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Prevalence of colonic diverticulosis by age group. The prevalence of colonic diverticulosis increased with age (p = 0.007). Figures in parentheses indicate the number of patients with diverticula and the total number of subjects in each group.
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The prevalence of colonic diverticulosis has been reported to be lower in Korea than in Western countries. This disease also shows markedly different characteristics in the Korean population. We describe herein a prospective investigation, based on colonoscopic examination, of the prevalence, clinical characteristics, and factors associated with co...
Context in source publication
Context 1
... (518 men and 330 women) was 50.9 ± 12.3 years. The prevalence of colonic Values are presented as mean ± SD or number (%). BMI, body mass index; MDA, mini dietary assessment. 21.9 (14 / 64) diverticulosis in this group was 12.1% (103 cases total, 79 men and 24 women, mean age 54.1 ± 12.4 years). Colonic diverticulosis prevalence increased with age (Fig. 1). About 60% of patients with colonic diverticulosis were asymp- tomatic. Those with symptoms (40%) complained of abdominal pain and discomfort (11.1%), diarrhea (6.2%), constipation (4.9%), and weight loss ...Citations
... A large prospective series linked an increased BMI to an elevated risk of diverticulitis 31 . However, other population studies have not replicated this and found no association between BMI and diverticulitis at colonoscopy 4,32 . Physical activity has a significant correlation with reducing complications of diverticulitis [15][16][17] . ...
Background
Diverticulosis is a normal anatomical variant of the colon present in more than 70% of the westernized population over the age of 80. Approximately 3% will develop diverticulitis in their lifetime. Many patients present emergently, suffer high morbidity rates and require substantial healthcare resources. Diverticulosis is the most common finding at colonoscopy and has the potential for causing a significant morbidity rate and burden on healthcare. There is a need to better understand the aetiology and pathogenesis of diverticular disease. Research suggests a genetic susceptibility of 40–50% in the formation of diverticular disease. The aim of this review is to present the hypothesized functional effects of the identified gene loci and environmental factors.
Methods
A systematic literature review was performed using PubMed, MEDLINE and Embase. Medical subject headings terms used were: ‘diverticular disease, diverticulosis, diverticulitis, genomics, genetics and epigenetics’. A review of grey literature identified environmental factors.
Results
Of 995 articles identified, 59 articles met the inclusion criteria. Age, obesity and smoking are strongly associated environmental risk factors. Intrinsic factors of the colonic wall are associated with the presence of diverticula. Genetic pathways of interest and environmental risk factors were identified. The COLQ, FAM155A, PHGR1, ARHGAP15, S100A10, and TNFSF15 genes are the strongest candidates for further research.
Conclusion
There is increasing evidence to support the role of genomics in the spectrum of diverticular disease. Genomic, epigenetic and omic research with demographic context will help improve the understanding and management of this complex disease.
... 60 Nonetheless, conflicting results are available in the Literature, with data suggesting a link between high dietary fiber intake and increased risk of diverticular disease, thus suggesting that classical risk factors related to diverticular disease should be reassessed. [61][62][63] As to symptoms in diverticular disease, although some studies suggest that dietary or supplemental fibers could be beneficial in diverticular disease, their role in reducing abdominal symptoms or preventing acute diverticulitis is still debated and high-quality evidence is lacking. 64 Management of uncomplicated diverticular disease has been historically focused on high dietary fiber or fiber supplementation. ...
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.
... Preliminary data supported that ethnicity and genetic background may be implicated in the anatomical distribution and presentation of colonic DD [17]. Diverticula are mainly located in the left colon in Europeans [23][24][25], while they are reported in the right colon in Asians [15,[26][27][28][29][30]. However, discrepancies persist regarding the localization of diverticula in Africans; some studies have reported a pancolonic distribution [11,12], and others a right-sided [1,14] or sigmoid localization [13]. ...
Background:
Diverticulosis is not well characterized in the Caribbeans. Our aim was to compare the anatomical presentation of colonic diverticulosis in African Caribbeans (group AC) versus Europeans (group E) and severity.
