1
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Pallotta L, Pisano A, Vona R, Cappelletti M, Pignataro MG, Tattoli I, Maselli MA, Tarallo M, Casella G, Caronna R, Tancredi A, Scotti GB, Scalese G, Matarrese P, Giordano C, Severi C. From diverticulosis to complicated diverticular disease: Progression of myogenic alterations and oxidative imbalance. Neurogastroenterol Motil 2024; 36:e14850. [PMID: 38924329 DOI: 10.1111/nmo.14850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 04/12/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The natural history and pathophysiology of diverticular disease (DD) are still uncertain. An ex-vivo human complicated DD (cDD) model has recently shown a predominant transmural oxidative imbalance. The present study aims to evaluate whether the previously described alterations may precede the symptomatic form of the disease. METHODS Colonic surgical samples obtained from patients with asymptomatic diverticulosis (DIV), complicated DD, and controls were systematically and detailed morphologically and molecularly analyzed. Therefore, histologic, histomorphometric, immunohistochemical evaluation, and gene and protein expression analysis were performed to characterize colonic muscle changes and evaluate chronic inflammation, oxidative imbalance, and hypoxia. Functional muscle activity was tested on strips and isolated cells in response to contractile and relaxant agents. KEY RESULTS Compared with controls, DD showed a marketed increase in muscle layer thickness, smooth muscle cell syncytium disarray, and increased interstitial fibrosis; moreover, the observed features were more evident in the cDD group. These changes mainly affected longitudinal muscle and were associated with altered contraction-relaxation dynamics and fibrogenic switch of smooth muscle cells. Chronic lymphoplasmacytic inflammation was primarily evident in the mucosa and spared the muscle. A transmural increase in carbonylated and nitrated proteins, with loss of antioxidant molecules, characterized both stages of DD, suggesting early oxidative stress probably triggered by recurrent ischemic events, more pronounced in cDD, where HIF-1 was detected in both muscle and mucosa. CONCLUSION & INFERENCES The different DD clinical scenarios are part of a progressive process, with oxidative imbalance representing a new target in the management of DD.
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Affiliation(s)
- Lucia Pallotta
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Annalinda Pisano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Rosa Vona
- Center for Gender-Specific Medicine, Italian National Institute of Health, Rome, Italy
| | - Martina Cappelletti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Gemma Pignataro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ivan Tattoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Antonietta Maselli
- Experimental Pharmacology Laboratory, National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Mariarita Tarallo
- Department of Surgical Science, Sapienza University of Rome, Rome, Italy
| | - Giovanni Casella
- Department of Surgical Science, Sapienza University of Rome, Rome, Italy
| | - Roberto Caronna
- Department of Surgical Science, Sapienza University of Rome, Rome, Italy
| | - Andrea Tancredi
- Department of Methods and Models for Economy, Territory and Finance, Sapienza University of Rome, Rome, Italy
| | | | - Giulia Scalese
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Paola Matarrese
- Center for Gender-Specific Medicine, Italian National Institute of Health, Rome, Italy
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carola Severi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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2
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Pallotta L, Cammisotto V, Castellani V, Gioia A, Spigaroli M, Carlomagno D, Bartimoccia S, Nocella C, Cappelletti M, Pontone S, Carnevale R, Violi F, Vona R, Giordano C, Pignatelli P, Severi C. Diverticular Disease Worsening Is Associated with Increased Oxidative Stress and Gut Permeability: New Insights by Circulating Biomarkers. Antioxidants (Basel) 2023; 12:1537. [PMID: 37627532 PMCID: PMC10451802 DOI: 10.3390/antiox12081537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Diverticular disease (DD) management is impaired by its pathogenesis, which is still not completely defined, with an unmet clinical need for improved therapies. Ex vivo DD human models demonstrated the presence of a transmural oxidative imbalance that supports an ischemic pathogenesis. This study aimed to assess, with the use of circulating biomarkers, insights into DD pathogenesis and possible therapeutic targets. Nox2-derived peptide, H2O2, antioxidant capacity, isoprostanes, thromboxanes, TNF-α, LPS and zonulin were evaluated by ELISA in healthy subjects (HS) and asymptomatic and symptomatic DD patients. Compared to HS, DD patients presented low antioxidant capacity and increase in sNox2-dp, H2O2 and isoprostanes paralleled to a TNFα increase, lower than that of oxidative markers. TxB2 production correlated to Nox2 and isoprostanes, suggesting platelet activation. An increase in zonulin and LPS highlighted the role of gut permeability and LPS translocation in DD pathogenesis. The increase of all the markers statistically correlated with DD severity. The present study confirmed the presence of a main oxidative imbalance in DD and provides evidence of platelet activation driven by LPS translocation. The use of circulating biomarkers could represent a new clinical tool for monitoring disease progression and validate therapeutic strategies never tested in DD as antioxidant supplementation.
