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Kameyama H, Yamazaki T, Iwaya A, Uehara H, Utsumi S, Hirai M, Komatsu M, Kubota A, Katada T, Kobayashi K, Sato D, Yokoyama N, Kuwabara S, Otani T. Surgical approach for right-sided colonic diverticular bleeding: A single-center review of 43 consecutive cases. Asian J Endosc Surg 2021; 14:717-723. [PMID: 33595203 DOI: 10.1111/ases.12929] [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: 01/07/2021] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION While Asian populations develop colonic diverticular disease predominantly in the right colon, Western populations mainly present with left-sided disease. The present study aimed to clarify the outcomes of surgical treatment for right-sided colonic diverticular bleeding. METHODS Medical records of 43 patients who underwent surgery for right-sided colonic diverticular bleeding between 2010 and 2019 were reviewed. Those whose general condition became unstable underwent open surgery at our institution. Patients were then divided into two groups, the open surgery group (n = 17) and laparoscopic surgery group (n = 26), after which operative outcomes between both groups were compared. RESULTS This study included 36 men and seven women with a median age of 76 (range: 37-91) years. Laparoscopic surgery had a significantly longer operative time (183.5 minutes vs 110 minutes; P < .001) and significantly lower intraoperative blood transfusion rate (19.2% vs 82.4%; P < .001) than open surgery. The laparoscopic surgery group had earlier resumption of postoperative meals than open surgery group (postoperative day 3 vs postoperative day 4; P = .010). No significant difference in postoperative complications was observed between both groups. With regard to long-term outcomes, none of the cases exhibited rebleeding from the right-sided colon. CONCLUSION The present study revealed that laparoscopic surgery promoted lower intraoperative blood transfusion rates and earlier resumption of postoperative meals compared to open surgery for right-sided colonic diverticular bleeding. Hence, laparoscopic surgery can be feasible for right-sided colonic diverticular bleeding provided that the patient's general condition is stable.
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Affiliation(s)
- Hitoshi Kameyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Toshiyuki Yamazaki
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Akira Iwaya
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Hiroaki Uehara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Shiori Utsumi
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Motoharu Hirai
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Masaru Komatsu
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Akira Kubota
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Tomohiro Katada
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Kazuaki Kobayashi
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Daisuke Sato
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Naoyuki Yokoyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Shirou Kuwabara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Tetsuya Otani
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
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Soh YSA, Ooi SQD, Chan YH, Siah THK, Lee SE, Lee WJJ, Zhu F, Yeoh KG, Gwee KA. Rising prevalence of colonic diverticulosis in a westernized multi-ethnic Asian community. J Gastroenterol Hepatol 2021; 36:413-420. [PMID: 32602133 DOI: 10.1111/jgh.15165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/16/2020] [Accepted: 06/20/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIM Singapore is a multi-ethnic country that has undergone rapid development over the last few decades, with increasing influence of western culture, and faces an aging population. Previously, a varying prevalence of colonic diverticulosis (CD) was reported by a few small studies. This study aims to evaluate the prevalence of CD in Singapore and identify associations with common gastrointestinal symptoms and risk factors. METHODS We reviewed retrospective data of 20 395 consecutive colonoscopies performed from 2006 to 2016 for presence of CD and indications of screening, diarrhea, constipation, and abdominal pain. RESULTS The prevalence of CD progressively increased from 2006 to 2016 (14.9% vs 23.9%, adjusted trend < 0.001), with an overall prevalence of 19.6%. Patients with CD were older and had higher body mass index (BMI). CD was significantly more prevalent in Chinese compared with Malay and Indian races (20.5% vs 18.9% vs 15.5%, P < 0.05), and in male patients compared with female patients (21.5% vs 17.6%, P < 0.05). Right-sided CD was more common than left-sided or pan diverticulosis (16.2% vs 8.3% vs 4.8%, P < 0.05). Age [odds ratio (OR), 1.060; 95% confidence interval (CI), 1.052-1.068], BMI (OR, 1.051; 95% CI, 1.028-1.075), male gender (OR, 1.317; 95% CI, 1.084-1.600), and abdominal pain (OR, 1.409; 95% CI, 1.168-1.699) were positively associated, while constipation (OR, 0.566; 95% CI, 0.452-0.709) was negatively associated with CD. CONCLUSION The prevalence of CD in Singapore has progressively increased over the last decade and is associated with older age, higher BMI, and abdominal pain. These findings may provide insights for healthcare resource planning in the region.
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Affiliation(s)
- Yu Sen Alex Soh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shu Qin Delicia Ooi
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School Medicine, National University of Singapore, Singapore
| | - Tien-Ho Kewin Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Soh-Ee Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Jie Jonathan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Feng Zhu
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Khay Guan Yeoh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kok-Ann Gwee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Wu Z, Broad J, Sluyter J, Waayer D, Camargo CA, Scragg R. Effect of monthly vitamin D on diverticular disease hospitalization: Post-hoc analysis of a randomized controlled trial. Clin Nutr 2020; 40:839-843. [PMID: 32919816 DOI: 10.1016/j.clnu.2020.08.030] [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: 07/16/2020] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND & AIMS Some studies have linked low vitamin D status and high risk of diverticular disease, but the causal relationship between vitamin D and diverticular disease remains unclear; clinical trial data are warranted. The objective was to assess the efficacy of vitamin D3 supplementation on diverticular disease hospitalization. METHODS Post-hoc analysis of a community-based randomized double-blind placebo-controlled trial (RCT) with 5108 participants randomized to receive monthly 100,000 IU vitamin D (n = 2558) or identical placebo (n = 2550). The outcome was time to first diverticular disease hospitalization from randomization to the end of intervention (July 2015), including a prespecified subgroup analysis in participants with baseline deseasonalized 25-hydroxyvitamin D (25(OH)D) levels < 50 nmol/L. RESULTS Over a median of 3.3 years follow-up, 74 participants had diverticular disease hospitalization. There was no difference in the risk of diverticular disease hospitalization between vitamin D supplementation (35/2558 = 1.4%) and placebo (39/2550 = 1.5%) groups (adjusted hazard ratio (HR) = 0.90; p = 0.65), although in participants with deseasonalized 25(OH)D < 50 nmol/L (n = 1272), the risk was significantly lower in the vitamin D group than placebo (HR = 0.08, p = 0.02). DISCUSSION Monthly 100,000 IU vitamin D3 does not reduce the risk of diverticular disease hospitalization in the general population. Further RCTs are required to investigate the effect of vitamin D supplementation on the diverticular disease in participants with low 25(OH)D levels.
