Review article: uncomplicated diverticular disease of the colon

Genetic, epigenetic and environmental factors in diverticular disease: systematic review

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.

Bioactive components in Bambara groundnut (Vigna subterraenea (L.) Verdc) as a potential source of nutraceutical ingredients

The utilization of nutraceuticals on a global scale has significantly increased over the past few years due to their reported health benefits and consumer's reluctance to consume synthetic drugs. This paper provides information regarding new and potential value added uses of biologically active compounds in Bambara groundnut (BGN) as ingredients that could be further researched and exploited for various applications. Nutraceutical is a food or part of food that apart from providing basic nutrients, offers medicinal benefits either by prevention and or treatment of an illness. BGN is a legume with rich nutrient profile that is under exploited industrially. It is widely used in African traditional medicine for its various health outcome, but has not been explored scientifically for its numerous nutraceutical potentials. Compared to beans BGN has greater quantity of soluble fiber and also have high dietary fiber. It is rich in polyphenolic compound which include flavonoids subgroups like flavonols, flavanols, anthocyanindins, isoflavones and phenolic acids: both benzoic acid and cinnamic acid derivatives, biologically active polyunsaturated fatty acids, proteins and peptides, antioxidant vitamins and minerals. The rising interest and emphasis in plant-based biologically active components (nutraceuticals) for various health promotion, has positioned this African legume as a potential source of nutraceutical ingredients (bioactive components) that could be exploited for improved nutrition and health.

Recent advances in nanocarriers for nutrient delivery

For the past few years, there has been a surge in the use of nutraceuticals. The global nutraceuticals market in 2020 was USD 417.66 billion, and the market value is expected to increase by 8.9% compound annual growth rate from 2020 to 2028. This is because nutraceuticals are used to treat and prevent various diseases such as cancer, skin disorders, gastrointestinal, ophthalmic, diabetes, obesity, and central nervous system-related diseases. Nutritious food provides the required amount of nutrition to the human body through diet, whereas most of the bioactive agents present in the nutrients are highly lipophilic, with low aqueous solubility leading to poor dissolution and oral bioavailability. Also, the nutraceuticals like curcumin, carotenoids, anthocyanins, omega-3 fatty acids, vitamins C, vitamin B12, and quercetin have limitations such as poor solubility, chemical instability, bitter taste, and an unpleasant odor. Additionally, the presence of gastrointestinal (GIT) membrane barriers, varied pH, and reaction with GIT enzymes cause the degradation of some of the nutraceuticals. Nanotechnology-based nutrient delivery systems can be used to improve oral bioavailability by increasing nutraceutical stability in foods and GIT, increasing nutraceutical solubility in intestinal fluids, and decreasing first-pass metabolism in the gut and liver. This article has compiled the properties and applications of various nanocarriers such as polymeric nanoparticles, micelles, liposomes, niosomes, solid lipid nanocarriers, nanostructured lipid carrier, microemulsion, nanoemulsion, dendrimers in organic nanoparticles, and nanocomposites for effective delivery of bioactive molecules.

Recent trends in the prevalence and distribution of colonic diverticula in Japan evaluated using computed tomography colonography

BACKGROUND

Computed tomography colonography (CTC) may be superior to colonoscopy and barium enema for detecting diverticula. However, few studies have used CTC to diagnose diverticula.

AIM

To evaluate the current prevalence and distribution of colonic diverticula in Japan using CTC.

METHODS

This study was conducted as part of the Japanese National Computed Tomographic Colonography Trial, which included 1181 participants from 14 hospitals in Japan. We analyzed the prevalence and distribution of colonic diverticula and their relationships with age and sex. The relationship between the diverticula and the length of the large intestine was also analyzed.

RESULTS

Diverticulosis was present in 48.1% of the participants. The prevalence of diverticulosis was higher in the older participants (P < 0.001 for trend). The diverticula seen in younger participants were predominantly located in the right-sided colon. Older participants had a higher frequency of bilateral type (located in the right- and left-sided colon) diverticulosis (P < 0.001 for trend). The length of the large intestine with multiple diverticula in the sigmoid colon was significantly shorter in those without diverticula (P < 0.001).

CONCLUSION

The prevalence of colonic diverticulosis in Japan is higher than that previously reported. The prevalence was higher, and the distribution tended to be bilateral in older participants.

Dietary habits and the presence and degree of asymptomatic diverticular disease by magnetic resonance imaging in a Western population: a population-based cohort study

BACKGROUND

Despite the worldwide burden of diverticular disease, the connections between diverticular disease and dietary habits remain poorly understood, particularly in an asymptomatic representative sample. We investigated the association between asymptomatic diverticular disease as assessed by magnetic resonance imaging (MRI) and dietary habits in a Western study cohort.

METHODS

Participants from a cross-sectional sample of a population-based cohort study underwent whole-body 3T-MRI including an isotropic VIBE-Dixon sequence. The presence and extent of diverticular disease was assessed in blinded fashion. Habitual dietary intake was recorded using a blended approach, applying 24-h food lists and a food-frequency questionnaire. Traditional cardiometabolic risk factors were obtained by interviews and medical examination. Univariate and multivariate associations were calculated.

RESULTS

A total of 308 subjects were included in this analysis (56% male, 56.4 ± 9.1 years). 39.9% had any form of diverticular disease and 15.3% had advanced asymptomatic diverticular disease. After adjustment for age, sex and total energy intake a higher intake of fiber and vegetables was associated with a lower odds for asymptomatic diverticular disease (fiber: OR 0.68 95% CI [0.48, 0.95]; vegetables: OR 0.72 95% CI [0.53, 0.97]) and an increased intake of meat was associated with an approximately two-fold higher odds for advanced asymptomatic diverticular disease (OR 1.84 95% CI [1.13, 2.99]). However, after additional adjustment for body-mass-index (BMI), alcohol consumption, smoking behavior and physical activity only a high fiber and vegetables intake remained significantly associated with lower odds of asymptomatic diverticular disease.

CONCLUSION

Our results indicate that a high-fiber diet and increased intake of vegetables is associated with lower odds of having asymptomatic diverticular disease, independent of age, sex, total energy intake, BMI and other life-style factors.

