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Leifeld L, Germer CT, Böhm S, Dumoulin FL, Frieling T, Kreis M, Meining A, Labenz J, Lock JF, Ritz JP, Schreyer A, Kruis W. S3-Leitlinie Divertikelkrankheit/Divertikulitis – Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:613-688. [PMID: 35388437 DOI: 10.1055/a-1741-5724] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ludger Leifeld
- Medizinische Klinik 3 - Gastroenterologie und Allgemeine Innere Medizin, St. Bernward Krankenhaus, Hildesheim, apl. Professur an der Medizinischen Hochschule Hannover
| | - Christoph-Thomas Germer
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin, Universitätsklinikum Würzburg, Würzburg
| | - Stephan Böhm
- Spital Bülach, Spitalstrasse 24, 8180 Bülach, Schweiz
| | | | - Thomas Frieling
- Medizinische Klinik II, Klinik für Gastroenterologie, Hepatologie, Infektiologie, Neurogastroenterologie, Hämatologie, Onkologie und Palliativmedizin HELIOS Klinikum Krefeld
| | - Martin Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Alexander Meining
- Medizinische Klinik und Poliklinik 2, Zentrum für Innere Medizin (ZIM), Universitätsklinikum Würzburg, Würzburg
| | - Joachim Labenz
- Abteilung für Innere Medizin, Evang. Jung-Stilling-Krankenhaus, Siegen
| | - Johan Friso Lock
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin, Universitätsklinikum Würzburg, Würzburg
| | - Jörg-Peter Ritz
- Klinik für Allgemein- und Viszeralchirurgie, Helios Klinikum Schwerin
| | - Andreas Schreyer
- Institut für diagnostische und interventionelle Radiologie, Medizinische Hochschule Brandenburg Theodor Fontane Klinikum Brandenburg, Brandenburg, Deutschland
| | - Wolfgang Kruis
- Medizinische Fakultät, Universität Köln, Köln, Deutschland
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Flich-Carbonell J, Alegre-Martinez A, Alfonso-Sanchez JL, Torres-Sanchez MT, Gomez-Abril S, Martínez-Martínez MI, Martin-Moreno JM. The Potential Link between Episodes of Diverticulitis or Hemorrhoidal Proctitis and Diets with Selected Plant Foods: A Case-Control Study. Nutrients 2021; 13:nu13061791. [PMID: 34073981 PMCID: PMC8225048 DOI: 10.3390/nu13061791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
Diverticulitis and hemorrhoidal proctitis in the population are significant public health problems. We studied the potential association between the intake of certain plant foods and diverticulitis or hemorrhoidal episodes through a case-control study including 410 cases and 401 controls. We used a semiquantitative food frequency questionnaire. The intake was additionally quantified according to a 24 h recall. The plant foods or derived food products were categorized by their main chemical components into ethanol, caffeine/theine/theobromine, capsaicin, alliin, acids, eugenol, and miscellaneous foods such as curcumin. The mean score for overall intake of plant foods under consideration was 6.3 points, and this was significantly higher in cases (8.5) than in controls (4.1). Overall intake was similar in cases presenting with diverticulitis or hemorrhoidal proctitis. Cases had 13 times the odds of being in the upper quartile for overall intake (>7 points), compared to controls. Explanatory logistic regression models showed that the strongest association with diverticulitis and hemorrhoidal proctitis was shown by the chemical food group of capsaicin, followed by ethanol, eugenol, caffeine/theine/theobromine, and acids. Neither alliin nor miscellaneous food groups showed any association. High, frequent consumption of capsaicin, followed by ethanol, eugenol, caffeine/theine/theobromine, and acids increase the risk of diverticulitis and hemorrhoidal proctitis.