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Affiliation(s)
- Zhenqiang Wu
- School of Population Health, University of Auckland, Auckland, New Zealand; Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Joanna Broad
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - John Sluyter
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Debbie Waayer
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand.
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Strate LL, Morris AM, Hinchey EJ, Lough JO, Goresky CA. Epidemiology, Pathophysiology, and Treatment of Diverticulitis. Gastroenterology 2019; 156:1282-1298.e1. [PMID: 30660732 PMCID: PMC6716971 DOI: 10.1053/j.gastro.2018.12.033] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 02/06/2023]
Abstract
Diverticulitis is a prevalent gastrointestinal disorder that is associated with significant morbidity and health care costs. Approximately 20% of patients with incident diverticulitis have at least 1 recurrence. Complications of diverticulitis, such as abdominal sepsis, are less likely to occur with subsequent events. Several risk factors, many of which are modifiable, have been identified including obesity, diet, and physical inactivity. Diet and lifestyle factors could affect risk of diverticulitis through their effects on the intestinal microbiome and inflammation. Preliminary studies have found that the composition and function of the gut microbiome differ between individuals with vs without diverticulitis. Genetic factors, as well as alterations in colonic neuromusculature, can also contribute to the development of diverticulitis. Less-aggressive and more-nuanced treatment strategies have been developed. Two multicenter, randomized trials of patients with uncomplicated diverticulitis found that antibiotics did not speed recovery or prevent subsequent complications. Elective surgical resection is no longer recommended solely based on number of recurrent events or young patient age and might not be necessary for some patients with diverticulitis complicated by abscess. Randomized trials of hemodynamically stable patients who require urgent surgery for acute, complicated diverticulitis that has not improved with antibiotics provide evidence to support primary anastomosis vs sigmoid colectomy with end colostomy. Despite these advances, more research is needed to increase our understanding of the pathogenesis of diverticulitis and to clarify treatment algorithms.
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Affiliation(s)
- Lisa L. Strate
- Division of Gastroenterology, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave, Box 359773, Seattle, WA 98104
| | - Arden M. Morris
- S-SPIRE Center and Department of Surgery, Stanford University, Stanford California, 1070 Arastradero Rd, Ste 217, CA 94305
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Higher Mortality in Surgically Managed Diverticulitis is Associated with Asian Ethnicity and Right-Sided Disease. Dis Colon Rectum 2016; 59:216-23. [PMID: 26855396 DOI: 10.1097/dcr.0000000000000526] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although right-sided diverticulitis is perceived to have a higher incidence among Asians and infrequently requires surgical management in comparison with sigmoid diverticulitis, it is unknown whether differences in outcomes are due to ethnic disparity or disease pathophysiology. OBJECTIVE The aim of this study was to determine the surgical outcomes for Asian and non-Asian patients with diverticulitis who underwent colectomy. DESIGN Patients identifiable by ethnicity in the Nationwide Inpatient Sample with diverticulitis and colectomy between 2004 and 2010 were included. Univariate comparisons were made between Asian and non-Asian patients by using t tests for continuous variables and χ tests for categorical variables. Propensity score matching analysis was performed to compare Asian patients with otherwise similar non-Asian patients. PATIENTS Included were 58,142 non-Asian and 335 Asian patients with diverticulitis who underwent a colectomy. MAIN OUTCOME MEASURES The primary outcomes were in-hospital mortality, hospital length of stay, and total costs. RESULTS Asian patients were younger (56.1 vs. 59.2 years, p < 0.0001), were more likely to undergo a right colectomy (22.7% vs. 4.1%, p < 0.0001), and were more likely to have emergent/urgent surgery than the non-Asian patients (67.1% vs. 49.8%, p < 0.0001). Without controlling for patient/disease factors, there were statistically significant differences in mortality (non-Asian 2.2% vs. Asian 4.2%; p = 0.014), length of stay (non-Asian 8.9 vs. Asian 9.8 days; p = 0.0166), and costs (non-Asian $18,783 vs. Asian $21,901; p = 0.001). Propensity score matching comparing 333 non-Asian patients with 333 similar Asian patients showed that, whereas differences in cost and length of stay became insignificant, the difference in mortality remained statistically significant. LIMITATIONS The ethnicity variable was not uniformly collected by all states within the Nationwide Inpatient Sample database. CONCLUSIONS Among patients undergoing a colectomy for diverticulitis, a higher mortality was observed in Asian patients and right-sided disease. Future longitudinal studies comparing the natural history and outcomes of management between right- and left-sided diverticulitis are necessary to investigate whether a true ethnic disparity exists.
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Characteristics of Colonic Diverticulitis and Factors Associated With Complications: A Japanese Multicenter, Retrospective, Cross-Sectional Study. Dis Colon Rectum 2015; 58:1174-81. [PMID: 26544815 DOI: 10.1097/dcr.0000000000000488] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Little is known about the epidemiology of diverticulitis in Japan. Additional information is needed about its clinical characteristics and the factors associated with complications of diverticulitis. OBJECTIVE This study was designed to determine the clinical characteristics of diverticulitis and factors associated with its complications in Japanese patients. DESIGN This was a retrospective, multicenter, large-scale, cross-sectional study. SETTINGS All of the consecutive patients in 21 Japanese hospitals with a final diagnosis of acute colonic diverticulitis were included in this study. PATIENTS A total of 1112 patients, including 658 men and 454 women, with a mean age of 54.8 years, who were diagnosed by CT and/or ultrasonography between January 2006 and May 2011, were included in this study. INTERVENTIONS Data on medical history, investigations, treatments, and prognosis were collected using a standard form to create a dedicated database. MAIN OUTCOME MEASURES Clarification of the clinical characteristics of Japanese patients with acute diverticulitis was the main outcome measured. RESULTS Diverticulitis was detected mainly in men and women aged 40 to 60 years. Although diverticulitis more frequently affected the right colon (70.1%), diverticulitis of the left colon was significantly more frequent (61.0%) in elderly patients. Of the 1112 patients with diverticulitis, 179 (16.1%) developed complications, including abscess formation, perforation, stenosis, and/or fistula, some of which required surgical treatment, such as drainage or colonic resection. The duration of hospitalization (24.1 ± 19.5 days) and mortality rate (2.8%) were significantly higher in patients with versus without complications. Factors associated with complications were fever (>38.5°C), involvement of the left colon, higher age, and delayed diagnosis. LIMITATIONS Limitations included the nonconsideration of diverticulitis treatment, the effect of dietary fiber, and the retrospective design of the study. CONCLUSIONS Complications were more frequent in elderly men with left-sided diverticulitis, although diverticulitis was more common in middle-aged people and on the right side of the colon. Factors associated with complications were fever, site of involvement, older age, and longer time until diagnosis.