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Affiliation(s)
- Lucia Pallotta
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.G.); (M.S.); (D.C.); (M.C.); (C.S.)
| | - Vittoria Cammisotto
- Department of Clinical, Internal Medicine, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (V.C.); (S.B.); (C.N.); (F.V.); (P.P.)
| | - Valentina Castellani
- Department of General Surgery and Surgical Specialty, Sapienza University of Rome, Viale del Policlinico, 00161 Rome, Italy;
| | - Alessia Gioia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.G.); (M.S.); (D.C.); (M.C.); (C.S.)
| | - Margherita Spigaroli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.G.); (M.S.); (D.C.); (M.C.); (C.S.)
| | - Dominga Carlomagno
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.G.); (M.S.); (D.C.); (M.C.); (C.S.)
| | - Simona Bartimoccia
- Department of Clinical, Internal Medicine, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (V.C.); (S.B.); (C.N.); (F.V.); (P.P.)
| | - Cristina Nocella
- Department of Clinical, Internal Medicine, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (V.C.); (S.B.); (C.N.); (F.V.); (P.P.)
| | - Martina Cappelletti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.G.); (M.S.); (D.C.); (M.C.); (C.S.)
| | - Stefano Pontone
- Department of Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica, 04100 Latina, Italy;
- IRCCS Neuromed, Località Camerelle, 86077 Pozzilli, Italy
| | - Francesco Violi
- Department of Clinical, Internal Medicine, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (V.C.); (S.B.); (C.N.); (F.V.); (P.P.)
- Mediterranea Cardiocentro-Napoli, Via Orazio, 80122 Naples, Italy
| | - Rosa Vona
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Pasquale Pignatelli
- Department of Clinical, Internal Medicine, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (V.C.); (S.B.); (C.N.); (F.V.); (P.P.)
- Mediterranea Cardiocentro-Napoli, Via Orazio, 80122 Naples, Italy
| | - Carola Severi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (A.G.); (M.S.); (D.C.); (M.C.); (C.S.)
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3
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Pallotta L, Vona R, Maselli MA, Cicenia A, Bella A, Ignazzi A, Carabotti M, Cappelletti M, Gioia A, Tarallo M, Tellan G, Fiori E, Pezzolla F, Matarrese P, Severi C. Oxidative imbalance and muscular alterations in diverticular disease. Dig Liver Dis 2022; 54:1186-1194. [PMID: 35232677 DOI: 10.1016/j.dld.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/20/2021] [Accepted: 02/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is still a matter of debate if neuromuscular alterations reflect a primary event in diverticular disease (DD). AIMS This study aimed to assess colonic wall layers from both stenotic and non-stenotic complicated DD, bio-phenotypic alterations, inflammatory and oxidative status. METHODS A systematic analysis of colonic specimens obtained from stenotic and non-stenotic DD specimens was conducted and compared with controls. Biological activity and qPCR analysis were performed on longitudinal and circular muscles. Western blot analysis was performed throughout colonic wall layers to quantify oxidative and inflammatory markers. RESULTS A homogenous increase in oxidative stress was observed through all the layers, which were more sharpened in the longitudinal muscle for a loss in antioxidant defenses. In both stenotic and non-stenotic colon, the longitudinal muscle presented an impaired relaxation and a cellular phenotypic switch driven by transforming growth factor-β with an increase in mRNA expression of collagen Iα and a decrease in myosin heavy chain. The circular muscle, as the mucosa, was less affected by molecular alterations. No peculiar increase in inflammatory markers was observed. CONCLUSION A longitudinal colonic myopathy is present in DD, independently from the disease stage associated with an oxidative imbalance that could suggest new therapeutic strategies.