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Affiliation(s)
- Juan Flich-Carbonell
- Colorectal Surgery Section, General and Digestive Surgery Service, Dr. Peset University Hospital, 46017 Valencia, Spain; (J.F.-C.); (M.T.T.-S.); (S.G.-A.)
| | - Antoni Alegre-Martinez
- Department of Biomedical Sciences, Cardenal Herrera CEU University, Moncada, 46115 Valencia, Spain;
| | - Jose L. Alfonso-Sanchez
- Head of Preventive Medicine Service, University General Hospital of Valencia, 46014 Valencia, Spain
- Department of Preventive Medicine and Public Health, University of Valencia, 46010 Valencia, Spain
- Correspondence: or (J.L.A.-S.); (J.M.M.-M.)
| | - Maria T. Torres-Sanchez
- Colorectal Surgery Section, General and Digestive Surgery Service, Dr. Peset University Hospital, 46017 Valencia, Spain; (J.F.-C.); (M.T.T.-S.); (S.G.-A.)
| | - Segundo Gomez-Abril
- Colorectal Surgery Section, General and Digestive Surgery Service, Dr. Peset University Hospital, 46017 Valencia, Spain; (J.F.-C.); (M.T.T.-S.); (S.G.-A.)
| | | | - José M. Martin-Moreno
- Department of Preventive Medicine and Public Health, University of Valencia, 46010 Valencia, Spain
- INCLIVA and Clinical University Hospital, 46010 Valencia, Spain
- Correspondence: or (J.L.A.-S.); (J.M.M.-M.)
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Rottier SJ, Dreuning LC, van Pelt J, van Geloven AAW, Beele XDY, Huisman PM, Deurholt WY, Rottier CA, van Leeuwen K, de Boer M, van Mierlo G, Boermeester MA, Schreurs WH. Alpha-1-antitrypsin deficiency (carrier) as possible risk factor for development of colonic diverticula. A multicentre prospective case-control study: the ALADDIN study. Colorectal Dis 2020; 22:2243-2251. [PMID: 32666625 PMCID: PMC7818100 DOI: 10.1111/codi.15270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/21/2020] [Indexed: 02/08/2023]
Abstract
AIM Connective tissue changes due to ageing or diseases leading to changes in the colonic wall are one theory for the development of diverticula. Alpha-1-antitrypsin (A1AT), a protease inhibitor that protects connective tissue, possibly plays a role in the aetiology of diverticulosis. The aim of this study was to explore associations between the development of diverticula and A1AT deficiency. METHODS This was a multicentre prospective case-control study. A total of 221 patients aged ≥ 60 years with acute abdominal pain undergoing abdominal CT were included and analysed. Patients with diverticula were defined as the research group, patients without diverticula as controls. Genotype analysis for A1AT deficiency was performed. RESULTS Twenty-six of 221 (11.8%) patients were diagnosed with (being a carrier of) A1AT deficiency. A non-significant difference in prevalence between patients with and without diverticula was found, 20 (13.9%) of 144 vs 6 (7.8%) of 77, respectively, with a crude OR of 1.9 (95% CI 0.7-5.0; P = 0.186) and after adjustment for confounders an adjusted OR of 1.5 (95% CI 0.5-4.0; P = 0.466). A non-significant difference in 30-day mortality rate from acute diverticulitis between A1AT deficient patients (or carriers) and those without was observed: two (22.2%) of nine patients with A1AT deficiency vs 1 (1.8%) of 55 without. CONCLUSION We found no convincing evidence that A1AT deficiency plays a role in the aetiology of diverticulitis, although deficient patients and carriers had a higher mortality when experiencing diverticulitis. Diverticulitis is a multifactorial disease and larger numbers may be needed to explore the role of A1AT deficiency among other contributing factors.