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Reichert MC, Lammert F. The genetic epidemiology of diverticulosis and diverticular disease: Emerging evidence. United European Gastroenterol J 2015; 3:409-18. [PMID: 26535118 DOI: 10.1177/2050640615576676] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Diverticular disease (DD) is one of the most prevalent gastrointestinal disorders. The pathogenesis of diverticulosis and DD is controversially discussed. Current studies call the traditional concept of a fibre-deficient diet causing the development of diverticula into question. Data from two recent twin studies have provided conclusive evidence for a strong genetic component to diverticulosis. Although genomewide association studies have provided new insights into the polygenic architecture of human diseases, genomic research in diverticulosis and DD has just been started. This is an astonishing fact given the high morbidity and mortality of the disease, as well as the substantial economic burden on health care systems. For this review, we provide an update of the molecular pathobiology and summarise recent evidence supporting the hypothesis that distinct, yet unidentified genetic variants contribute to the development of diverticulosis and DD.
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Affiliation(s)
- Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
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Hewett R, Chhaya V, Chan D, Kang JY, Poullis A. Differences in intestinal metaplasia in Barrett's esophagus patients in an ethnically diverse south London population. Indian J Gastroenterol 2015; 34:399-403. [PMID: 26541341 DOI: 10.1007/s12664-015-0597-9] [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: 03/31/2015] [Accepted: 10/14/2015] [Indexed: 02/04/2023]
Abstract
Barrett's esophagus (BE) is the replacement of any portion of the normal distal squamous epithelial mucosa by metaplastic columnar epithelium and is the only known precursor for esophageal adenocarcinoma. We undertook a study to identify ethnic differences for the presence of intestinal metaplasia (IM) in BE in patients in an ethnically diverse south London population. Retrospective analysis was done using the endoscopy database of St George's Hospital NHS Trust, which serves a large ethnically diverse London population. Gastroscopy records between 2009 and 2012 were retrieved, and patients with an endoscopic diagnosis of BE were identified. Patients of Indian subcontinent Asian origin (ISCA) were further identified. The presence of IM was retrieved from hospital pathology databases and was the primary outcome measured. Multivariate logistic regression analysis was performed to determine the odds of having IM by ethnic origin. ISCAs were 70% less likely to have IM compared to non-ISCAs (OR 0.32, 95% CI: 0.16-0.61, p = 0.001). This is the first study to identify differences in histological findings in ISCAs with BE living in the UK. Our findings may be useful for the future risk stratification of BE patients. Identification of environmental factors responsible for this difference would be of great therapeutic value.
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Affiliation(s)
- Rhys Hewett
- Department of Gastroenterology, St George's Hospital NHS Trust, Blackshaw Road, London, SW17 0QT, UK.
| | - Vivek Chhaya
- Department of Gastroenterology, St George's Hospital NHS Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Derek Chan
- Department of Gastroenterology, St George's Hospital NHS Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Jin-Yong Kang
- Department of Gastroenterology, St George's Hospital NHS Trust, Blackshaw Road, London, SW17 0QT, UK
| | - Andrew Poullis
- Department of Gastroenterology, St George's Hospital NHS Trust, Blackshaw Road, London, SW17 0QT, UK
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Vather R, Broad JB, Jaung R, Robertson J, Bissett IP. Demographics and trends in the acute presentation of diverticular disease: a national study. ANZ J Surg 2015; 85:744-8. [PMID: 25925134 DOI: 10.1111/ans.13147] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diverticular disease (DD) is a major health problem in the Western world. The aim of this study was to describe demographics and trends in acute DD admissions in New Zealand. METHODS Information pertaining to acute hospital admissions between January 2000 and June 2012 for a primary diagnosis of large bowel DD was retrieved from a national database. RESULTS There were 25,167 admissions for acute DD. Mean age of presentation decreased from 65.9 years in 2000 to 64.1 years in 2012 (P < 0.001). Mean age was lower in men than women (61.4 versus 67.4 years, P < 0.001). Although men comprised 45.2% of the cohort they were over-represented in the 18-44 years stratum (68.6 versus 31.4%; P < 0.001). Europeans accounted for 84.8% of admissions and presented at an older age (65.8 years) than Māori (56.2 years), Pacific Islanders (58.4 years) or Asians (58.9 years) (P < 0.001). Acute DD admissions were higher in more deprived populations (P < 0.001). Mean length of hospital stay (LOS) reduced from 5.8 days in 2000 to 4.1 days in 2012 (P < 0.001). LOS increased with age (P < 0.001) and deprivation (P = 0.013), but did not differ between ethnicities (P = 0.088). Computed tomography scanning of acute admissions doubled from 2000 to 2012 (29.7-59.2%; P < 0.001) with a halving in the use of acute in-patient colonoscopy (26.1-13.2%; P < 0.001) and emergent surgery (14.8-7.2%; P < 0.001). Percutaneous drain use increased from 0.6% in 2000 to 1.1% in 2012 (P = 0.003). CONCLUSION Acute DD is a source of considerable morbidity in New Zealand and there have been significant changes in its admission demographics and trends over the last decade.
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Affiliation(s)
- Ryash Vather
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Rebekah Jaung
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Jason Robertson
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Lan Y, Xu ZQ, Si XB. Etiology and risk factors for colon diverticulum: Differences between Westerns and Easterns. Shijie Huaren Xiaohua Zazhi 2015; 23:533-538. [DOI: 10.11569/wcjd.v23.i4.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Rectal diverticulum is defined as the sac-like pathological hernia that protrudes outside the intestinal wall. In recent years, the incidence of rectal diverticulum as revealed by autopsy has gradually increased. The development of colon diverticulum is related to anatomical factors, disorders of intestinal motor nerves, intestinal bacterial overgrowth and hormonal factors. In addition, the development of colon diverticulum is also affected by race, gender, environment, food styles and exercise. Colon diverticulum is different between Westerns and Easterns in terms of epidemiology and etiology. Previous studies have demonstrated that high fat diet and low fiber diet might be important in the onset of colon diverticulum. In this review, we will discuss the differences in etiology and risk factors for colon diverticulum between Westerns and Easterns.
