surgery, Tergooi, Hilversum, Netherlands.
- Department of Surgery, Amsterdam UMC, Amsterdam, Netherlands.
| | - J de Jonge
- Department of Surgery, Tergooi, Hilversum, Netherlands
| | - L C Dreuning
- Department of Surgery, Tergooi, Hilversum, Netherlands
| | - J van Pelt
- Department of Clinical laboratory, Northwest Clinics, Alkmaar/Den Helder, Netherlands
| | | | - X D Y Beele
- Department of Radiology, Tergooi, Hilversum, Netherlands
| | - P M Huisman
- Department of Radiology, Tergooi, Hilversum, Netherlands
| | - W Y Deurholt
- Department of Radiology, Northwest Clinics, Alkmaar/Den Helder, Netherlands
| | - C A Rottier
- Department of Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar/Den Helder, Netherlands
| | - M A Boermeester
- Department of Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - W H Schreurs
- Department of Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar/Den Helder, Netherlands
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Bolkenstein HE, van de Wall BJ, Consten EC, van der Palen J, Broeders IA, Draaisma WA. Development and validation of a diagnostic prediction model distinguishing complicated from uncomplicated diverticulitis. Scand J Gastroenterol 2019; 53:1291-1297. [PMID: 30394135 DOI: 10.1080/00365521.2018.1517188] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Most diverticulitis patients (80%) who are referred to secondary care have uncomplicated diverticulitis (UD) which is a self-limiting disease and can be treated at home. The aim of this study is to develop a diagnostic model that can safely rule out complicated diverticulitis (CD) based on clinical and laboratory parameters to reduce unnecessary referrals. METHODS A retrospective cross-sectional study was performed including all patients who presented at the emergency department with CT-proven diverticulitis. Patient characteristics, clinical signs and laboratory parameters were collected. CD was defined as > Hinchey 1A. Multivariable logistic regression analyses were used to quantify which (combination of) variables were independently related to the presence or absence of CD. A diagnostic prediction model was developed and validated to rule out CD. RESULTS A total of 943 patients were included of whom 172 (18%) had CD. The dataset was randomly split into a derivation and validation set. The derivation dataset contained 475 patients of whom 82 (18%) patients had CD. Age, vomiting, generalized abdominal pain, change in bowel habit, abdominal guarding, C-reactive protein and leucocytosis were univariably related to CD. The final validated diagnostic model included abdominal guarding, C-reactive protein and leucocytosis (AUC 0.79 (95% CI 0.73-0.84)). At a CD risk threshold of ≤7.5% this model had a negative predictive value of 96%. CONCLUSION This proposed prediction model can safely rule out complicated diverticulitis. Clinical practitioners could cautiously use this model to aid them in the decision whether or not to subject patients to further secondary care diagnostics or treatment.
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Affiliation(s)
| | | | - Esther Cj Consten
- b Department of Surgery , Diakonessenhuis , Utrecht , The Netherlands.,c Department of Surgery , Meander Medical Centre , Amersfoort , The Netherlands
| | - Job van der Palen
- d Department of Research Methodology, Measurement & Data Analysis , University of Twente , Enschede , The Netherlands
| | - Ivo Amj Broeders
- b Department of Surgery , Diakonessenhuis , Utrecht , The Netherlands.,e Department of Surgery , Meander Medical Centre , Amersfoort , The Netherlands
| | - Werner A Draaisma
- b Department of Surgery , Diakonessenhuis , Utrecht , The Netherlands.,f Department of Surgery , Jeroen Bosch Hospital , 's-Hertogenbosch , The Netherlands
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