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Affiliation(s)
- Lucia Pallotta
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy.
| | - Rosa Vona
- Center for Gender-Specific Medicine, Italian National Institute of Health, Rome, Italy
| | - Maria Antonietta Maselli
- Experimental Pharmacology Laboratory, National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, BA, USA
| | - Alessia Cicenia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Italian National Institute of Health, Rome, Italy
| | - Antonia Ignazzi
- Experimental Pharmacology Laboratory, National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, BA, USA
| | - Marilia Carabotti
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sapienza University of Rome, Italy
| | - Martina Cappelletti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Alessia Gioia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Mariarita Tarallo
- Department of Surgery "P. Valdoni", Sapienza University of Rome, Italy
| | - Guglielmo Tellan
- Department of Internistic, Anaesthetic and Cardiovascular Clinical Sciences, Sapienza University of Rome, Italy
| | - Enrico Fiori
- Department of Surgery "P. Valdoni", Sapienza University of Rome, Italy
| | - Francesco Pezzolla
- Experimental Pharmacology Laboratory, National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, BA, USA
| | - Paola Matarrese
- Center for Gender-Specific Medicine, Italian National Institute of Health, Rome, Italy
| | - Carola Severi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
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4
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Lactobacillus paracasei CNCM I 1572: A Promising Candidate for Management of Colonic Diverticular Disease. J Clin Med 2022; 11:jcm11071916. [PMID: 35407527 PMCID: PMC8999804 DOI: 10.3390/jcm11071916] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023] Open
Abstract
Diverticular disease (DD) is a common gastrointestinal condition. Patients with DD experience a huge variety of chronic nonspecific symptoms, including abdominal pain, bloating, and altered bowel habits. They are also at risk of complications such as acute diverticulitis, abscess formation, hemorrhage, and perforation. Intestinal dysbiosis and chronic inflammation have recently been recognized as potential key factors contributing to disease progression. Probiotics, due to their ability to modify colonic microbiota balance and to their immunomodulatory effects, could present a promising treatment option for patients with DD. Lactobacillus paracasei CNCM I 1572 (LCDG) is a probiotic strain with the capacity to rebalance gut microbiota and to decrease intestinal inflammation. This review summarizes the available clinical data on the use of LCDG in subjects with colonic DD.
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5
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You H, Sweeny A, Cooper ML, Von Papen M, Innes J. The management of diverticulitis: a review of the guidelines. Med J Aust 2019; 211:421-427. [PMID: 31352692 DOI: 10.5694/mja2.50276] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Radiological evidence of inflammation, using computed tomography (CT), is needed to diagnose the first occurrence of diverticulitis. CT is also warranted when the severity of symptoms suggests that perforation or abscesses have occurred. Diverticulitis is classified as complicated or uncomplicated based on CT scan, severity of symptoms and patient history; this classification is used to direct management. Outpatient treatment is recommended in afebrile, clinically stable patients with uncomplicated diverticulitis. For patients with uncomplicated diverticulitis, antibiotics have no proven benefit in reducing the duration of the disease or preventing recurrence, and should only be used selectively. For complicated diverticulitis, non-operative management, including bowel rest and intravenous antibiotics, is indicated for small abscesses; larger abscesses of 3-5 cm should be drained percutaneously. Patients with peritonitis and sepsis should receive fluid resuscitation, rapid antibiotic administration and urgent surgery. Surgical intervention with either Hartmann procedure or primary anastomosis, with or without diverting loop ileostomy, is indicated for peritonitis or in failure of non-operative management. Colonoscopy is recommended for all patients with complicated diverticulitis 6 weeks after CT diagnosis of inflammation, and for patients with uncomplicated diverticulitis who have suspicious features on CT scan or who otherwise meet national bowel cancer screening criteria.