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Bhopal RS, Cezard G, Bansal N, Ward HJT, Bhala N. Ethnic variations in five lower gastrointestinal diseases: Scottish health and ethnicity linkage study. BMJ Open 2014; 4:e006120. [PMID: 25335961 PMCID: PMC4208048 DOI: 10.1136/bmjopen-2014-006120] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Our objective was to augment the limited evidence mainly from local, clinical studies of ethnic differences in gastrointestinal disorders. Our question was: are there ethnic variations in hospitalisation/death for lower gastrointestinal disorders in Scotland? SETTING Scotland. POPULATION This retrospective-cohort linked 4.65 (of 4.9) million people in the 2001 census of Scotland (providing data on ethnicity, country of birth and indicators of socioeconomic deprivation) to 9 years of National Health Service hospitalisation and death records. PRIMARY AND SECONDARY OUTCOME MEASURES AND ANALYSIS For appendicitis, we studied all ages; for irritable bowel syndrome, ulcerative colitis, Crohn's disease and diverticular disease, we included those ≥20 years. Using Poisson regression (robust variance) we calculated, by ethnic group and sex, first-hospitalisation/death age-adjusted rates per 100,000 person-years, and relative risks (RRs) with 95% CIs multiplied by 100, so the White Scottish reference population had an RR=100. RESULTS There were ethnic variations; for example, for irritable bowel syndrome, RRs (95% CIs) were comparatively high in Other White British women (128.4 (111.0 to 148.6)), and low in Pakistani women (75.1 (60.6 to 93.1)). For appendicitis, RRs were high in men in Other White British (145.2 (127.8 to 164.9)), and low in most non-White groups, for example, Pakistanis (73.8 (56.9 to 95.6)). For ulcerative colitis, RRs were high in Indian (169.8 (109.7 to 262.7)) and Pakistani (160.8 (104.2 to 248.2)) men. For Crohn's disease, the RR was high in Pakistani men (209.2 (149.6 to 292.6)). For diverticular disease, RRs were high in Irish men (176.0 (156.9 to 197.5)), and any Mixed background women (144.6 (107.4 to 194.8)), and low in most non-White groups, for example, Chinese men (47.1 (31.0 to 71.6) and women (46.0 (30.4 to 69.8)). CONCLUSIONS Appendicitis and diverticular disease were comparatively low in most non-White groups, while ulcerative colitis and Crohn's disease were mostly higher in South Asians. Describing and understanding such patterns may help clinical practice and research internationally.
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Affiliation(s)
- Raj S Bhopal
- Edinburgh Ethnicity and Health Research Group (EEHRG), Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Genevieve Cezard
- Edinburgh Ethnicity and Health Research Group (EEHRG), Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Narinder Bansal
- Edinburgh Ethnicity and Health Research Group (EEHRG), Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
- Cardiovascular Epidemiology Unit, Department of Public Health & Primary Care, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, UK
| | - Hester J T Ward
- Edinburgh Ethnicity and Health Research Group (EEHRG), Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
- Public Health and Intelligence, NHS National Services Scotland, Gyle Crescent, Edinburgh, UK
| | - Neeraj Bhala
- Gastroenterology and Liver Units, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
- Department of Gastroenterology, Wellington Regional Hospital, Capital and Coast District Health Board, Newtown, Wellington, New Zealand
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Lahiri RP, Abeles A, Burnand KM, Alazawi W, Bhattacharya S, Foster GR, Knowles CH. A cross sectional study of colonic diverticulosis in the London Bangladeshi population. United European Gastroenterol J 2014; 1:191-7. [PMID: 24917959 DOI: 10.1177/2050640613489282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/04/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Diverticular disease is the most common morphological abnormality of the colon and the fifth most important gastrointestinal disease in terms of cost in the Western world. Tower Hamlets is the poorest borough in London containing a large Bangladeshi community. We observed that emergency admissions with complications of colonic diverticulosis were minimal in the Bangladeshi community. The objective was to compare the background prevalence of colonic diverticulosis in Bangladeshis with other ethnicities in patients undergoing colonoscopy at a single centre in Tower Hamlets. METHODS Four thousand four hundred and fifty-four consecutive colonoscopy reports over a 2-year period were retrospectively analysed. Patients under 40 years of age and repeat colonoscopies were excluded, leaving 3151 patients (mean age: 63 years; 48% male). Demographics including ethnicity and medical background were retrieved from the electronic patient record system and findings correlated with the prevalence of other 'Western' diseases in the cohort. RESULTS Six hundred and thirty out of 3151 (20%) colonoscopies were performed on Bangladeshis. The prevalence of colonic diverticulosis was significantly lower in Bangladeshis (17/630: 2.7%) than Caucasians (673/1869: 36%), Indians/Pakistanis (16/161: 9.9%), Oriental (15/44: 34%) and Black (90/369: 24.4%) patient groups (χ(2) p < 0.0001 for all comparisons). The prevalence of classical sigmoid diverticulosis in the Bangladeshi cohort was only 1.0%, despite significantly more Bangladeshi patients undergoing colonoscopy for abdominal pain (p < 0.0001, χ(2)) and diarrhoea (p < 0.0034, χ(2)). There was also a significantly greater incidence of type 2 diabetes mellitus and ischaemic heart disease (p < 0.0001, χ(2)) in Bangladeshi patients. CONCLUSIONS There is a negligible prevalence of colonic diverticulosis in the Bangladeshi population of London who undergo colonoscopy. This is in spite of a high incidence of type 2 diabetes and ischaemic heart disease. The effect of diet and genetics on the prevalence of colonic diverticulosis in Bangladeshis is not known and merits further investigation.
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Affiliation(s)
- Rajiv P Lahiri
- Department of Hepatology, Centre for Digestive Diseases, The Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK ; Barts Health HPB Centre, Royal London Hospital, London, UK
| | - Aliza Abeles
- National Centre for Bowel Research and Surgical Innovation, Centre for Digestive Diseases, The Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London UK
| | - Katherine M Burnand
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - William Alazawi
- Department of Hepatology, Centre for Digestive Diseases, The Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | | | - Graham R Foster
- Department of Hepatology, Centre for Digestive Diseases, The Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Charles H Knowles
- National Centre for Bowel Research and Surgical Innovation, Centre for Digestive Diseases, The Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London UK
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Lohsiriwat V, Suthikeeree W. Pattern and distribution of colonic diverticulosis: Analysis of 2877 barium enemas in Thailand. World J Gastroenterol 2013; 19:8709-8713. [PMID: 24379590 PMCID: PMC3870518 DOI: 10.3748/wjg.v19.i46.8709] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/22/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the pattern and distribution of colonic diverticulosis in Thai adults.