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Affiliation(s)
- S. J. Rottier
- Department of SurgeryNorthwest ClinicsAlkmaar/Den HelderThe Netherlands,Department of SurgeryTergooi HospitalHilversumThe Netherlands,Department of SurgeryAcademic Medical CenterAmsterdamThe Netherlands
| | - L. C. Dreuning
- Department of SurgeryTergooi HospitalHilversumThe Netherlands
| | - J. van Pelt
- Department of Clinical LaboratoryNorthwest ClinicsAlkmaar/Den HelderThe Netherlands
| | | | - X. D. Y. Beele
- Department of RadiologyTergooi HospitalHilversumThe Netherlands
| | - P. M. Huisman
- Department of RadiologyTergooi HospitalHilversumThe Netherlands
| | - W. Y. Deurholt
- Department of RadiologyNorthwest ClinicsAlkmaar/Den HelderThe Netherlands
| | - C. A. Rottier
- Department of SurgeryNorthwest ClinicsAlkmaar/Den HelderThe Netherlands
| | - K. van Leeuwen
- Department of Molecular and Cellular HemostasisSanquin Blood SupplyDivision Research and Landsteiner Laboratory of the Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - M. de Boer
- Department of Molecular and Cellular HemostasisSanquin Blood SupplyDivision Research and Landsteiner Laboratory of the Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - G. van Mierlo
- Department of ImmunopathologySanquin Blood SupplyDivision Research and Landsteiner Laboratory of the Academic Medical CenterUniversity of Amsterdam,AmsterdamThe Netherlands
| | - M. A. Boermeester
- Department of SurgeryAcademic Medical CenterAmsterdamThe Netherlands
| | - W. H. Schreurs
- Department of SurgeryNorthwest ClinicsAlkmaar/Den HelderThe Netherlands
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Coakley KM, Davis BR, Kasten KR. Complicated Diverticular Disease. Clin Colon Rectal Surg 2020; 34:96-103. [PMID: 33642949 DOI: 10.1055/s-0040-1716701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The modern management of colonic diverticular disease involves grouping patients into uncomplicated or complicated diverticulitis, after which the correct treatment paradigm is instituted. Recent controversies suggest overlap in management strategies between these two groups. While most reports still support surgical intervention for the treatment of complicated diverticular disease, more data are forthcoming suggesting complicated diverticulitis does not merit surgical resection in all scenarios. Given the significant risk for complication in surgery for diverticulitis, careful attention should be paid to patient and procedure selection. Here, we define complicated diverticulitis, discuss options for surgical intervention, and explain strategies for avoiding operative pitfalls that result in early and late postoperative complications.
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Affiliation(s)
- Kathleen M Coakley
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Bradley R Davis
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Kevin R Kasten
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
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5
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Arnold MH. The management of diverticulitis: a review of the guidelines. Med J Aust 2020; 212:434-434.e1. [DOI: 10.5694/mja2.50526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Mark H Arnold
- School of Rural HealthUniversity of Sydney Dubbo NSW
- University of Sydney Sydney NSW
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6
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Rottier SJ, de Jonge J, Dreuning LC, van Pelt J, van Geloven AAW, Beele XDY, Huisman PM, Deurholt WY, Rottier CA, Boermeester MA, Schreurs WH. Prevalence of alpha-1-antitrypsin deficiency carriers in a population with and without colonic diverticula. A multicentre prospective case-control study: the ALADDIN study. Int J Colorectal Dis 2019; 34:933-938. [PMID: 30767045 DOI: 10.1007/s00384-019-03248-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE The underling pathophysiological mechanisms that cause the formation of colonic diverticula (diverticulosis) remain unclear. Connective tissue changes due to ageing that cause changes in collagen structure of the colonic wall is one theory. Alpha-1-antitrypsin (A1AT) is a protease inhibitor known to protect connective tissue in other organs. Associations between (carriers of) A1AT deficiency and the development of colonic diverticula will be the main focus of this study. METHODS A multicentre prospective case-controlled study. In total, 230 patients ≥ 60 years with acute abdominal pain undergoing an abdominal computed tomography (CT) will be included. The research group consists of patients with diverticulosis and/or diverticulitis; controls are patients without diverticula (0 to ≤ 5 diverticula). Genotype analysis for A1AT deficiency will be performed. RATIONALE Hypothetically, connective tissue changes, in particular related to (carriers of) A1AT deficiency, can contribute to the development of diverticula and diverticulitis. We expect to find a higher prevalence of A1AT carriers in patients with diverticulosis compared to patients without diverticulosis. Having diverticulosis does not affect the general health of these individuals per se, when asymptomatic. Once an association is found, present findings can be the basis for a second study to assess the risk of developing acute diverticulitis and its disease course in carriers of A1AT deficiency. Because a large cohort is needed in the latter, we shall first perform a pilot study to investigate the likelihood of the primary hypothesis. TRIAL REGISTRATION Netherlands Trial register, NTR6251, NL55016.094.15.
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Affiliation(s)
- S J Rottier
- Department of Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar/Den Helder, Netherlands.