Promoting Sustainable and Healthy Diets to Mitigate Food Insecurity Amidst Economic and Health Crises in Lebanon

Introduction: Lebanon, a middle-income Eastern Mediterranean country, continues to face detrimental economic, health and socio-political challenges that are further exacerbated by the COVID-19 pandemic. In parallel, the country has been experiencing a remarkable nutrition transition that has contributed to the burden of malnutrition and non-communicable diseases, all imposing serious repercussions on people's livelihoods, food security, and health. Such circumstances have prodded public demand for guidance on affordable, healthy, and sustainable dietary choices to alleviate the burden to this emerging unfortunate situation. Objective: The purpose of this study is to provide evidence-based sustainable and healthy dietary recommendations which balance the tradeoffs among the health, environmental footprint and cost dimensions of sustainability, while closely resembling the usual food consumption pattern. Methodology: Data from the latest available national food consumption survey was used as the usual food consumption pattern of Lebanese adults. Optimized dietary patterns were calculated using the optimization model Optimeal which produced patterns most similar to the usual diet and simultaneously satisfying the three main sets of constraints: health, environmental footprints, and cost. The identified healthy and sustainable dietary options were vetted by multiple key stakeholders from the government, academia, international, and national non-governmental organizations. Results: Compared to the usual intake, the optimized diet included higher intakes of whole grain bread, dark green vegetables, dairy products, and legumes, and lower intakes of refined bread, meat, poultry, added sugars, saturated fat, as compared to usual national mean consumption. The optimized dietary model resulted in a decrease in the associated environmental footprints: water use (-6%); and GHG (-22%) with no change in energy use. The cost of the optimized diet was not different from that of the usual intake. Conclusion: An evidence-based sustainable and healthy diet was developed for Lebanon providing the population and policy makers with some answers to a complex situation. Findings highlight the need for the development of sustainable food based dietary guidelines for Lebanon to promote diets that are healthy, sustainable, culturally acceptable, and affordable and that can alleviate food insecurity among the general population.

Presentation and anatomical distribution of diverticular disease in four hospitals in Sudan

Introduction

diverticular disease (DD) was thought to be more prevalent in the western countries, especially the white populations, but the recent increase in incidence among African and Asian population, was reported. Up to our knowledge, there is no previous study of DD in Sudan.

Methods

this is a descriptive cross-sectional study conducted at the department of endoscopy in four Sudanese hospitals in the period from October 2017 to February 2019. We included all patients who underwent colonoscopy during the study period. The main objective is to study the presentation and the anatomical pattern of diverticular disease among the Sudanese population.

Results

prevalence of DD in the included population was 7.5% (104/1393). The mean age was 66.4 ± 12.5 years with the percentage of males in our study is 77.1% and females were 22.9%. Presenting complains were: abdominal pain in all patients, constipation in 78.8% and rectal bleeding in 57.7%. Regarding anatomical distribution: 63.5% have left colonic DD, 19.2% in the right colon and 17.3% involving the entire colon. There was a significant correlation between the left side DD and following clinical presentations: mucus per-rectum (p = 0.015) and weight loss (p = 0.048). Other endoscopic findings of significance were internal pile in 21.2% and colo-rectal polyp in 15.4%.

Conclusion

the prevalence of DD in the included population, is 7.5% which is consistent with recent literature from the Middle East, Africa and Asia but still less than the prevalence in the western countries and left side colon is predominantly affected.

Awareness and Knowledge Regarding the Consumption of Dietary Fiber and Its Relation to Self-Reported Health Status in an Adult Arab Population: A Cross-Sectional Study

The objective of this study was to examine the awareness, knowledge, and habits regarding dietary fiber intake and to analyze its relationship with self-reported health status among Saudi adults. A survey-based study using face-to-face interview was designed, and 1363 apparently healthy adult Saudi males and females participated. Most participants were females (81.2%), aged 25 and above (87.2%), and were educated at least up to the secondary level of education (80.8%). The majority of the participants were aware of the role of fiber-rich foods in health conditions such as obesity (70.5%), cardiovascular diseases (68.9%), and regulation of blood sugar (68.9%), with females significantly having higher nutrition knowledge than males. A disconnect in translating this nutrition knowledge was observed particularly in food choices when eating out, where preferences for white bread (84.4%), fried potatoes (69.9%) and peeled fruits (60.6%) were significantly higher than preferences for cooked vegetables (29.6%) and brown bread (18.1%). The most common reason for this disconnect was due to perception that foods rich in dietary fibers were expensive (72.1%), have less health benefits (56.5%), were not readily available (51.6%), and participants’ disliking of the taste (52.8%). Participants in the highest quartile (Q4) for dietary fiber consumption reported a lower prevalence of constipation (odds ratio, 95% confidence interval of 0.40, 0.28–0.57, p < 0.01), high cholesterol (0.43, 0.27–0.68, p < 0.01) and obesity (0.67, 0.44–0.98, p = 0.03) than participants in the lowest quartile (Q1). Dietary fiber intake appears to be protective against constipation, high cholesterol and obesity in Saudi adults. However, a disparity observed between knowledge and attitude towards intake of dietary fibers could limit its health benefits. Further studies including adolescents should be conducted to impart knowledge on the emotional, cognitive and sensory factors related to food choices in order to minimize the gap between nutrition knowledge and the consumption of healthy high-fiber diets.

A Brief Review of Nutraceutical Ingredients in Gastrointestinal Disorders: Evidence and Suggestions

The dietary effect on gut health has long been recognized through the empirical practice of soothing gastric discomfort with certain types of food, and recently the correlation between specific diets with lower incidences of several gastrointestinal diseases has been revealed. Ingredients from those considered beneficial foods have been isolated and studied, and some of them have already been put into the supplement market. In this review, we focus on latest studies of these food-derived ingredients for their proposed preventive and therapeutic roles in gastrointestinal disorders, with the attempt of drawing evidence-based suggestions on consuming these products.

Antibiotics Versus No Antibiotics for Acute Uncomplicated Diverticulitis: A Systematic Review and Meta-analysis

BACKGROUND

Antibiotics are routinely used for diverticulitis irrespective of severity. Current practice guidelines favor against the use of antibiotics for acute uncomplicated diverticulitis.

OBJECTIVE

We performed a systematic review and meta-analysis to examine the role of antibiotic use in an episode of uncomplicated diverticulitis.

DATA SOURCES

PubMed/Medline, Embase, Scopus, and Cochrane were used.

STUDY SELECTION

Eligible studies included those with patients with uncomplicated diverticulitis receiving any antibiotics compared with patients not receiving any antibiotics (or observed alone).

MAIN OUTCOME MEASURES

Pooled odds rate of total complications, treatment failure, recurrent diverticulitis, readmission rate, sigmoid resection, mortality rate, and length of stay were measured.