METHODS: A review of the computerized radiology database for double contrast barium enema (DCBE) in Thai adults was performed at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Incomplete studies and DCBE examinations performed in non-Thai individuals were excluded. The pattern and distribution of colonic diverticulosis detected during DCBE studies from June 2009 to October 2011 were determined. The occurrence of solitary cecal diverticulum, rectal diverticulum and giant diverticulum were reported. Factors influencing the presence of colonic diverticulosis were evaluated.
RESULTS: A total of 2877 suitable DCBE examinations were retrospectively reviewed. The mean age of patients was 59.8 ± 14.7 years. Of these patients, 1778 (61.8%) were female and 700 (24.3%) were asymptomatic. Colonic diverticulosis was identified in 820 patients (28.5%). Right-sided diverticulosis (641 cases; 22.3%) was more frequently reported than left-sided diverticulosis (383 cases; 13.3%). Pancolonic diverticulosis was found in 98 cases (3.4%). The occurrence of solitary cecal diverticulum, rectal diverticulum and giant diverticulum were 1.5% (42 cases), 0.4% (12 cases), and 0.03% (1 case), respectively. There was no significant difference in the overall occurrence of colonic diverticulosis between male and female patients (28.3% vs 28.6%, P = 0.85). DCBE examinations performed in patients with some gastrointestinal symptoms revealed the frequent occurrence of colonic diverticulosis compared with those performed in asymptomatic individuals (29.5% vs 25.3%, P = 0.03). Change in bowel habit was strongly associated with the presence of diverticulosis (a relative risk of 1.39; P = 0.005). The presence of diverticulosis was not correlated with age in symptomatic patients or asymptomatic individuals (P > 0.05).
CONCLUSION: Colonic diverticulosis was identified in 28.5% of DCBE examinations in Thai adults. There was no association between the presence of diverticulosis and gender or age.
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Gryspeerdt S, Lefere P. Chronic diverticulitis vs. colorectal cancer: findings on CT colonography. ACTA ACUST UNITED AC 2013; 37:1101-9. [PMID: 22366853 DOI: 10.1007/s00261-012-9858-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this update article is to evaluate findings on CT colonography in patients with chronic diverticulitis and to compare the findings in patients with colorectal carcinoma. MATERIALS AND METHODS Different morphological criteria retrieved from a literature review were retrospectively analyzed in a series of 13 patients with proven chronic diverticulitis. The findings were compared with a series of 10 patients with colorectal carcinoma. RESULTS Overall, the findings in chronic diverticulitis resemble the findings in acute diverticulitis. The advantage of virtual CT colonography in differentiating both entities relies in the combination of morphological features previously described on axial computed tomography and double contrast barium enema. The single strongest morphological feature pointing towards the diagnosis of chronic diverticulitis is the presence of diverticula in the affected segment. In the presence of diverticula in the affected segment, a long segment (≥10 cm), thick fascia sign without adenopathies, mild bowel wall thickening, tapered margins, and distorted but preserved mucosal folds are likely to further improve accuracy of diagnosing chronic diverticulitis. CONCLUSION The single strongest morphological sign to differentiate chronic diverticulitis from colorectal cancer is the presence of diverticula in the affected segment.
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Affiliation(s)
- Stefaan Gryspeerdt
- Virtual Colonoscopy Teaching Centre, Akkerstraat 32 c, 8830 Hooglede, Belgium.
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16
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Strate LL, Erichsen R, Baron JA, Mortensen J, Pedersen JK, Riis AH, Christensen K, Sørensen HT. Heritability and familial aggregation of diverticular disease: a population-based study of twins and siblings. Gastroenterology 2013; 144:736-742.e1; quiz e14. [PMID: 23313967 DOI: 10.1053/j.gastro.2012.12.030] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 11/27/2012] [Accepted: 12/30/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS Little is known about the role of heritable factors in diverticular disease. We evaluated the contribution of heritable factors to the development of diverticular disease diagnosed at a hospitalization or outpatient visit. METHODS Using nationwide patient registries, we identified 142,123 incident cases of diverticular disease diagnosed at a hospitalization (1977-2011) or an outpatient hospital visit (1995-2011) in Denmark, including cases in 10,420 index siblings and 923 twins. We calculated standardized incidence ratios for siblings versus the general population and concordance rates for monozygotic versus dizygotic twin pairs as measures of relative risk (RR). RESULTS The RR for diverticular disease in siblings of index cases was 2.92 (95% confidence interval [CI], 2.50-3.39) compared with the general population. The RRs were similar irrespective of the sex of the sibling or index case and were particularly strong in siblings of hospitalized cases and cases that underwent surgery. The proband-wise concordance rate for monozygotic twins was double that of dizygotic twins (0.16 [95% CI, 0.11-0.22] vs 0.07 [95% CI, 0.05-0.11], respectively). The RR of diverticular disease in one twin when the other had diverticular disease was 14.5 (95% CI, 8.9-23) for monozygotic twins compared with 5.5 (95% CI, 3.3-8.6) for dizygotic twins. Associations were stronger in female monozygotic twins compared with male twins (tetrachoric correlation, 0.60 [95% CI, 0.49-0.70] vs 0.33 [95% CI, 0.13-0.51]; P = .03 in an analysis stratified by sex and zygosity). We estimate that 53% (95% CI, 45%-61%) of susceptibility to diverticular disease results from genetic factors. CONCLUSIONS Based on a population-based study in Denmark, genetic factors appear to contribute to development of diverticular disease.
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Affiliation(s)
- Lisa L Strate
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
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17
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Surgical approach of complicated diverticulitis with colovesical fistula: technical note in a particular condition. Open Med (Wars) 2012. [DOI: 10.2478/s11536-012-0036-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractBackground: Diverticular disease of the colon is common in the Western world. With the first episode of diverticulitis, most patients will benefit from medical therapy, but in 10% to 20% of cases some complications will develop, such as intra-abdominal abscesses, obstructions, fistulas. In these conditions it is important to define the most appropriate surgical approach. Discussion: The management of diverticular disease has been successful owing to the advances in diagnostic methods, intensive care and surgical experience, but there is debate about the best treatment for some conditions. Fistulas complicating diverticulitis are the result of a localized perforation into adjacent viscera. In particular, the connection between the colon and the urinary tract is a serious anatomical abnormality that must be urgently corrected before a serious urinary infection results. Indications, timing and surgical procedures are determined by the severity of the disease and the patient’s general condition. Summary: Diverticular disease can lead to many complications. One of the most difficult to correct is an internal fistula, such as a colo-vesical fistula. The correct approach in cases where the disorder is clinically suspected has always been controversial, and the guidelines for sigmoid diverticulitis have not established the most appropriate method for diagnosis and treatment. At present, the surgical strategy for these cases requires interruption of the fistula and resection to remove the inflamed colonic segment, with or without primary anastomosis, focusing attention on the construction of the anastomosis to well vascularized and anatomically healthy tissues. It is clear, therefore, that establishing guidelines is difficult, because many pathological situations may be related to diverticulitis, and so, as our experience shows, the surgical approach has to be tailored to the patient’s general and local condition.