- Department of Surgery, Tergooi, Hilversum, Netherlands.
- Department of Surgery, Amsterdam UMC, Amsterdam, Netherlands.
| | - J de Jonge
- Department of Surgery, Tergooi, Hilversum, Netherlands
| | - L C Dreuning
- Department of Surgery, Tergooi, Hilversum, Netherlands
| | - J van Pelt
- Department of Clinical laboratory, Northwest Clinics, Alkmaar/Den Helder, Netherlands
| | | | - X D Y Beele
- Department of Radiology, Tergooi, Hilversum, Netherlands
| | - P M Huisman
- Department of Radiology, Tergooi, Hilversum, Netherlands
| | - W Y Deurholt
- Department of Radiology, Northwest Clinics, Alkmaar/Den Helder, Netherlands
| | - C A Rottier
- Department of Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar/Den Helder, Netherlands
| | - M A Boermeester
- Department of Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - W H Schreurs
- Department of Surgery, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar/Den Helder, Netherlands
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Järbrink-Sehgal ME, Schmidt PT, Sköldberg F, Hemmingsson T, Hagström H, Andreasson A. Lifestyle Factors in Late Adolescence Associate With Later Development of Diverticular Disease Requiring Hospitalization. Clin Gastroenterol Hepatol 2018; 16:1474-1480.e1. [PMID: 29654917 DOI: 10.1016/j.cgh.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/21/2018] [Accepted: 04/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The burden of diverticular disease on society is high and is increasing with an aging population. It is therefore important to identify risk factors for disease development or progression. Many lifestyle behaviors during adolescence affect risk for later disease. We searched for adolescent lifestyle factors that affect risk of diverticular disease later in life. METHODS We performed a retrospective analysis of data from 43,772 men (age, 18-20 y) conscripted to military service in Sweden from 1969 through 1970, with a follow-up period of 39 years. All conscripts underwent an extensive mental and physical health examination and completed questionnaires covering alcohol consumption, smoking, and use of recreational drugs; cardiovascular fitness was assessed using an ergometer cycle at the time of conscription. Outcome data were collected from national registers to identify discharge diagnoses of diverticular disease until the end of 2009. We performed Cox regression analysis to determine whether body mass index, cardiovascular fitness, smoking, use of recreational drugs, alcohol consumption, and risky use of alcohol, at time of conscription are independent risk factors for development of diverticular disease. RESULTS Overweight and obese men had a 2-fold increased risk of diverticular disease compared to normal-weight men (hazard ratio, 2.00; P < .001). A high level of cardiovascular fitness was associated with a reduced risk of diverticular disease requiring hospitalization (P = .009). Smoking (P = .003), but not use of recreational drugs (P = .11), was associated with an increased risk of diverticular disease requiring hospitalization. Risky use of alcohol, but not alcohol consumption per se, was associated with a 43% increase in risk of diverticular disease requiring hospitalization (P = .007). CONCLUSIONS In a retrospective analysis of data from 43,772 men in Sweden, we associated being overweight or obese, a smoker, a high-risk user of alcohol, and/or having a low level of cardiovascular fitness in late adolescence with an increased risk of developing diverticular disease requiring hospitalization later in life. Improving lifestyle factors among adolescents might reduce the economic burden of diverticular disease decades later.
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Affiliation(s)
- M Ellionore Järbrink-Sehgal
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Digestive Disease Center, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas.