RESULTS

Of 1050 citations reviewed, 7 studies were eligible for the analysis. There were total of 2241 patients: 895 received antibiotics (mean age = 59.1 y; 38% men) and 1346 did not receive antibiotics (mean age = 59.4 y; 37% men). Antibiotics were later added in 2.7% patients who initially were observed off antibiotics. Length of hospital stay was not significantly different among either group (no antibiotics = 3.1 d vs antibiotics = 4.5 d; p = 0.20). Pooled rate of recurrent diverticulitis was not significantly different among both groups (pooled OR = 1.27 (95%, CI 0.90-1.79); p = 0.18). Rate of total complications (pooled OR = 1.99 (95% CI, 0.66-6.01); p = 0.22), treatment failure (pooled OR = 0.68 (95% CI, 0.42-1.09); p = 0.11), readmissions (pooled OR = 0.75 (95% CI, 0.44-1.30); p = 0.31). and patients who required sigmoid resection (pooled OR = 3.37 (95% CI, 0.65-17.34); p = 0.15) were not significantly different among patients who received antibiotics and those who did not. Mortality rates were 4 of 1310 (no-antibiotic group) versus 4 of 863 (antibiotic group).

LIMITATIONS

Only 2 randomized controlled studies were available and there was high heterogeneity in existing data.

CONCLUSIONS

This meta-analysis of current literature shows that patients with uncomplicated diverticulitis can be monitored off antibiotics.

Cyclic rifaximin therapy effectively prevents the recurrence of symptoms after exacerbation of symptomatic uncomplicated diverticular disease: a retrospective study

Introduction

Symptomatic uncomplicated diverticular disease (SUDD) is the most common manifestation of diverticulosis. Data concerning the optimal treatment after SUDD exacerbation are inconsistent.

Aim

To assess the effectiveness and necessity of cyclic rifaximin treatment for recurrent SUDD symptoms and for preventing exacerbations in patients who responded to the initial treatment.

Material and methods

A retrospective observational study was performed in 2017. Physicians responded to a survey on patients with recurrent SUDD during the observation period, who were cyclically treated with rifaximin 400 mg b.i.d. for 7 days per month. The patients’ SUDD history, diagnostic methods, treatment, and results were evaluated.

Results

In total 294 patients were included in this study (67% women, median age: 65 years (26–87)). The mean duration of diverticular disease (DD) was 4.5 years (1–20), and 88% had at least one repeated episode of SUDD exacerbation before rifaximin. A total of 267 patients were treated with rifaximin. Changes in the severity of pain, abdominal tenderness, diarrhoea, constipation, and bloating were assessed every 2 months. After 6 months of rifaximin treatment there was a statistically significant reduction in the total severity score (median from 1.8 (max. 3 points) to 0.2; p < 0.0001; sum from 9.37 (max. 18 points) to 1.35; p < 0.0001) and an improvement in individual symptom score.

Conclusions

Cyclical rifaximin is effective in treating exacerbation of SUDD. This regimen leads to a gradual cessation of symptoms over a 6-month period. In patients who responded to the initial treatment, cyclic rifaximin therapy is needed to maintain remission.

Inclusion of Fructooligosaccharide and Resistant Maltodextrin in High Fat Diets Promotes Simultaneous Improvements on Body Fat Reduction and Fecal Parameters

This study investigated the effects of incorporating a mixture of fructooligosaccharide (FOS) and resistant maltodextrin (RMD) at a ratio of 1:2 on body fat accumulation and fecal bacterial parameters in rats. Our results indicated that high dietary fat consumption might effectively (p < 0.05) increase body fat, but consequently inducing a significantly (p < 0.05) higher growth of C. perfringens and retarded growth (p < 0.05) of the Bifidobacterium spp. in the large intestine. As compared with the high fat control, an incorporation of the FOS and RMD mixture at a high dose (0.97 and 1.94 g/kg body weight, respectively) could result in a significant (p < 0.05) reduction in feed efficiency (−16%), total visceral fat (−17.4%), non-visceral fat levels (−20.3%), and total body fat (−19.2%). Furthermore, feeding the FOS and RMD mixture at a high dose was capable to counter the above undesirable impacts by reducing the C. perfringens count (−14.8%) and increasing the total Bifidobacterium count (134.4%) and total fecal short chain fatty acids (195.4%). A supplementation of adequate amount of FOS and RMD might confer a concreted solution to the obesity and deteriorated fecal bacteria profiles due to high fat consumption.

Quality of life after laparoscopic sigmoid resection for uncomplicated diverticular disease

PURPOSE

The study aimed to evaluate the QoL in patients who underwent elective surgery for uncomplicated diverticulitis using a recently developed diverticulitis quality of life questionnaire (DV-QoL).

METHODS

All consecutive patients who underwent surgery for uncomplicated diverticulitis or who were hospitalized and treated conservatively for acute uncomplicated diverticulitis episodes in three referral centers, in a 5-year period, were included in the study. The 36-Item Short Form Survey and the DV-QoL were administered to the patients to assess their QoL before and after treatment of diverticular disease.

RESULTS

Ninety-seven patients who underwent surgery, 44 patients who were treated conservatively, and 44 healthy volunteers were included in the study. DV-QoL scores correlated with SF-36 scores (p < 0.0001). The surgically treated patients reported a worse quality of life before treatment with respect to the patients treated conservatively (mean 21.12 surgical vs 15.41 conservative, p = 0.0048). The surgically treated patients presented better post-treatment global scores with respect to the conservatively treated patients (mean: 6.90 surgical vs 10.61 conservative, p = 0.0186). Covariance analysis confirmed that the differences between the pre- and post-treatment DV-QoL scores were significantly higher in the surgical (p = 0.0002) with respect to the non-surgical patients. As far as single items were concerned, differences between the two groups were found in the pre- and post-treatment "concerns" and "behavioral changes" DV-QoL items.

CONCLUSIONS

Sigmoidectomy reduces concerns about diverticulitis and behavioral changes due to the disease. Quality of life should be considered when referring patients with uncomplicated diverticulitis to surgery. Prospective studies are required to confirm this result.

Cactus (Opuntia humifusa) water extract ameliorates loperamide-induced constipation in rats

BACKGROUND

Korean cactus Cheonnyuncho (Opuntia humifusa) is rich in pectin, phenols, flavonoids, and minerals such as calcium and phosphorus. Some Koreans drink Cheonnyuncho juice prepared by grinding Cheonnyuncho with water. Cheonnyuncho is well known for its functional properties and antioxidant effects, but its effect on constipation has not been sufficiently studied.