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Jeyarajah S, Papagrigoriadis S. Review article: the pathogenesis of diverticular disease--current perspectives on motility and neurotransmitters. Aliment Pharmacol Ther 2011; 33:789-800. [PMID: 21306406 DOI: 10.1111/j.1365-2036.2011.04586.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Low-fibre diet, structural abnormalities and ageing are traditional aetiological factors implicated in the development of diverticular disease. More recently, motility disorders are implicated in its causation leading to speculation that neurotransmitters play a role in mediating these disturbances. AIMS To draw together studies on the role of neurotransmitters in the development of diverticular disease and its symptoms. METHODS Medline, GoogleScholar and Pubmed were searched for evidence on this subject using the terms neurotransmitters, motility, diverticular disease and pathogenesis. Articles relevant to the subject were cited and linked references were also reviewed. RESULTS Serotonin, which has been found to be an excitatory colonic neurotransmitter, has been found in early studies to be increased in colonic enterochromaffin cells. Acetylcholine, which is thought to be an excitatory neurotransmitter and cholinergic activity, has also seen to be increased in diverticular disease. These findings may suggest that an increase in excitatory neurotransmitters may result in the hypersegmentation thought to cause pulsion diverticula. Similarly, a decrease in nitric oxide which is inhibitory is found. CONCLUSIONS There is some evidence that neurotransmitters may play a role in the motility disturbances seen in diverticular disease; however, a clear role is yet to be ascertained.
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Affiliation(s)
- S Jeyarajah
- Department of Colorectal Surgery, Kings College Hospital, Denmark Hill, London, UK.
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Commane DM, Arasaradnam RP, Mills S, Mathers JC, Bradburn M. Diet, ageing and genetic factors in the pathogenesis of diverticular disease. World J Gastroenterol 2009; 15:2479-88. [PMID: 19468998 PMCID: PMC2686906 DOI: 10.3748/wjg.15.2479] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 04/22/2009] [Accepted: 04/29/2009] [Indexed: 02/06/2023] Open
Abstract
Diverticular disease (DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK. This high prevalence ranks it as one of the most common bowel disorders in western nations. The majority of patients remain asymptomatic but there are associated life-threatening co-morbidities, which, given the large numbers of people with DD, translates into a considerable number of deaths per annum. Despite this public health burden, relatively little seems to be known about either the mechanisms of development or causality. In the 1970s, a model of DD formulated the concept that diverticula occur as a consequence of pressure-induced damage to the colon wall amongst those with a low intake of dietary fiber. In this review, we have examined the evidence regarding the influence of ageing, diet, inflammation and genetics on DD development. We argue that the evidence supporting the barotrauma hypothesis is largely anecdotal. We have also identified several gaps in the knowledge base which need to be filled before we can complete a model for the etiology of diverticular disease.
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Meurs-Szojda MM, Terhaar sive Droste JS, Kuik DJ, Mulder CJJ, Felt-Bersma RJF. Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies. Int J Colorectal Dis 2008; 23:979-84. [PMID: 18594842 DOI: 10.1007/s00384-008-0510-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS There are conflicting data concerning the association between diverticular disease and colorectal carcinoma (CRC). This study was performed to determine the prevalence and association of diverticulosis, diverticulitis, polyps, and CRC. MATERIALS AND METHODS In a cross-sectional, retrospective study, we analyzed the colonoscopy reports of complete colonoscopies and patho-histological results of all patients referred for colonoscopy in a period of 3 months in 18 hospitals in The Netherlands. Diverticulosis was defined as three or more diverticula present and diverticulitis as diverticulosis with inflammation. Polyps were also coded according to localization and size. Advanced neoplastic lesions were defined as polyps >or=10 mm in diameter and/or villous architecture and/or adenomas with high grade dysplasia and/or invasive cancer. Actual and previous described CRC were registered. RESULTS A total of 4,241 patients were included in the study [1,996 (47%) male], mean age of 59 and range 18-95. Diverticula, diverticulitis, and polyps were seen in 1,052 (25%), 75 (2%), and 1,282 (30%) patients, respectively. No association was found between patients with polyps and those with and without diverticulosis (p=0.478). Invasive adenocarcinoma and adenomas >or=10 mm were most frequently observed. CRC was present in 372 (9%) patients. Negative relation between diverticulosis and CRC and invasive adenocarcinoma was observed. No association was found between polyps and CRC and patients with diverticulitis and CRC. In conclusion, there is no relation between patients with diverticulosis and higher incidence of polyps or CRC when using age-stratified analysis. No increased risk for polyps or CRC was found in patients with diverticulitis.
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Affiliation(s)
- M M Meurs-Szojda
- Department of Gastroenterology and Hepatology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
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21
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Abstract
The prevalence of diverticulosis and colorectal cancer (CRC) is markedly increased in the last century. Both diseases are highly frequent in Western countries and in aged people. Western diet--low in fiber and rich in dietary fat--has been largely regarded to play a major role in the pathogenesis of both conditions. A causal relationship between diverticulosis and CRC has been suggested in different studies. Epidemiologic series found a more frequent rectosigmoid localization of neoplastic lesions (advanced adenoma and CRC) in patients with diverticulosis as compared with controls, particularly in those with a previous diverticulitis episode or with an extensive disease. However, data are still controversial, with other studies failing to confirm this observation. Such discrepancy could be referred to the highly heterogeneous study design and setting in the different epidemiologic series. Pathologic studies showed that either macroscopic and microscopic chronic inflammation--which is regarded as risk factor for CRC development--is present in the colonic mucosa of some patients with diverticula. Moreover, alterations in the extracellular matrix, also involved in colorectal carcinogenesis, have been depicted in diverticulosis. In addition, an upward shifting of cell proliferation occurs in diverticular mucosa, and in nondiverticular patients with advanced adenomas. Finally, aberrant crypt foci--which are considered potential markers of CRC risk in ulcerative colitis--have been detected in colonic mucosa of patients with diverticulosis. Despite this substantial amount of evidence, however, the available data are not yet strong enough to suggest a more aggressive CRC prevention in diverticular as compared with nondiverticular subjects.