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Affiliation(s)
| | - Amy Sweeny
- Griffith University, Gold Coast, QLD.,Gold Coast Hospital and Health Service, Gold Coast, QLD.,Research Support Network, Queensland Emergency Medicine Foundation, Brisbane, QLD
| | | | - Michael Von Papen
- Griffith University, Gold Coast, QLD.,Gold Coast Hospital and Health Service, Gold Coast, QLD
| | - James Innes
- Gold Coast Hospital and Health Service, Gold Coast, QLD
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6
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Does Colonic Diverticulosis Raise the Risk of Colorectal Adenoma in Patients with Colorectal Cancer? Gastroenterol Res Pract 2019; 2019:8901026. [PMID: 31236110 PMCID: PMC6545780 DOI: 10.1155/2019/8901026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/11/2019] [Accepted: 03/11/2019] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study was to evaluate the risk of development of colorectal adenomas in patients with colorectal cancer (CRC) with and without colonic diverticulosis. Methods We performed a retrospective cohort study that included patients with CRC between 2008 and 2011. All patients underwent preoperative colonoscopic and barium enema examinations. Follow-up colonoscopic examinations were performed within 1 year and between 3 and 5 years postoperatively. The incidence of colorectal adenomas was compared based on the presence or absence of diverticulosis. Additionally, multivariate logistic regression analysis was performed to identify the factors independently associated with the development of synchronous and metachronous colorectal adenomas. Results Of the 168 patients with CRC included in the study, 55 showed colonic diverticulosis. Synchronous colorectal adenomas were more common in CRC patients with diverticulosis than in those without diverticulosis (P > 0.001). Multivariate regression analysis showed that colonic diverticulosis (odds ratio (OR) 3.874, 95% confidence interval (CI) 1.843–8.144, P > 0.001) and obesity (body mass index > 25.0 kg/m2, OR 2.395, 95% CI 1.089–5.270, P = 0.030) were associated with an increased risk of synchronous colorectal adenomas. The presence of synchronous colorectal adenomas increased the risk of metachronous colorectal adenomas (OR 4.407, 95% CI 1.855–10.473, P > 0.001). Conclusions Colonic diverticulosis was associated with synchronous colorectal adenomas in patients with CRC, which is eventually increasing the risk of metachronous adenomas.
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7
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Maguire LH, Handelman SK, Du X, Chen Y, Pers TH, Speliotes EK. Genome-wide association analyses identify 39 new susceptibility loci for diverticular disease. Nat Genet 2018; 50:1359-1365. [PMID: 30177863 PMCID: PMC6168378 DOI: 10.1038/s41588-018-0203-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/23/2018] [Indexed: 12/31/2022]
Abstract
Diverticular disease is common and has a high morbidity. Treatments are limited owing to the poor understanding of its pathophysiology. Here, to elucidate its etiology, we performed a genome-wide association study of diverticular disease (27,444 cases; 382,284 controls) from the UK Biobank and tested for replication in the Michigan Genomics Initiative (2,572 cases; 28,649 controls). We identified 42 loci associated with diverticular disease; 39 of these loci are novel. Using data-driven expression-prioritized integration for complex traits (DEPICT), we show that genes in these associated regions are significantly enriched for expression in mesenchymal stem cells and multiple connective tissue cell types and are co-expressed with genes that have a role in vascular and mesenchymal biology. Genes in these associated loci have roles in immunity, extracellular matrix biology, cell adhesion, membrane transport and intestinal motility. Phenome-wide association analysis of the 42 variants shows a common etiology of diverticular disease with obesity and hernia. These analyses shed light on the genomic landscape of diverticular disease.