METHODS

Loperamide (2 mg/kg) was injected subcutaneously to induce constipation in rats. The animals were divided into four groups: a normal group (NOR), constipation control group (CON), and two constipation groups receiving the Cheonnyuncho extract (CE) at two different concentrations in drinking water, 3% (L-CE group) and 6% (H-CE group), for 25 days.

RESULTS

The fecal pellet numbers of NOR and L-CE were significantly increased from 35.67 ± 2.09 (CON) to 50.60 ± 1.38 and 46.50 ± 2.91 after loperamide treatment, respectively (p < 0.05). The water content of fecal excretions was significantly enhanced in only the L-CE group (33.05 ± 0.49%) compared to control (23.38 ± 1.26%) (p < 0.05) after loperamide treatment. The oral intake of CE (L-CE and H-CE groups) significantly increased levels of the intestinal transit ratio (45.25 ± 1.86% and 41.05 ± 2.47%, respectively) compared to the CON group (32.15 ± 2.05%) (p < 0.05). Treatment with the low concentration of CE significantly increased fecal levels of acetic, propionic, butyric, and valeric acids, as well as the total short-chain fatty acid (SCFA) concentration. Histological analyses revealed that the thickness of the distal colon also increased in the CE-treated groups in a dose-dependent manner.

CONCLUSIONS

Constipation decreased when CE was fed to the rats. In particular, the fecal pellet number and water content, as well as histological parameters such as distal colon thickness, improved. The CE treatment also increased the fecal SCFA content. These results show that the extract of Cheonnyuncho (O. humifusa) alleviated the symptoms of loperamide-induced constipation.

Mesalazine for the Treatment of Symptomatic Uncomplicated Diverticular Disease of the Colon and for Primary Prevention of Diverticulitis: A Systematic Review of Randomized Clinical Trials

BACKGROUND

Symptomatic uncomplicated diverticular disease (SUDD) is a common gastrointestinal disease, because it affects about one fourth of the patient harboring colonic diverticula.

GOAL

To assess the effectiveness of mesalazine in improving symptoms (namely abdominal pain) and in preventing diverticulitis occurrence in patients with SUDD.

STUDY

Only randomized clinical trials (irrespective of language, blinding, or publication status) that compared mesalazine with placebo or any other therapy in SUDD were evaluated. The selected endpoints were symptom relief and diverticulitis occurrence at maximal follow-up. Absolute risk reduction (ARR, with 95% confidence interval) and the number needed to treat were used as measures of the therapeutic effect.

RESULTS

Six randomized clinical trials enrolled 1021 patients: 526 patients were treated with mesalazine and 495 with placebo or other therapies. Symptom relief with mesalazine was always larger than that with placebo and other therapies. However, absolute risk reduction was significant only when mesalazine was compared with placebo, a high-fiber diet, and low-dose rifaximin. The incidence of diverticulitis with mesalazine was lower than that observed with placebo and other treatments, being significant only when compared with placebo.

CONCLUSIONS

Mesalazine is effective in achieving symptom relief and primary prevention of diverticulitis in patients with SUDD.

Prevalence and distribution of colonic diverticula assessed with CT colonography (CTC)

OBJECTIVES

This study aimed to evaluate the prevalence of colonic diverticula according to age, gender, distribution, disease extension and symptoms with CT colonography (CTC).

METHODS

The study population included 1091 consecutive patients who underwent CTC. Patients with diverticula were retrospectively stratified according to age, gender, clinical symptoms and colonic segment involvement. Extension of colonic diverticula was evaluated using a three-point quantitative scale. Using this data, a multivariate regression analysis was applied to investigate the existence of any correlation among variables.

RESULTS

Colonic diverticula were observed in 561 patients (240 men, mean age 68 ± 12 years). Symptomatic uncomplicated diverticular disease (SUDD) was present in 47.4% of cases. In 25.6% of patients ≤40 years, at least one diverticulum in the colon was observed. Prevalence of right-sided diverticula in patients >60 years was 14.2% in caecum and 18.5% in ascending colon. No significant difference was found between symptomatic and asymptomatic patients regarding diverticula prevalence and extension. No correlation was present between diverticula extension and symptoms.

CONCLUSION

The incidence of colonic diverticula appears to be greater than expected. Right colon diverticula do not appear to be an uncommon finding, with their prevalence increasing with patient age. SUDD does not seem to be related to diverticula distribution and extension.

KEY POINTS

Incidence of colonic diverticula appears to be greater than expected. Right colon diverticula do not appear to be an uncommon finding. SUDD does not seem to be related to diverticula distribution and extension.

A national evaluation of the management practices of acute diverticulitis

INTRODUCTION

Diverticulitis is a common surgical admission that presents with a wide range of symptoms and severity. Overall there has been a shift to conservative management practices, including the consideration of non-antibiotic treatment approaches in select cases.

METHODS

A national survey of all consultant surgeons evaluating their practices was performed. Reasons for changes in management, use of radiological imaging, role of non-antibiotic treatment approaches and indications for elective surgical management were evaluated.

RESULTS

Response rate for this survey was 67.7% (n = 67/99). An overwhelming 92.5% stated that computed tomography imaging was routinely used to investigate acute presentations. Interestingly, 22.4% stated they would consider a non-antibiotic treatment approach in uncomplicated diverticulitis. Main reasons for adopting this approach was low inflammatory markers with short duration of symptoms. Co-amoxiclav was the most common antibiotic used for acute diverticulitis, with considerable variability in duration of treatment. Additionally, there was considerable heterogeneity regarding how many recurrences were necessary before surgical management was required.

CONCLUSION

This review highlights substantial variation in the management of diverticulitis across Ireland. Shifts to non-antibiotic treatment approaches for uncomplicated cases are observed, but less so than in Northern Europe. National guidelines are required to establish uniform treatment protocols including indications for surgical resection.