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Pezzilli R, Barassi A, Morselli Labate AM, Finazzi S, Fantini L, Gizzi G, Lotzniker M, Villani V, Melzi d'Eril G, Corinaldesi R. Fecal calprotectin levels in patients with colonic polyposis. Dig Dis Sci 2008; 53:47-51. [PMID: 17468955 DOI: 10.1007/s10620-007-9820-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 03/06/2007] [Indexed: 12/25/2022]
Abstract
CONTEXT The usefulness of stool calprotectin determination in diagnosis of inflammatory disease of the colon has been reported; information about its usefulness for patients with polyposis are scarce, however. OBJECTIVE To evaluate the significance of stool calprotectin concentrations for patients affected by colonic polyposis. PATIENTS Sixty-three consecutive patients (35 males, 28 females, mean age 60.3 years, range 39-78 years) were enrolled: 26 patients (41.3%) with polyps, 17 patients (27.0%) with asymptomatic diverticular disease, and 20 subjects (31.7%) with normal endoscopic appearance of the colon. RESULTS Stool calprotectin concentrations were 17.4 +/- 24.5 microg g(-1) for patients with colonic polyposis, significantly higher than concentrations for patients with diverticulosis (7.1 +/- 5.7 microg g(-1); P = 0.026) or for patients with normal appearance of the colon (calprotectin 6.0 +/- 5.8 microg g(-1); P = 0.003). For patients with a single polyp, stool calprotectin concentrations were similar to those for patients with multiple polyps. Calprotectin fecal concentrations for patients with sessile polyps and those with flat polyps were not significantly different. Calprotectin concentrations were not significantly related to the size of the polyps. CONCLUSION Our data show that colonic polyposis may cause an increase in stool calprotectin values and that these colonic lesions should be suspected when elevated stool calprotectin concentrations are found.
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Affiliation(s)
- Raffaele Pezzilli
- Department of Internal Medicine and Gastroenterology, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, Bologna, Italy.
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Peppas G, Bliziotis IA, Oikonomaki D, Falagas ME. Outcomes after medical and surgical treatment of diverticulitis: a systematic review of the available evidence. J Gastroenterol Hepatol 2007; 22:1360-8. [PMID: 17716342 DOI: 10.1111/j.1440-1746.2007.05118.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is still controversy regarding the appropriate management of diverticulitis of the colon in cases when both surgical and conservative treatment may be an option. We performed a systematic review of the available evidence regarding the outcomes after medical and surgical treatment of diverticulitis from studies published after 1980 and indexed in the PubMed database. We included original studies that reported comparative data for at least one outcome in medically- and surgically-treated patients with transverse or left colon diverticulitis. The main outcomes of interest were mortality, morbidity, and recurrence of diverticulitis after medical or surgical treatment. There were 21 studies fulfilling our inclusion criteria out of 1360 initially identified as possibly relevant. More patients were treated conservatively in the included studies compared to emergency surgery (24 862 vs 6504). Emergency surgery was the main option for patients with severe complications of diverticular disease, including peritonitis. In most studies, in-hospital mortality for patients treated surgically was generally higher than that of patients treated medically, whereas there were insufficient comparative data regarding mortality during follow up. However, readmission to the hospital due to diverticular disease during follow up was more common in the group of patients treated conservatively compared to those treated surgically (4358/23 446 [18.6%]vs 22/359 [6.1%]). Conservatively-treated patients, with a first or second episode of diverticulitis, required surgery for recurrent disease during follow up in a maximum of 45% of cases, with larger studies reporting percentages lower than 11%. It should be emphasized that medical and surgical treatments have not ever been compared in a randomized controlled trial in patients with diverticulitis (without generalized peritonitis that is a surgical emergency). Although medical treatment results in more readmissions due to recurrence, it may be reasonable to avoid surgical therapy in the vast majority of patients with acute diverticulitis. It is unclear what the best treatment option is for younger patients (<50 years), namely whether elective surgery should be considered with the first episode of diverticulitis.
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Affiliation(s)
- George Peppas
- Alfa Institute of Biomedical Sciences (AIBS), and Department of Surgery, Henry Dunant Hospital, Athens, Greece
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Ma WT, Mahadeva S, Kunanayagam S, Poi PJH, Goh KL. Colonoscopy in elderly Asians: a prospective evaluation in routine clinical practice. J Dig Dis 2007; 8:77-81. [PMID: 17532819 DOI: 10.1111/j.1443-9573.2007.00289.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Colonoscopy is believed to be more complicated in elderly patients in Western countries. It is uncertain if the situation holds true among Asians. This study is to determine differences in colonoscopy performance and sedation complications between patients aged<65 years and those>or=65 years of age in an Asian population. METHODS A prospective, cross-sectional study of adults attending outpatient colonoscopy at a tertiary institution. Clinical and endoscopic data were obtained from all consenting adults. RESULTS Two hundred and one patients (70 elderly and 131 aged<65 years) were enrolled. Compared to the patients aged<65 years, the elderly patients had similar levels of good (42.9%vs 45.8%), satisfactory (42.9%vs 33.6%) and poor (14.3%vs 20.6%) bowel preparations (P=NS). Cecal intubation was achieved in 60 (85.7%) of the elderly patients and 116 (88.5%) of the younger adults (P=NS). The differences in mean total colonoscopy duration was not significant (30+/-13 vs 27+/-11 min). Although the elderly patients received lower mean sedation doses of midazolam (4.7 vs 5.1 mg) and pethidine (37.8 vs 46.4 mg) compared to the younger adults, the hypotension rates were significantly higher in the elderly patients (7.1%vs 0.8%, P=0.01). The elderly patients had in additional one or more co-morbid illnesses (P=0.001), with significantly higher rates of diabetes (P=0.004), ischemic heart disease (P=0.03), hypertension (P=0.001) and stroke disease (P=0.004). CONCLUSION Colonoscopy performance in elderly Asians is similar to that in younger adults. However, the conscious sedation of these patients results in a higher rate of cardio-vascular complications.