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Affiliation(s)
- Lillias H Maguire
- Department of Surgery, Division of Colorectal Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Samuel K Handelman
- Department of Internal Medicine, Division of Gastroenterology, Ann Arbor, MI, USA
| | - Xiaomeng Du
- Department of Internal Medicine, Division of Gastroenterology, Ann Arbor, MI, USA
| | - Yanhua Chen
- Department of Internal Medicine, Division of Gastroenterology, Ann Arbor, MI, USA
| | - Tune H Pers
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Elizabeth K Speliotes
- Department of Internal Medicine, Division of Gastroenterology, Ann Arbor, MI, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
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8
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Munie ST, Nalamati SPM. Epidemiology and Pathophysiology of Diverticular Disease. Clin Colon Rectal Surg 2018; 31:209-213. [PMID: 29942208 DOI: 10.1055/s-0037-1607464] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Colonic diverticular disease is a common health care issue which has historically been attributed to western countries and older age population. Recent studies have shown a rise in incidence among developing countries that have adopted western diets as well as rise in prevalence among younger patients. In this article, the authors discuss the incidence, epidemiology, and pathophysiology of colonic diverticular disease.
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Affiliation(s)
- Semeret T Munie
- Department of General Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Surya P M Nalamati
- Department of Colon and Rectal Surgery, Henry Ford Hospital, Detroit, Michigan
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9
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Laparoscopically Assisted Reversal of Hartmann's Procedure for Perforated Diverticulitis. Int Surg 2017. [DOI: 10.9738/intsurg-d-16-00125.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to retrospectively review the clinical outcomes of laparoscopically assisted and open surgical reversal of Hartmann's procedure (HR). We reviewed all patients undergoing laparoscopic or open HR at Tri-Service General Hospital, Taipei, Taiwan, between January 2002 and January 2010. A total of 34 perforated diverticulitis patients initially treated by exploratory laparotomy with Hartmann's procedure were enrolled and divided into 2 groups: laparoscopic and open HR. Data relative to patient age at the time of HR, sex, body mass index, operative time, longest incision length, estimated blood loss, intraoperative complications, postoperative complications, time to bowel function return, duration of hospitalization, and length of follow-up were reviewed. The median colostomy closure period was significantly higher in the laparoscopic group than in the open group (P = 0.011). The median longest incision length, estimated blood loss, time to first oral intake, and hospital stay were significantly lower in the laparoscopic group compared with the open group. Laparoscopic HR may be a technically safe, feasible approach that provides better cosmesis, less blood loss, and faster recovery compared with open HR.