Saciedade subjetiva, aceitação sensorial e aspectos tecnológicos de salsicha com adição de fibra de trigo

Resumo O objetivo deste trabalho foi a elaboração de salsichas com diferentes concentrações de fibra de trigo e a avaliação de suas características tecnológicas, aceitação sensorial e saciedade subjetiva causada por sua ingestão. Foram produzidas salsichas com adição de zero (Controle), 1,5% e 3% de fibra de trigo. Os aspectos tecnológicos avaliados foram: composição centesimal (teores de proteínas, lipídios, umidade e cinzas), valor de pH, textura instrumental, cor objetiva, estabilidade de emulsão e rendimento do processo. Para análise sensorial foi realizado teste afetivo de aceitação com 60 consumidores que avaliaram os atributos sabor, textura, suculência e aceitação global, utilizando escala hedônica de 9 pontos. Para a análise de saciedade, 30 consumidores relataram, em uma escala visual analógica, a sensação de fome sentida antes, imediatamente depois e a cada 30 minutos após comerem as salsichas, durante 2 horas. Os resultados demonstraram que, exceto para a luminosidade (L*), as salsichas com adição de fibras (1,5% e 3%) não diferiram em nenhum dos aspectos tecnológicos em relação à amostra Controle. Na avaliação sensorial, as salsichas com 3% de fibra foram consideradas mais suculentas e tiveram melhor aceitação global (p<0,05) que as com 1,5%, ambas não diferindo da amostra Controle. A aceitação dos atributos sabor e textura não diferiu entre todas as amostras. Em relação à avaliação da saciedade, não houve diferença entre as amostras, ou seja, a adição de até 3% de fibra de trigo nas salsichas não foi suficiente para promover maior saciedade nos consumidores em comparação com a salsicha sem adição de fibra. Pode-se concluir que, apesar de não ter sido observada maior sensação de saciedade pela adição de fibra de trigo, salsichas contendo 1,5% e 3% desta fibra podem ser produzidas sem prejuízo das características tecnológicas e com boa aceitação sensorial, podendo favorecer o aumento do consumo de fibras pela população.

Cost-of-illness analysis reveals potential healthcare savings with reductions in type 2 diabetes and cardiovascular disease following recommended intakes of dietary fiber in Canada

BACKGROUND

Type 2 diabetes (T2D) and cardiovascular disease (CVD) are leading causes of mortality and two of the most costly diet-related ailments worldwide. Consumption of fiber-rich diets has been repeatedly associated with favorable impacts on these co-epidemics, however, the healthcare cost-related economic value of altered dietary fiber intakes remains poorly understood. In this study, we estimated the annual cost savings accruing to the Canadian healthcare system in association with reductions in T2D and CVD rates, separately, following increased intakes of dietary fiber by adults.

METHODS

A three-step cost-of-illness analysis was conducted to identify the percentage of individuals expected to consume fiber-rich diets in Canada, estimate increased fiber intakes in relation to T2D and CVD reduction rates, and independently assess the potential annual savings in healthcare costs associated with the reductions in rates of these two epidemics. The economic model employed a sensitivity analysis of four scenarios (universal, optimistic, pessimistic, and very pessimistic) to cover a range of assumptions within each step.

RESULTS

Non-trivial healthcare and related savings of CAD$35.9-$718.8 million in T2D costs and CAD$64.8 million-$1.3 billion in CVD costs were calculated under a scenario where cereal fiber was used to increase current intakes of dietary fiber to the recommended levels of 38 g per day for men and 25 g per day for women. Each 1 g per day increase in fiber consumption resulted in annual CAD$2.6 to $51.1 million savings for T2D and $4.6 to $92.1 million savings for CVD.

CONCLUSION

Findings of this analysis shed light on the economic value of optimal dietary fiber intakes. Strategies to increase consumers' general knowledge of the recommended intakes of dietary fiber, as part of healthy diet, and to facilitate stakeholder synergy are warranted to enable better management of healthcare and related costs associated with T2D and CVD in Canada.

Risk Factors for Diverticulosis, Diverticulitis, Diverticular Perforation, and Bleeding: A Plea for More Subtle History Taking

Background

Diverticulosis is a very common condition. Around 20% of diverticula carriers are believed to suffer from diverticular disease during their lifetime. This makes diverticular disease one of the clinically and economically most significant conditions in gastroenterology. The etiopathogenesis of diverticulosis and diverticular disease is not well understood. Epidemiological studies allowed to define risk factors for the development of diverticulosis and the different disease entities associated with it, in particular diverticulitis, perforation, and diverticular bleeding.

Methods

A comprehensive literature search was performed, and the current knowledge about risk factors for diverticulosis and associated conditions reviewed.

Results

Non-controllable risk factors like age, sex, and genetics, and controllable risk factors like foods, drinks, and physical activity were identified, as well as comorbidities and drugs which increase or decrease the risk of developing diverticula or of suffering from complications. In naming risk factors, it is of utmost importance to differentiate between diverticulosis and the different disease entities.

Conclusion

Risk factors for diverticulosis and diverticular disease may give a clue towards the possible etiopathogenesis of the conditions. More importantly, knowledge of comorbidities and particularly drugs conferring a risk for development of complicated disease is crucial for patient management.

Activation of Endogenous Phytase and Degradation of Phytate in Wheat Bran

Wheat bran contains a significant amount of the anti-nutritional factor phytate. This study is the first to explore the effectiveness of activating endogenous phytase and further reducing phytate content through resulting programmed cell death (PCD). Effects of solid-liquid ratio (1:1, 1:2, 1:3, and 1:6), incubation temperature (4, 20, 38, 55, and 70 °C), metal ions (Na⁺, K⁺, Ca²⁺, and Mg²⁺), gibberellin concentration (0, 5, 50, 500, 2000, and 5000 mg/L), hydrogen peroxide concentration (0, 0.2, 0.4, 0.6, 0.8, and 1.0%), and incubation time (30, 80, 180, and 360 min) on activation of endogenous phytase activity and phytate degradation in wheat bran samples are discussed in this study. It was found that when the wheat bran was incubated with distilled water at 55 °C for 80 min, its endogenous phytase activity was dramatically increased 4-fold from 12.96 to 53.54 FTU/g, whereas the phytate content was reduced by about 70% from 45.20 to 13.52 mg/g. By comparison of photomicrographs of raw wheat bran sample and sample incubated with distilled water for 360 min at 55 °C, a conclusion could be drawn that PCD in aleurone cells had occurred.

Recent trends in colonic diverticulosis in Yokohama City: a possibility of changing to a more Western profile

OBJECTIVE

Right-sided type colonic diverticulosis has been predominant in Japan, in contrast to European counties where the left-sided type is predominant. Considering the recent change in the dietary habits of Japanese people to a more Western diet in urban areas of Japan, the features of colonic diverticulosis may also change to reflect a more Western type. Therefore, we attempted to clarify the current situation.

METHODS

A total of 435 consecutive outpatients who agreed to a barium enema and complete examination were enrolled in this study.