Methods:
We conducted a prospective controlled study involving 274 patients admitted for lower gastrointestinal haemorrhage (LGIH) in France (center 1: Guadeloupe; center 2: La Roche-sur-Yon); 179 cases with diverticular haemorrhage, including 129 in group AC and 40 in group E. Exploration of the colon included a detailed assessment of diverticula using a dedicated endoscopic grid.
Results:
AC and E had similar characteristics in terms of age, gender, previous history of LGIH, body mass index, dietary habits, and medications, but AC had significantly poorer hemodynamic parameters at admission and required more blood transfusions (66.7% vs. 42.5%; p=0.01) during hospitalization. Out of the 169 patients included in the study, a complete exploration of the colon was achieved in 81% (N = 137) (AC, n = 106; E, n = 31), and revealed right-side diverticulosis in AC (in 90.6%, included into a pancolonic form in 73.6% vs. 35.5%; p=0.0002) and left-side diverticulosis in E (in 96.8%, isolated form in 58.1% vs. 9.4%, p=0.0002). These data were confirmed by a sensitivity analysis using an endoscopic grid in 92 patients, achieving a higher frequency and larger size of diverticula in AC.
Conclusion:
Our study has shown that diverticulosis was pancolonic in AC and more frequently associated with more severe haemorrhage than the left-sided diverticulosis of Europeans. This anatomical presentation may be driven by the genetic background more than the environment and diet.
... ► Our outcome of a discharge diagnosis of diverticular disease is sensitive to diagnostic surveillance as diverticulosis is often asymptomatic, which we have attempted to address through stratification on colonoscopy status and analysis of diverticular disease complications. Open access diabetes increased, 6-8 decreased 9 10 or had no impact [11][12][13][14] on the risk of diverticular disease. In addition, most studies did not discern diabetes type (eg, type 1 or 2) and had limited data on potential confounding factors. ...
Objectives
To investigate the association between type 2 diabetes and risk of diverticular disease. Unlike previous studies, which have found conflicting results, we aimed to distinguish between diabetes types and adjust for modifiable risk factors.
Design
Observational cohort study.
Setting
Population-based Danish medical databases, covering the period 2005–2018.
Participants
Respondents of the 2010 or the 2013 Danish National Health Survey, of which there were 15 047 patients with type 2 diabetes and 210 606 patients without diabetes.
Primary and secondary outcome measures
Hazard ratios (HRs) for incident hospital diagnosis of diverticular disease adjusted for survey year, sex, age, body mass index (BMI), physical activity intensity, smoking behaviour, diet and education based on Cox regression analysis. As latency may affect the association between type 2 diabetes and diverticular disease, patients with type 2 diabetes were stratified into those with <2.5, 2.5–4.9 and ≥5 years duration of diabetes prior to cohort entry.
Results
For patients with and without diabetes the incidence rates of diverticular disease were 0.76 and 0.54 events per 1000 person years, corresponding to a crude HR of 1.08 (95% CI 1.00 to 1.16) and an adjusted HR of 0.88 (95% CI 0.80 to 0.96). The HR was lower among patients with ≥5 years duration of diabetes (adjusted HR: 0.76, 95% CI 0.67 to 0.87) than among those with 2.5–4.9 years or <2.5 years duration.
Conclusion
We found that patients with type 2 diabetes had a higher incidence rate of diverticular disease compared with patients without diabetes. However, after adjustment for modifiable risk factors, driven by BMI, type 2 diabetes appeared to be associated with a slightly lower risk of diverticular disease. Lack of adjustment for BMI may partially explain the conflicting findings of previous studies.
... This difference may be due to the genetic predispositions of the subjects. Choe et al [17] performed a genome-wide association study in South Korea and found that the WNT4, RHOU, and OAS1/3 genes might be the underlying cause of the development of right-sided diverticulosis. January 7, 2022 Volume 10 Issue 1 Multivariate logistic regression analysis further indicated that advanced age, male sex, obesity, alcohol intake, hypertension, hypertriglyceridemia, and hyperuricemia were independent risk factors for colonic diverticulosis. ...