| | - Peter T Schmidt
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Filip Sköldberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tomas Hemmingsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Hannes Hagström
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Andreasson
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Psychology, Macquarie University, North Ryde, New South Wales, Australia
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Mahmood MW, Abraham-Nordling M, Håkansson N, Wolk A, Hjern F. High intake of dietary fibre from fruit and vegetables reduces the risk of hospitalisation for diverticular disease. Eur J Nutr 2018; 58:2393-2400. [PMID: 30084005 PMCID: PMC6689272 DOI: 10.1007/s00394-018-1792-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 07/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUNDS AND AIMS High intake of dietary fibres has been associated with a reduced risk of DD. However, reports on which type of dietary fibre intake that is most beneficial have been conflicting. The aim of this study was to investigate the association between different dietary fibres and hospitalisation due to diverticular disease (DD) of the colon. METHODS This was a major cohort study. The Swedish Mammography Cohort and the Cohort of Swedish Men were linked to the Swedish Inpatient Register and the Causes of Death Register. Data on the intake of dietary fibre were collected through questionnaires. The effect of intake (in quartiles) of different types of dietary fibre on the incidence of hospitalisation due to DD was investigated using multivariable Cox regression. Estimates were adjusted according to age, BMI, physical activity, co-morbidity, intake of corticosteroids, smoking, alcohol intake and education level. RESULTS Women with intake of fruit and vegetable fibres in the highest quartile (median 12.6 g/day) had a 30% decreased risk of hospitalisation compared to those with the lowest intake (4.1 g/day). Men within the highest quartile (10.3 g/day) had a 32% decreased risk compared to those with a low intake (2.9 g/day). High intake of fibres from cereals did not affect the risk. CONCLUSION A high intake of fruits and vegetables may reduce the risk of hospitalisation due to DD. Intake of cereals did not influence the risk.
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Affiliation(s)
- Mahmood W Mahmood
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
- Department of Surgery and Urology, Danderyd University Hospital, 182 88, Stockholm, Sweden.
| | - Mirna Abraham-Nordling
- Division of Coloproctology, Center of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Niclas Håkansson
- The National Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- The National Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Hjern
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Division of Coloproctology, Center of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
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9
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Reichert MC, Krawczyk M, Appenrodt B, Casper M, Friesenhahn-Ochs B, Grünhage F, Jüngst C, Zimmer V, Lammert F, Dauer M. Selective association of nonaspirin NSAIDs with risk of diverticulitis. Int J Colorectal Dis 2018; 33:423-430. [PMID: 29411119 DOI: 10.1007/s00384-018-2968-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study is to investigate the association of intake of nonsteroidal anti-inflammatory drugs (NSAIDs) and in particular nonaspirin NSAIDs and compare it with other risk factors for the progression of diverticulosis to diverticulitis in patients who underwent colonoscopy. METHODS A total of 194 patients who underwent complete colonoscopy in our center between 2012 and 2016 were recruited: 144 with diverticulosis without prior diverticulitis (median age 71 years, 59.7% men) and 50 with diverticulitis (median age 64 years, 54.0% men). Data concerning current and previous medication as well as concomitant diseases were collected using a structured questionnaire and by revision of patients medical charts. RESULTS Patients with diverticulitis were significantly (p < 0.001) younger as compared to individuals with plain diverticulosis (median age 64 versus 71 years, respectively). The intake of NSAIDs significantly (p = 0.002) increased the risk of prior diverticulitis (OR 3.2, 95% CI 1.5-6.9). In the multivariate model, both age (p < 0.001) and NSAIDs (p = 0.03) proved to be independent determinants of diverticulitis. When analyzing aspirin intake, it was not associated with diverticulitis. CONCLUSIONS Our study demonstrates, in line with previous reports, that intake of NSAIDs is associated with diverticulitis. We show in particular that nonaspirin NSAIDs might be selectively associated with diverticulitis. These results point to divergent role of aspirin and nonaspirin NSAIDs in the development of diverticulitis.
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Affiliation(s)
- Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, 66421, Homburg, Germany.