RESULTS

113 patients (26.0%) revealed colon diverticulosis; 50.4% of the patients had more than ten diverticula. The percentage of man with ten or more diverticula (67.4%) was significantly higher than that of women patients (40.0%, p<0.01). Among the 88 patients who had four or more diverticula, 39 patients (44.3%) were right-side dominant, 27 (30.7%) left-side dominant and 22 (25.0%) were both-sides. Thirteen (68.4%) of the 19 patients who had more than 30 diverticula were left-side dominant.

CONCLUSION

The clinical features of colon diverticulosis in the patients living in Yokohama may be changing to reflect a more Western type, in particular decreased right-side dominance, increases in the left-side and both-sides dominant patients, and the emergence of patients with crowded diverticula in the left-side colon was observed.

Right-Sided Diverticulosis and Disparities from Left-Sided Diverticulosis in the Vietnamese Population Living in Boston, Mass., USA: A Retrospective Cohort Study

OBJECTIVE

To report the prevalence, clinical differences and complications of right-sided diverticulosis (RD) and to investigate the potential disparities from left-sided diverticulosis (LD) in the Vietnamese population.

SUBJECTS AND METHODS

A retrospective cohort study was conducted using medical records of Vietnamese-born patients from 2000 to 2013 in a community teaching hospital in Boston, Mass., USA. By simple randomization, a randomized control group of 299 Caucasian patients was also selected from the same time frame [167 males (M) and 132 females (F)]. Colonoscopy reports were reviewed for demographics (age and gender), indication and anatomical location of the colonic diverticulosis (CD), concomitant colonic findings, symptoms, and endoscopic complications.

RESULTS

A total of 207 patients were included in the Vietnamese cohort (mean age 61.6 ± 8.9 years). The mean age at first screening colonoscopy was 58.2 ± 7.2 years (114 F/92 M, 55.7/44.4%). Our study identified 104 (50.5%) patients with LD (57 M/47 F), 65 (31.1%) with RD (35 M/30 F) and 38 (18.4%) with both LD and RD (23 M/15 F); 133 (64%) were asymptomatic. A total of 21 (33%) patients with RD were symptomatic. The mean age of the control group was 61.6 ± 8.1 years. The average age at first screening colonoscopy was 52.8 ± 6.4 years. Of the 299 in the Caucasian group, 254 (84.9%) had LD (114 M/140 F), 9 (3.0%) had RD (2 M/7 F) and 36 (12%) had both LD and RD (16 M/20 F); 225 (75%) were asymptomatic and came in for screening colonoscopies. A total of 2 patients (22%) with RD were symptomatic.

CONCLUSION

RD was common in this Vietnamese population, and the prevalence was higher than in the Caucasian control group.

Mesalamine did not prevent recurrent diverticulitis in phase 3 controlled trials

BACKGROUND & AIMS

No therapy has been proven to prevent the recurrence of diverticulitis. Mesalamine has shown efficacy in preventing relapse in inflammatory bowel disease, and there is preliminary evidence that it might be effective for diverticular disease. We investigated the efficacy of mesalamine in preventing recurrence of diverticulitis in 2 identical but separate phase 3, randomized, double-blind, placebo-controlled, multicenter trials (identical confirmatory trials were conducted for regulatory reasons).

METHODS

We evaluated the efficacy and safety of multimatrix mesalamine vs placebo in the prevention of recurrent diverticulitis in 590 (PREVENT1) and 592 (PREVENT2) adult patients with ≥1 episodes of acute diverticulitis in the previous 24 months that resolved without surgery. Patients received mesalamine (1.2 g, 2.4 g, or 4.8 g) or placebo once daily for 104 weeks. The primary end point was the proportion of recurrence-free patients at week 104. Diverticulitis recurrence was defined as surgical intervention at any time for diverticular disease or presence of computed tomography scan results demonstrating bowel wall thickening (>5 mm) and/or fat stranding consistent with diverticulitis. For a portion of the study, recurrence also required the presence of abdominal pain and an increase in white blood cells.

RESULTS

Mesalamine did not reduce the rate of diverticulitis recurrence at week 104. Among patients in PREVENT1, 53%-63% did not have disease recurrence, compared with 65% of those given placebo. Among patients in PREVENT2, 59%-69% of patients did not have disease recurrence, compared with 68% of those given placebo. Mesalamine did not reduce time to recurrence, and the proportions of patients requiring surgery were comparable among treatment groups. No new adverse events were identified with mesalamine administration.

CONCLUSIONS

Mesalamine was not superior to placebo in preventing recurrent diverticulitis. Mesalamine is not recommended for this indication. ClinicalTrials.gov ID: NCT00545740 and NCT00545103.

[Dietary fiber--adequate intake and effects on metabolism health]

The positive effects of dietary fiber are related, in part, to the fact that a portion of the fermentation of components takes place in the large intestine, which has an impact on the speed of digestion, pH of the colon, and production of by-products with important physiological functions. Individuals with high fiber intake seem to have lower risk of developing coronary artery disease, hypertension, obesity, diabetes, and colon cancer. The increase in fiber intake reduces serum cholesterol, improves blood glucose in patients with diabetes, reduces body weight, and is associated with lower serum ultrasensitive C-reactive protein. Increased fiber intake and intake of more fiber than the currently recommended level (14 g/1,000 kcal) may provide greater health benefits, including reducing low-grade inflammation.

[A prospective study of factors influencing on the clinical characteristics of colonic diverticulosis]

BACKGROUND/AIMS

The prevalence of colonic diverticulosis in Korea is increasing in conjunction with the adoption of western dietary pattern, extension of lifespan, and advances in diagnostic modalities. The clinical characteristics of colonic diverticulosis seem to be gradually becoming similar to those of Western societies. Therefore, factors associated with the clinical characteristics of colonic diverticulosis in Korea were investigated.

METHODS

The data of 200 patients diagnosed with colonic diverticulosis using colonoscopy between May 2010 and April 2012 at Inje University Seoul Paik Hospital (Seoul, Korea) were prospectively collected. Clinical parameters acquired through a questionnaire include age, body mass index, waist circumference, exercise, diet, smoking, drinking habits, etc. Correlation between these factors and the clinical features of diverticulosis were analyzed.

RESULTS

Mean age of the patients was 54.9±11.9 (range 17-79) years and male to female ratio was 2.2:1. Most diverticula were located on the right side of the colon (83%) and the mean number of diverticulum was 4.07±3.9. Factor associated with the location of diverticulum on the left side was age (p=0.001). There was a positive correlation between the waist circumference and the number of diverticulum (partial correlation coefficient r'=0.143, p=0.047). Diverticulitis occurred more frequently in younger patients than in older patients (p=0.002).