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.
... В западных странах дивертикулез обнаруживали в сигмовидной (левой) кишке в 90% случаев, тогда как в Японии [4] и Южной Корее [5] его чаще выявляли в восходящей (правой) кишке (75-85% случаев). Кроме того, у афроамериканцев доля дивертикулов (как по распределению, так и по общему количеству) в правых отделах ободочной кишки выше, чем у представителей белой расы [6]. ...
Дивертикулы ободочной кишки - наиболее частое анатомическое изменение, диагностируемое при колоноскопии. Распространенность данного заболевания выше у пожилых пациентов старше 65 лет со сдвигом в сторону снижения возраста (40-45 лет). Несмотря на высокую распространенность заболевания (по разным данным, от 7 до 20%), патофизиологические механизмы его формирования до конца не изучены. Установлено, что в формировании дивертикулов участвует множество факторов, которые в настоящее время признаны факторами риска развития данного патологического процесса: генетическая предрасположенность, нарушение моторики кишечника, образ жизни (в том числе употребление алкоголя, курение, избыточная масса тела), пищевое поведение (употребление красного мяса, низкое потребление клетчатки и т. д.), нарушение состава микробиоты толстого кишечника, а также прием лекарственных препаратов (нестероидные противовоспалительные средства, аспирин и др.).
Colon diverticula are the most common anatomical changes diagnosed with colonoscopy. The prevalence of this disease is higher in elderly patients over 65 years old with a shift towards decrease of age (40-45 years). Despite the high prevalence of the disease (according to various sources, from 7 to 20%), the pathophysiological mechanisms of its formation are not fully understood. It was found that many factors are involved in the formation of diverticula that are currently recognized as risk factors of development of this pathological process: genetic predisposition, alteration of colonic motility, lifestyle conditions (including alcohol consumption, smoking, overweight), eating behavior (consumption of red meat, low fiber intake, etc.), alterations in colonic microbiota composition, as well as certain medications (non-steroidal anti-inflammatory drugs, aspirin, etc.).
... Kopylov et al. [19] demonstrated an association between obesity and CD; alternatively, Song et al. [50] determined that typically patients with CD have higher BMI. Furthermore, obesity expressed not only as BMI, but also as waist circumference and waist-to-hip ratio, has recently been highlighted as one of the strongest risk factors for CDD [12,15]. ...
Non-alcoholic fatty liver disease and colonic diverticulosis are widespread, obesity-related diseases. It hasrecently become clear that non-alcoholic fatty liver disease is a systemic disease and may play a key rolein metabolic syndrome; therefore, the term metabolic-dysfunction-associated fatty liver disease has beenintroduced in the literature. Excess visceral adipose tissue is an important predictor of complications in bothnon-alcoholic fatty liver disease and colonic diverticulosis. Current evidence suggests that intestinal dysbiosismay be involved in the development of both non-alcoholic fatty liver disease and colonic diverticulosis, andthat metabolic syndrome is a consequence rather than a cause of this complex relationship. In this review, ouraim was to assess the current knowledge of the complex interplay between metabolic syndrome, non-alcoholicfatty liver disease, and colonic diverticulosis.
... Up to now, data on the association between obesity (BMI ≥ 30 kg/m 2 ) and CD is conflicting. Whereas some authors report that higher BMI increases the risk for developing CD [24][25][26], others find no such association [27] or propose an increased waist circumference due to visceral and subcutaneous fat collection to be a better predictive factor [28]. Our findings, using a colonoscopy-based cohort, are consistent with earlier studies demonstrating that obese participants (BMI≥30 kg/m2) have increased odds of diverticulosis compared with subjects a normal BMI [24][25][26]. ...
... Therefore, our study which shows a significant association between obesity and CD even after carefully adjusting for confounding factors, adds further emphasis to this link. To explain a mismatch with some published reports, we suggest that previous studies in which no such link was found were limited by either relying on a self-reported diagnosis, possibly leading to diagnostic bias [28] or were conducted in Asian populations in which the prevalence of obesity and diverticulosis is significantly lower [27]. The mechanism by which obesity is associated with colonic diverticula remains unknown. ...