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Affiliation(s)
- Wee-Tah Ma
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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25
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Soran A, Harlak A, Wilson JW, Nesbitt L, Lembersky BC, Wienad HS, O'Connell MJ. Diverticular Disease in Patients with Colon Cancer: Subgroup Analysis of National Surgical Adjuvant Breast and Bowel Project Protocol C-06. Clin Colorectal Cancer 2006; 6:140-5. [PMID: 16945170 DOI: 10.3816/ccc.2006.n.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Similar epidemiologic characteristics suggest a common etiology for colon cancer (CC) and diverticular disease of the colon (DD). The relationship between the 2 diseases is still unclear, and the impact of DD in patients diagnosed with CC on disease-free survival (DFS) and overall survival (OS) is unknown. National Surgical Adjuvant Breast and Bowel Project (NASBP) protocol C-06 is a clinical trial comparing oral uracil/tegafur/leucovorin with 5-fluorouracil/leucovorin in patients with resected stage II/III carcinoma of the colon. PATIENTS AND METHODS The NASBP enrolled 1,608 patients who had undergone potentially curative resection for stage II/III colon cancer from 256 medical sites between February 14, 1997, and March 31, 1999. RESULTS Pathology reports from 1561 eligible patients retrospectively reviewed for the presence of DD revealed that 160 (10.2%) had this disease. The median ages of patients with CC and DD and without DD were 67 and 61 years, respectively (P < 0.05). The majority of patients were white, and Hispanic patients were better represented in the group with DD (P < 0.05). Colon cancer was located in the rectosigmoid in 46.88% of patients with DD and in 31.92% of patients without DD (P < 0.05). A baseline diagnosis of DD made no significant contribution to DFS or OS without adjustment for confoundin factors (P = 0.2 and P = 0.32, respectively) or adjusted for Dukes classification and age (P = 0.49 and P = 0.68, respectively). CONCLUSION The prevalence of DD in patients diagnosed and treated for CC was 10.2%. Patients with CC with and without DD differed from each other with respect to age, tumor location, and ethnicity. There was no negative impact of having DD on DFS and OS in patients treated for stage II/III CC.
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Affiliation(s)
- Atilla Soran
- The National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers, USA.
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Hjern F, Johansson C, Mellgren A, Baxter NN, Hjern A. Diverticular disease and migration--the influence of acculturation to a Western lifestyle on diverticular disease. Aliment Pharmacol Ther 2006; 23:797-805. [PMID: 16556182 DOI: 10.1111/j.1365-2036.2006.02805.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diverticular disease of the colon is more common in the Western world, compared with non-Western countries. AIM To investigate the risk of diverticular disease in immigrants of diverse ethnicity and in different phases of acculturation. METHODS Socio-demographic indicators and the risk of diverticular disease were investigated. The study population was a prospectively followed national cohort of 4 million residents born between 1925 and 1965. Risk ratios (RRs) of hospital admissions and deaths because of diverticular disease and acute diverticulitis from 1991 through 2000 were calculated. RESULTS The risk of hospital admission because of diverticular disease, after adjustment for age, sex and socio-economic indicators, was lower in non-Western immigrants (RRs = 0.5-0.7) compared with natives and the risk increased with time after the settlement. Women of all origins had a higher risk compared with men (RR = 1.5). This sex-difference increased with age (P < 0.001). Socio-economic status, residency or housing situation were not risk factors. CONCLUSION This population-based study found that immigrants from non-Westernized countries had lower relative risks for hospitalization because of diverticular disease than natives, but the risk increased during a relatively short period of time after settlement. Diverticular disease of the colon appears to be an acquired disorder and acculturation to a Western lifestyle has an impact on the risk.
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Affiliation(s)
- F Hjern
- Department of Surgery, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden.
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Loffeld RJLF. Diverticulosis of the colon is rare amongst immigrants living in the Zaanstreek region in the Netherlands. Colorectal Dis 2005; 7:559-62. [PMID: 16232235 DOI: 10.1111/j.1463-1318.2005.00830.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Data on prevalence of diverticulosis related to ethnicity or race in the Western world are very sparse. A cross-sectional study was done in patients undergoing endoscopy of the colon in order to assess the prevalence of diverticulosis and relate the presence to ethnicity. METHODS An analysis was undertaken of the endoscopy reports from all consecutive patients undergoing endoscopy of the colon. As a reference group all patients in whom no abnormalities were detected were used. In the Zaanstreek region a large population of immigrants, mostly of Turkish descent, is present. These immigrants were studied separately. RESULTS In a period of 12 years 3004 patients were diagnosed with diverticulosis. Of these 2975 were authentic Dutch. The remainder 29 patients were immigrants. Diverticulosis was diagnosed significantly more often in immigrant men (P < 0.0001). Immigrants with diverticulosis were significantly younger than the authentic Dutch, P < 0.001. There was no major difference in representation of immigrants with diverticular disease in different age cohorts. The reference group consisted of 3356 patients. In this group 2998 patients were authentic Dutch, while 358 patients were immigrants. There was no difference in numbers of men and women amongst the immigrants. Of the patients with a normal colon and rectum 11% is immigrant. In the group of patients with diverticulosis only 0.9% was immigrant. CONCLUSION This study clearly shows that prevalence of diverticular disease is very low in immigrants. The majority of these immigrants are of Turkish descent. In addition, the majority of immigrants with diverticulosis was male.
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Affiliation(s)
- R J L F Loffeld
- Department of Internal Medicine, Zaans Medisch Centrum, Zaandam, Netherlands.
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Rajendra S, Ho JJ. Colonic diverticular disease in a multiracial Asian patient population has an ethnic predilection. Eur J Gastroenterol Hepatol 2005; 17:871-5. [PMID: 16003138 DOI: 10.1097/00042737-200508000-00015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Traditionally, diverticular disease of the colon has been attributed to ageing, low dietary fibre and a high intraluminal pressure. Recently, genetic and racial factors have also been implicated. METHODS Four-hundred and ten consecutive multiracial Asian patients undergoing colonoscopy for a variety of bowel symptoms in a private endoscopy unit were studied for differing frequencies (if any) in colonic diverticular disease and concomitant abnormalities. RESULTS Forty-one patients (10%) had diverticular disease. Diverticula were present in 22/147 Chinese (15%), 14/153 Indians (9%) and 5/110 Malays (4.5%). The mean age of patients with diverticular disease was 55 years as compared with 51.3 years in those without (P = 0.12) and there was no gender difference. Thirty-six patients (88%) had diverticula in the right colon only, four patients (10%) exclusively in the left hemicolon, and one patient (2%) had bilateral involvement. Using regression analysis, Chinese ethnicity [odds ratio (OR)=2.11; 95% confidence interval (CI), 1.09-4.09; P = 0.027), constipation (OR = 2.65; 95% CI, 1.23-5.42; P = 0.007) and colorectal adenomas (OR = 2.65; 95% CI, 1.08-6.46; P = 0.033) were independently associated with diverticular disease. CONCLUSIONS Colonic diverticular disease in a multiracial Asian patient population has an ethnic predilection and is predominantly right-sided.
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Affiliation(s)
- Shanmugarajah Rajendra
- Division of Gastroenterology, Department of Medicine, Royal College of Medicine, Perak, Malaysia.
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