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, 66421, Homburg, Germany
- Laboratory of Metabolic Liver Diseases, Centre for Preclinical Research, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Beate Appenrodt
- Department of Medicine II, Saarland University Medical Center, 66421, Homburg, Germany
| | - Markus Casper
- Department of Medicine II, Saarland University Medical Center, 66421, Homburg, Germany
| | | | - Frank Grünhage
- Department of Medicine II, Saarland University Medical Center, 66421, Homburg, Germany
| | - Christoph Jüngst
- Department of Medicine II, Saarland University Medical Center, 66421, Homburg, Germany
| | - Vincent Zimmer
- Department of Medicine II, Saarland University Medical Center, 66421, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, 66421, Homburg, Germany
| | - Marc Dauer
- Department of Medicine II, Saarland University Medical Center, 66421, Homburg, Germany
- Department Medicine 2, Klinikum St. Marien, Amberg, Germany
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Diabetes Increases Morbidities of Colonic Diverticular Disease and Colonic Diverticular Hemorrhage: A Systematic Review and Meta-Analysis. Am J Ther 2017; 24:e213-e221. [DOI: 10.1097/mjt.0000000000000410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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11
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Socioeconomic characteristics and comorbidities of diverticular disease in Sweden 1997-2012. Int J Colorectal Dis 2017; 32:1591-1596. [PMID: 28785818 PMCID: PMC5635093 DOI: 10.1007/s00384-017-2853-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to evaluate the association of socioeconomic status and comorbidities with uncomplicated and complicated diverticular disease (DD) in Sweden. METHODS We identified all individuals aged ≥30 years in Sweden diagnosed with DD between 1997 and 2012 using the Swedish National Population and Housing Census and the Hospital Discharge Register. Data were analyzed by multivariable logistic regression, with individual-level characteristics as covariates. RESULTS A total of 79,481 patients (median age 66 [range 30-86] years) were hospitalized for DD, 15,878 (20%) of whom for complicated DD. Admissions for both uncomplicated and complicated DD were more common in women (p < 0.001). A low education level was identified as a risk factor for uncomplicated (unadjusted hazard ratio [HR] 1.79, 95% confidence interval [CI] 1.75-1.82; adjusted HR 1.22, 95% CI 1.19-1.24) and complicated DD (unadjusted HR 1.84, 95% CI 1.77-1.92; adjusted HR 1.26, 95% CI 1.21-1.32). Patients with the lowest income had a lower risk of hospitalization for uncomplicated (adjusted HR 0.94, 95% CI 0.91-0.96) and complicated DD (adjusted HR 0.87, 95% CI 0.83-0.92) than those with the highest income. The correlation coefficient between income and education was 0.25. Diabetes and cardiovascular disease were identified as protective factors against uncomplicated DD (adjusted HR 0.68, 95% CI 0.66-0.69 and HR 0.79, 95% CI 0.74-0.84, respectively). CONCLUSIONS Patients with the lowest education level had an increased risk of hospitalization for DD. Further studies are needed to explore the association of diabetes and cardiovascular disease with uncomplicated DD.
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12
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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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Sallinen V, Mali J, Leppäniemi A, Mentula P. Assessment of risk for recurrent diverticulitis: a proposal of risk score for complicated recurrence. Medicine (Baltimore) 2015; 94:e557. [PMID: 25715253 PMCID: PMC4554145 DOI: 10.1097/md.0000000000000557] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Recurrence of acute diverticulitis is common, and--especially complicated recurrence--causes significant morbidity. To prevent recurrence, selected patients have been offered prophylactic sigmoid resection. However, as there is no tool to predict whose diverticulitis will recur and, in particular, who will have complicated recurrence, the indications for sigmoid resections have been variable. The objective of this study was to identify risk factors predicting recurrence of acute diverticulitis. This is a retrospective cohort study of patients presenting with computed tomography-confirmed acute diverticulitis and treated nonresectionally during 2006 to 2010. Risk factors for recurrence were identified using uni- and multivariate Cox regression. A total of 512 patients were included. History of diverticulitis was an independent risk factor predicting uncomplicated recurrence of diverticulitis (1-2 earlier diverticulitis HR 1.6, 3 or more--HR 3.2). History of diverticulitis (HR 3.3), abscess (HR 6.2), and corticosteroid medication (HR 16.1) were independent risk factors for complicated recurrence. Based on regression coefficients, risk scoring was created: 1 point for history of diverticulitis, 2 points for abscess, and 3 points for corticosteroid medication. The risk score was unable to predict uncomplicated recurrence (AUC 0.48), but was able to predict complicated recurrence (AUC 0.80). Patients were further divided into low-risk (0-2 points) and high-risk (>2 points) groups. Low-risk and high-risk groups had 3% and 43% 5-year complicated recurrence rates, respectively. Risk for complicated recurrence of acute diverticulitis can be assessed using risk scoring. The risk for uncomplicated recurrence increases along with increasing number of previous diverticulitis.
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Affiliation(s)
- Ville Sallinen
- From the Department of Abdominal Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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