CONCLUSIONS

Colonic diverticulosis in older patients is found more frequently on the left colon, and the number of diverticulosis is associated with central obesity.

Outpatient versus hospitalization management for uncomplicated diverticulitis: a prospective, multicenter randomized clinical trial (DIVER Trial)

OBJECTIVE

We compare the results of 2 different strategies for the management of patients with uncomplicated left colonic diverticulitis and to analyze differences in quality of life and economic costs.

BACKGROUND

The most frequent standard management of acute uncomplicated diverticulitis still is hospital admission both in Europe and United States.

METHODS

This multicenter, randomized controlled trial included patients older than 18 years with acute uncomplicated diverticulitis. All the patients underwent abdominal computed tomography. There were 2 strategies of management: hospitalization (group 1) and outpatient (group 2). The first dose of antibiotic was given intravenously to all patients in the emergency department and then group 1 patients were hospitalized whereas patients in group 2 were discharged. The primary end point was the treatment failure rate of the outpatient protocol and need for hospital admission. The secondary end points included quality-of-life assessment and evaluation of costs.

RESULTS

A total of 132 patients were randomized: 4 patients in group 1 and 3 patients in group 2 presented treatment failure without differences between the groups (P=0.619). The overall health care cost per episode was 3 times lower in group 2, with savings of €1124.70 per patient. No differences were observed between the groups in terms of quality of life.

CONCLUSIONS

Outpatient treatment is safe and effective in selected patients with uncomplicated acute diverticulitis. Outpatient treatment allows important costs saving to the health systems without negative influence on the quality of life of patients with uncomplicated diverticulitis. Trial registration ID: EudraCT number 2008-008452-17.

Microencapsulated sodium butyrate administered to patients with diverticulosis decreases incidence of diverticulitis--a prospective randomized study

BACKGROUND

Microencapsulated sodium butyrate (MSB) has been previously associated with anti-inflammatory and regenerative properties regarding large bowel mucosa. We aimed to examine a role of MSB in patients with diverticulosis, hypothesizing its potential for reduction of diverticulitis episodes and diverticulitis prevention.

METHODS

Seventy-three patients with diverticulosis (diagnosed in colonoscopy or/and barium enema or/and CT colography) were recruited for the study and randomized. The investigated group was administered MSB 300 mg daily; the control group was administered placebo. After 12 months, a total of 52 patients completed the study and were subject to analysis (30 subjects and 22 controls). During the study, the number of episodes of diverticulitis (symptomatic diagnosis with acute pain, fever, and leukocytosis), hospitalizations, and surgery performed for diverticulitis were recorded. Additionally, a question regarding subjective improvement of symptoms reflected changes in quality of life during the analysis.

RESULTS

After 12 months, the study group noted a significantly decreased number of diverticulitis episodes in comparison to the control group. The subjective quality of life in the study group was higher than in the control group. There were no side effects of the MSB during the therapy.

CONCLUSIONS

MSB reduces the frequency of diverticulitis episodes, is safe, and improves the quality of life. It can play a role in the prevention of diverticulitis.

Non-interventional study evaluating efficacy and tolerability of rifaximin for treatment of uncomplicated diverticular disease

Patients with symptomatic uncomplicated diverticular disease represent a spectrum of patients who report recurrent abdominal symptoms, however are lacking substantial colonic inflammation in contrast to patients with acute diverticulitis. This non-interventional study investigated the efficacy and tolerability of rifaximin, a broad-spectrum poorly absorbable antibiotic, in cyclic treatment of these patients. Adult patients with uncomplicated diverticular disease in care of physicians in private practice intended to be treated with rifaximin were included. Patients with acute diverticulitis and symptoms suggestive of more severe intestinal inflammation were excluded. Data of 1,003 patients treated in cycles of 7-10 days per month over a period of 3 months were evaluated. In total, 75 % of patients had more than three episodes of symptoms in the last year before inclusion in the study. However, two-third of patients did not receive any treatment before. Over the 3-month treatment period with rifaximin, all assessed symptoms of diverticular disease, such as abdominal pain, diarrhoea and flatulence, improved significantly. There was an overall good compliance to the scheme of cyclic drug administration of rifaximin. During the study, 24 adverse events in 20 patients were recorded, of which 6 adverse events showed a causal relationship to the use of rifaximin (0.6 %). We conclude that cyclic rifaximin shows good clinical efficacy and tolerability in patients with symptomatic uncomplicated diverticular disease treated in a routine private practice outpatient setting.

A randomized controlled study of mesalamine after acute diverticulitis: results of the DIVA trial

BACKGROUND/AIMS

We evaluated the efficacy of mesalamine (Asacol) in reducing gastrointestinal symptoms after an acute attack of diverticulitis.

METHODS

This was a 1-year double-blind, randomized, placebo-controlled study in which patients with computed tomography scan confirmed acute diverticulitis received placebo, mesalamine, or mesalamine+Bifidobacterium infantis 35624 (Align) for 12 weeks and followed for 9 additional months. Efficacy was assessed using a global symptom score (GSS) of 10 symptoms (abdominal pain, abdominal tenderness, nausea/vomiting, bloating, constipation, diarrhea, mucus, urgency, painful straining, and dysuria). Patients were required to have a GSS≥12 at baseline, including an abdominal pain score >2.

RESULTS

One hundred seventeen patients (placebo, 41; mesalamine, 40; mesalamine+probiotic, 36) were randomized and treated. GSS decreased in all groups during treatment without a statistically significant difference between mesalamine and placebo, however; scores were consistently lower for mesalamine at all time points. The rate of complete response (GSS=0) was significantly higher with mesalamine than placebo at weeks 6 and 52 (P<0.05), and was particularly high for rectosigmoid symptoms at weeks 6, 12, 26, and 52. Recurrence of diverticulitis was low and comparable across groups. Probiotic in combination with mesalamine did not provide additional efficacy.

CONCLUSIONS

In the first US randomized placebo-controlled trial of anti-inflammatory treatment after a documented case of diverticulitis, mesalamine demonstrated a consistent trend in reducing symptoms. Addition of probiotic did not increase mesalamine efficacy. This study supports further investigation into the use of anti-inflammatory agents, such as mesalamine, in the long-term management of diverticulitis. ClinicalTrials.gov NCT00554099.

The prevalence of right-sided colonic diverticulosis and diverticular haemorrhage

AIM

The study was performed to determine the prevalence of right-sided diverticular disease in a western population and whether it is more likely to bleed than disease on the left side.