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10
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Fornai M, Colucci R, Antonioli L, Ippolito C, Segnani C, Buccianti P, Marioni A, Chiarugi M, Villanacci V, Bassotti G, Blandizzi C, Bernardini N. Role of cyclooxygenase isoforms in the altered excitatory motor pathways of human colon with diverticular disease. Br J Pharmacol 2016; 171:3728-40. [PMID: 24758697 DOI: 10.1111/bph.12733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/14/2014] [Accepted: 04/10/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE The COX isoforms (COX-1, COX-2) regulate human gut motility, although their role under pathological conditions remains unclear. This study examines the effects of COX inhibitors on excitatory motility in colonic tissue from patients with diverticular disease (DD). EXPERIMENTAL APPROACH Longitudinal muscle preparations, from patients with DD or uncomplicated cancer (controls), were set up in organ baths and connected to isotonic transducers. Indomethacin (COX-1/COX-2 inhibitor), SC-560 (COX-1 inhibitor) or DFU (COX-2 inhibitor) were assayed on electrically evoked, neurogenic, cholinergic and tachykininergic contractions, or carbachol- and substance P (SP)-induced myogenic contractions. Distribution and expression of COX isoforms in the neuromuscular compartment were assessed by RT-PCR, Western blot and immunohistochemical analysis. KEY RESULTS In control preparations, neurogenic cholinergic contractions were enhanced by COX inhibitors, whereas tachykininergic responses were blunted. Carbachol-evoked contractions were increased by indomethacin or SC-560, but not DFU, whereas all inhibitors reduced SP-induced motor responses. In preparations from DD patients, COX inhibitors did not affect electrically evoked cholinergic contractions. Both indomethacin and DFU, but not SC-560, decreased tachykininergic responses. COX inhibitors did not modify carbachol-evoked motor responses, whereas they counteracted SP-induced contractions. COX-1 expression was decreased in myenteric neurons, whereas COX-2 was enhanced in glial cells and smooth muscle. CONCLUSIONS AND IMPLICATIONS In control colon, COX-1 and COX-2 down-regulate cholinergic motility, whereas both isoforms enhance tachykininergic motor activity. In the presence of DD, there is a loss of modulation by both COX isoforms on the cholinergic system, whereas COX-2 displays an enhanced facilitatory control on tachykininergic contractile activity.
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Affiliation(s)
- M Fornai
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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11
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Alvarez-Berdugo D, Espín F, Arenas C, López I, Clavé P, Gallego D. Changes in the response to excitatory antagonists, agonists, and spasmolytic agents in circular colonic smooth muscle strips from patients with diverticulosis. Neurogastroenterol Motil 2015; 27:1600-12. [PMID: 26303606 DOI: 10.1111/nmo.12659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/22/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colonic samples from asymptomatic diverticulosis (DS) patients presented enhanced electrical field stimulation (EFS)-contractions, in an earlier study of ours, suggesting increased endogenous responses. The aim of this study was to explore changes in excitatory neuromuscular transmission and to assess the pharmacodynamics of spasmolytic agents in DS. METHODS Circular muscle strips from sigmoid colon of DS patients (n = 30; 69.5 ± 14.8 years) and controls (n = 32; 64.7 ± 16.2 years) were studied using organ baths to evaluate the direct effect of excitatory agonists (carbachol, neurokinin A [NKA] and substance P [SP]), and the effect of antagonists (atropine and NK2 antagonist GR94800) and spasmolytic drugs (otilonium bromide [OB] and N-butyl-hyoscine) on the contractions induced by EFS-stimulation of excitatory motorneurons. qRT-PCR was also performed to compare mRNA expression of M2 , M3 , NK2 receptors and L-type calcium channels. KEY RESULTS Contractions to carbachol (Emax : 663.7 ± 305.6% control vs 2698.0 ± 439.5% DS; p < 0.0005) and NKA (Emax : 387.8 ± 35.6% vs 1102.0 ± 190.1%; p < 0.0005) were higher in DS group, without differences for SP. Higher potency for DS patients was observed in the concentration-response curves for atropine (pIC50 = 8.56 ± 0.15 control vs pIC50 = 9.95 ± 0.18 DS group; p < 0.005) and slightly higher for GR94800 (pIC50 = 7.21 ± 0.18 control vs pIC50 = 7.97 ± 0.32 group; p < 0.0001). Lower efficacy (Emax ) and potency (pIC50 ) was observed for spasmolytic drugs in DS, whereas no differences were found regarding the relative expression of the receptors evaluated between groups. CONCLUSIONS & INFERENCES The greater response to cholinergic and tachykinergic agonists and greater potency for muscarinic and NK2 antagonists observed in DS might play a role in the spasticity found in diverticular disease.