Background and aims:
Colonic diverticulosis (CD) is among the most common conditions of the large bowel. Several factors have been associated with an increased risk of CD and its complications, including advanced age, obesity, physical inactivity, and a low-fiber diet. Available data is conflicting and a comprehensive analysis of different bowel, dietary and environmental habits linked with CD is lacking. We aimed to investigate the relationship between potential risk factors and CD prevalence using full data from a colonoscopy-based cross-sectional study in Europe.
Methods:
The study was conducted at three tertiary referral centers in Germany and Lithuania. It included consecutive adult patients referred for routine colonoscopy who completed a detailed questionnaire on our considered multiple risk factors for diverticulosis and diverticulitis, including dietary and environmental factors, and bowel habits.
Results:
The study included 1,333 patients, 696 women and 635 men. Colonic diverticulosis was diagnosed in 858 (64%) of patients. Multivariate analysis revealed that age (OR: 1.08, 95%CI: 1.06-1.10, p<0.001) and obesity (OR: 1.05, 95%CI: 1.02-1.09, p=0.004) were associated with CD. We also revealed new risk factors for CD: increased frequency of bowel movements (OR: 0.10, 95%CI: 0.03-0.33, p<0.001) and feeling of incomplete bowel emptying (OR: 2.05, 95%CI: 1.47-2.87, p<0.001). Older participants had reduced odds (OR: 0.921, 95 CI: 0.89-0.95, p<0.05) of diverticulitis compared to younger subjects. Feeling of incomplete bowel emptying after defecation was associated with increased odds (OR: 2.769, 95% CI 1.35-5.7, p<0.006) for diverticulitis. Moreover, participants with a higher educational status had increased odds (OR: 2.453, 95%CI: 1.31-4.59, p=0.005) for diverticulitis compared to the lower education group.
Conclusions:
Study shows that older age, obesity, frequency of bowel movements, and feeling of incomplete bowel emptying are associated with the risk of CD. Furthermore, older age, feeling of incomplete bowel emptying, and higher education were associated with the risk of diverticulitis among CD patients.
... Dietary factors, obesity, physical inactivity, smoking, alcohol, non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids have been claimed to predispose to the disease [22][23][24][25][26][27] . Studies suggest that hemoglobin (HGB), vitamin D and C-reactive protein (CRP) could be predictive of the disease severity 28-31. ...
... Their hypothesis of the decrease in colonic transit time due to low-fiber diet (associated with high pressure in the sigmoid colon) has been questioned based on research using colonic motility studies as well as on epidemiological evidence (31,32). Recently diet has been challenged as the main risk factor responsible for diverticulosis and diverticular disease following recent epidemiologic and genetic studies (33)(34)(35)(36). Based on anatomic studies showing the prevalence of diverticulosis in the right colon in Asian population, the role of the "high pressure problem" in the sigmoid colon had to be revised. ...
... Based on anatomic studies showing the prevalence of diverticulosis in the right colon in Asian population, the role of the "high pressure problem" in the sigmoid colon had to be revised. In addition, several studies dealing with population migration have failed to show an increase of diverticular disease and/or complication as well as a shift from right sided to sigmoid localization due to a change to Western lifestyle thus proposing a genetic impact (33)(34)(35)(36). Analysis of the Swedish twin registry by Granlund and coworkers revealed an odds ratio (OR) of 7.15 to develop diverticular problems in monozygotic twins compared to only 3.2 for dizygotic twins (37). ...
Diverticular disease is among the most common gastrointestinal disorders affecting the Western population. Although complications arising from colonic diverticula significantly affect a patient’s quality of life and the overall health sector, the scientific evidence to facilitate its better management is limited in the literature. Several recommendations and guidelines have been made, albeit based on expert opinions rather than on the outcomes of controlled clinical trials. The more recent research on the natural history of this disorder has led to a shift from the historic dogmatic recommendations to a more individualised approach.
