Diverticular disease. Epidemiology and pharmacological treatment

Long-term follow-up and development of diverticulitis in patients diagnosed with diverticulosis of the colon

INTRODUCTION

Diverticulosis of the colon is the most occurring abnormality in the digestive tract. Little is known on the risk of developing diverticulitis.

AIM

The study aims to assess the risk of diverticulitis.

PATIENTS AND METHODS

All patients undergoing colonoscopy in the years 1998, 1999, and 2000 were studied. Patients with cancer, inflammatory bowel disease, anastomoses, and prior diverticulitis were excluded. In the summer of 2015, all hospital records, endoscopy reports, and reports from the department of radiology were studied. Diverticulitis had to be confirmed by the clinical presentation but also via ultrasound or CT scan. In order to obtain enough follow-up years, patients above the age of 75 years were excluded.

RESULTS

After exclusions, a study group of 433 patients remained. There was no difference is gender between patients developing diverticulitis and those who did not. There was no difference in age at time of the index colonoscopy. The sum of follow-up years was 6191. Range of follow-up was 0 to 17 years. The mean follow-up was 14.1 years per patient. Thirty cases of diverticulitis (7 %) could be identified; this is 4.8 cases per 1000 years. The mean time to development of diverticulitis was 5.9 years. Diverticulitis had a mild presentation in 19 patients and a severe presentation needing surgical intervention in 11.

CONCLUSION

The risk of developing diverticulitis is low. This contradicts the belief that diverticulosis has a high rate of progression. These results can help inform patients with diverticulosis about their risk of developing acute diverticulitis.

Diverticular disease of the colon: New perspectives in symptom development and treatment

Diverticular disease of the colon is a common disease worldwide. Although the disease is asymptomatic in about 70%-80% of patients, it represents, at least in Western countries, one of the most important gastrointestinal diseases in terms of direct and indirect health costs. Pathogenesis of the disease is still unknown. However, it is the result of complex interactions between colonic structure, intestinal motility, diet and genetic factors. Whilst efficacious preventive strategies remain to be identified, fibre supplementation in the diet is recommended. Why symptoms develop is still unclear. Results of recent experimental studies on irritable bowel syndrome speculated that low grade inflammation of colonic mucosa, induced by changes in bacterial microflora, could affect the enteric nervous system, which is crucial for normal gut function, thus favouring symptom development. This hypothesis could be extrapolated also for diverticular disease, since bacterial overgrowth is present, at least in a subgroup of patients. These perspectives on symptom development are reviewed and new therapeutic approaches are hypothesized.

Diverticular disease of the colon and concomitant abnormalities in patients undergoing endoscopic evaluation of the large bowel

OBJECTIVE: To study the prevalence of diverticula and presence of concomitant pathology in consecutive patients undergoing endoscopic examination of the colon. METHODS: A cross-sectional analysis of the endoscopy reports of all patients sent for endoscopic evaluation of the colon in a period of 8.5 years. RESULTS: A total of 9086 endoscopies were performed. Of these 2259 (24.7%) were undertaken for follow-up. Diverticula were seen in 1849 patients (27%) (739 male, 1110 female, mean age 69 year). In 4978 patients (73%)(2162 male, 2816 female, mean age 52 year) no diverticula were seen, of these 2303 (46%) had no abnormalities in their colon. Patients with diverticula were significantly older, 69 vs 46.7 years (P < 0.001). No difference was present in gender. Colorectal cancer and inflammatory bowel disease were significantly more common in patients without diverticula, while polyps were more often seen in patient with diverticula. Patients with diverticula had a significantly lower incidence of colorectal cancer. In addition, the number of cancers located proximal to the splenic flexure was statistically higher in the group of patients presenting with diverticula (P < 0.001). CONCLUSIONS: The overall prevalence of diverticular disease in patients undergoing endoscopy is 27%, and increases with age. Patients with diverticulosis have significantly lower incidence of colorectal cancer and if cancer is detected then it is more common proximal to the splenic flexure.