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Affiliation(s)
- D Alvarez-Berdugo
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Espín
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Arenas
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - I López
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.,Health Sciences Research Institute of the Germans Trias i Pujol Foundation, Barcelona, Spain
| | - D Gallego
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
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Pantaroto M, Lopes Filho GDJ, Pinto CAL, Antico Filho A. Comparative study of collagen deposition in the colon wall of patients operated for sigmoid diverticular disease. Acta Cir Bras 2015; 30:715-9. [DOI: 10.1590/s0102-865020150100000010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/15/2015] [Indexed: 01/19/2023] Open
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Espín F, Rofes L, Ortega O, Clavé P, Gallego D. Nitrergic neuro-muscular transmission is up-regulated in patients with diverticulosis. Neurogastroenterol Motil 2014; 26:1458-68. [PMID: 25109425 DOI: 10.1111/nmo.12407] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/04/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neuro-transmission impairment could be associated to motility changes observed in patients with diverticular disease. Therefore, the objective was to characterize the inhibitory neuro-muscular transmission and gene expression changes of the enteric inhibitory pathways in patients with diverticulosis (DS). METHODS Circular muscle strips from sigmoid colon of patients with DS and controls were studied using the organ bath technique to evaluate spontaneous contractility and enteric motor neurons stimulated by electrical field and qRT-PCR to assess the expression of nNOS, iNOS, P2Y1 R and PGP9.5. KEY RESULTS Patients with DS presented decreased spontaneous rhythmic contractions (SRC) that were significantly enhanced after incubation with L-NNA (1 mM) and TTX (1 μM), and unaffected by the P2Y1 antagonist MRS2500 (1 μM). Stimulation on enteric motor neurons caused an increased duration of the latency of OFF-contractions in DS group (p < 0.001), antagonized by L-NNA and slightly affected by MRS2500 (1 μM). No differences in the IC50 between controls and DS patients were observed on inhibition of SRC for the NO-donor sodium nitroprusside (SNP) and the preferential P2Y agonist ADPβS. Moreover, nNOS relative expression was also up-regulated 2.3-fold in the DS group (p < 0.05) whereas there was no significant difference in relative expression of iNOS, P2Y1 R and the neuronal marker PGP9.5 between groups. CONCLUSIONS & INFERENCES Patients with DS presented an over-expression of nNOS with increased endogenously NO-mediated responses suggesting enhanced NO-release. Up-regulation in the nitrergic pathway in early stages of the disease might play a role in colonic motor disorders associated to diverticular disease.
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Affiliation(s)
- F Espín
- Department of Surgery, Gastrointestinal Physiology Laboratory, Hospital de Mataró, Mataró, Barcelona, Spain
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14
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Tomita R. Are there any functional differences of the enteric nervous system between the right-sided diverticular colon and the left-sided diverticular colon? An in vitro study. Int J Colorectal Dis 2014; 29:571-7. [PMID: 24562545 DOI: 10.1007/s00384-014-1837-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate functional differences of the enteric nervous system (ENS) in patients between right-side colonic diverticula (RCD) and left-sided colonic diverticula (LCD), the author compared the ENS responses between RCD and LCD. METHODS Ten specimens were obtained from 10 patients with RCD, and 16 specimens were taken from 16 LCD. As a control, twenty-two specimens of right-sided normal colon (RNC) were obtained from 22 colonic cancers. Twenty-four specimens of left sided normal colon (LNC) were obtained from 24 colonic cancers. A mechanography was used to evaluate in vitro muscle responses to electrical field stimulation (EFS) before and after treatment with various autonomic nerve blockers. RESULTS Before blockade of the adrenergic and cholinergic nerves, the incidences of contraction via cholinergic nerve in the colons with diverticula were significantly greater than those in the normal colons (right-sided colon; p = 0.0022, left-sided colon; p < 0.0001). There were no significant differences between RNC and LNC (p = 0.3606), and between RCD and LCD (p = 0.7684). After the blockade of adrenergic and cholinergic nerves, the incidence of relaxation via non-adrenergic non-cholinergic inhibitory (NANC) nerve in the normal colons was significantly greater than that in the diverticular colons (right-sided colon; p = 0.0435, left-sided colon; p = 0.0034). There were no significant differences between RNC and LNC (p = 0.2909) and between RCD and LCD (p = 0.9464). CONCLUSION Cholinergic nerves were dominant in bilateral diverticular colon compared with bilateral normal colon. NANC inhibitory nerves were dominant in bilateral normal colon compared with bilateral diverticular colon. There were also no functional differences of the ENS between RCD and LCD.