METHOD

From January 2004 to June 2005, 796 consecutive patients were referred for total colonoscopy to 17 physicians. Data obtained included age, gender, and presence and localization of diverticula. This population was compared with a cohort of 133 consecutive patients who were admitted for colonic diverticular bleeding.

RESULTS

Three-hundred and eighteen (40%) of the 796 patients presented with noncomplicated diverticulosis. Of these, 103 (32.4%) had right-sided diverticula. In univariate analysis, the presence of right diverticula in patients admitted for diverticular bleeding was about twice as frequent as in patients who had diverticula with no bleeding (65.2% vs 32.4%; P = 0.0001). In multivariate analysis, the right localization of the diverticulosis was associated with a risk of bleeding, which was independent of the patients' age (P = 0.0001, OR = 3.6).

CONCLUSION

The prevalence of colonic diverticula increased from < 10% in adults under 40 years of age to about 75% in those over 75 years of age. Of these patients, nearly one-third presented with right-sided involvement. Right-sided localization was associated with a significant risk of bleeding, which was independent of the patients' age.

Viscous versus nonviscous soluble fiber supplements: mechanisms and evidence for fiber-specific health benefits

PURPOSE

This review focuses on the health benefits of viscous versus nonviscous soluble fibers, why symptoms can occur with increased fiber consumption, and how to avoid symptoms to improve adherence with a high-fiber diet.

DATA SOURCES

Review of scientific literature as well as evidence-based guidelines and resources.

CONCLUSIONS

While it is generally known that "fiber is good for you," it is less well known that specific health benefits are associated with specific fiber characteristics. Many of the health benefits of fiber can be directly correlated with the viscosity of soluble fibers when hydrated (i.e., gel-forming). A reduction in viscosity of a given fiber will attenuate these health benefits, and a nonviscous fiber does not exhibit these health benefits.

IMPLICATIONS FOR PRACTICE

Increasing the viscosity of chyme with a viscous soluble fiber has been shown clinically to lower cholesterol for cardiovascular health, improve glycemic control in type 2 diabetes, normalize stool form in both constipation (softens hard stool) and diarrhea (firms loose/liquid stool), and improve the objective clinical measures of metabolic syndrome (glycemic control, lipoprotein profile, body mass index/weight loss, and blood pressure).

Glucocorticoid-induced tumour necrosis factor receptor expression: a potential molecular link between steroid intake and complicated diverticulitis?

AIM

Immunosuppression and steroid medication have been identified as risk factors for complicated sigmoid diverticulitis. The underlying molecular mechanisms have not yet been elucidated. We hypothesized that glucocorticoid-induced tumour necrosis factor receptor (GITR) and matrix metalloproteinase-9 (MMP-9) might play a role.

METHOD

GITR and MMP-9 were analysed at protein [immunohistochemistry/immunofluorescence (IF)] and messenger RNA level (real-time polymerase chain reaction) in surgical specimens with complicated and non-complicated diverticulitis (n=101). IF double staining and regression analysis were performed for both markers. GITR expression was correlated with clinical data and its usefulness as a diagnostic test was investigated.

RESULTS

High GITR expression (≥41%) was observed in the inflammatory infiltrate in complicated diverticulitis, in contrast to non-complicated diverticulitis where GITR expression was low (P<0.001). High GITR expression was significantly associated with steroid use and pulmonary diseases (both P<0.001). MMP-9 expression correlated with GITR expression (R(2) =0.7268, P<0.0001, r=0.85) as demonstrated with IF double-staining experiments. Co-labelling of GITR with CD68, but not CD15, suggested that GITR-expressing cells in diverticulitis are macrophages. GITR expression was superior to C-reactive protein (CRP), white cell count and temperature in distinguishing complicated and non-complicated diverticulitis.

CONCLUSIONS

Our results suggest that GITR expression in inflammatory cells might potentially indicate a molecular link between steroid use and complicated forms of acute sigmoid diverticulitis. Increased MMP-9 expression by GITR signalling might explain the morphological changes in the colonic wall of perforated and phlegmonous diverticulitis. Analysis of soluble GITR might be a promising strategy for future research.

The genetic influence on diverticular disease--a twin study

BACKGROUND

The contribution of hereditary factors to the development of diverticular disease (DD) of the colon is unknown. Prevalence and location of diverticula differ in Western world compared to in Asia and several case reports describing families with DD have been published.

AIM

To assess the heritability of DD in a large population-based sample of twins.

METHODS

The Swedish Twin Registry was cross-linked to the Swedish Inpatient Registry. All twins, born between 1886 and 1980 and not dead before 1969, with a discharge diagnosis of DD were identified. Twins with diagnoses of colon cancer, coeliac disease or non-infectious colitis were excluded to decrease bias. Co-twin odds ratio (OR), concordance rates and tetrachoric correlations were calculated for monozygotic (MZ) and same gender-dizygotic (SS-DZ) twins. Mx-analyses were used to estimate the relative contributions of genetic effects and environmental factors to susceptibility for DD. Calculations were based on both primary and secondary discharge diagnoses to provide estimates reflecting impact of severity of the disease.

RESULTS

A total of 104,452 twins met the inclusion criteria. Of these, 2296 had a diagnosis of DD. The OR of developing the disease given one's co-twin was affected was 7.15 (95% CI: 4.82-10.61) for MZ and 3.20 (95% CI: 2.21-4.63) for SS-DZ twins. Similarly, concordance rates and tetrachoric correlations were higher in MZ than those in SS-DZ twins. The heritability was estimated to 40% and the non shared environmental effects to 60%.

CONCLUSION

Genetic susceptibility is an important component, along with individual specific environmental factors, for the development of diverticular disease of the colon.

Role of nutraceuticals in human health

Nutraceutical is the hybrid of 'nutrition' and 'pharmaceutical'. Nutraceuticals, in broad, are food or part of food playing a significant role in modifying and maintaining normal physiological function that maintains healthy human beings. The principal reasons for the growth of the nutraceutical market worldwide are the current population and the health trends. The food products used as nutraceuticals can be categorized as dietary fibre, prebiotics, probiotics, polyunsaturated fatty acids, antioxidants and other different types of herbal/ natural foods. These nutraceuticals help in combating some of the major health problems of the century such as obesity, cardiovascular diseases, cancer, osteoporosis, arthritis, diabetes, cholesterol etc. In whole, 'nutraceutical' has lead to the new era of medicine and health, in which the food industry has become a research oriented sector.