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Affiliation(s)
- Ryouichi Tomita
- Department of Surgery, School of Life Dentistry, Nippon Dental University, 2-3-16 Fujimi, Chiyoda-ku, Tokyo, 102-8158, Japan,
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15
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In vitro motor patterns and electrophysiological changes in patients with colonic diverticular disease. Int J Colorectal Dis 2013; 28:1413-22. [PMID: 23702821 DOI: 10.1007/s00384-013-1716-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE The underlying mechanism responsible for motility changes in colonic diverticular disease (DD) is still unknown. In the present study, our aim was to investigate the structural and in vitro motor changes in the sigmoid colon of patients with DD. METHODS Muscle bath, microelectrodes and immunohistochemical techniques were performed with samples obtained from the left and sigmoid colon of patients with DD and compared with those of patients without DD. RESULTS The amplitude and area under the curve of the spontaneous rhythmic phasic contractions were greatly reduced in patients with DD whereas their frequency and tone remained unaltered. Electrical field stimulation induced a neurally mediated, enhanced ON-contraction (amplitude) in patients with DD and increased the duration of latency of OFF-contractions. The resting membrane potential of smooth muscle cells was hyperpolarized and the amplitude of the inhibitory junction potential was increased in patients with DD. In contrast, no significant histological differences were observed in patients with DD as smooth muscle (circular and longitudinal layers), interstitial cells of Cajal, glial cells and myenteric neurons densities remained unaltered. CONCLUSIONS Sigmoid strips from patients with asymptomatic DD showed an altered motor pattern with reduced spontaneous motility and enhanced neurally mediated colonic responses involving both excitatory and inhibitory motor pathways. No major neural and muscular structural elements were detected at this stage of the disease. These findings could be valuable in understanding the pathophysiology of this prevalent digestive disease.
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Plasma serotonin level in left-sided colonic diverticulosis: A pilot study. Open Med (Wars) 2012. [DOI: 10.2478/s11536-012-0041-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractNeurotransmitters might participate in the development of diverticular disease. We measured fasting and postprandial serotonin levels in colonic diverticulosis patients and healthy volunteers. We demonstrated significantly lower maximal concentrations of serotonin in patients than the controls (respectively 109.8±61.4 and 251.3±44.1 ng/ml, p<0.001) as well as lower serotonin minimal values (respectively 38.4±21.8 and 124.6±41.4 ng/ml, p<0.001) and areas under time-course curves (respectively 288.8±139.8 and 739±167.4 ng/ml, p<0.001); significant difference between alternating pattern and normal bowel habit concerning fasting serotonin level, the hormone response to test meal (p=0.041) as well as minimal serotonin level (p=0.044). Bowel habit was also related to peak serotonin values following a test meal with 38.5 ng/ml in constipation, 139.5 ng/ml in diarrhea, 122.4 ng/ml in alternating pattern and 249 ng/ml in subjects with normal bowel habit (p=0.040) as well as AUC with 120.8 ng/ml in constipation, 416 ng/ml in diarrhea, 298 ng/ml in alternating pattern and 684 ng/ml in subjects with normal bowel habit (p=0.043). We demonstrated substantial differences in fasting serum serotonin levels as well as the hormone response to a test meal between colonic diverticulosis patients and healthy individuals, which seemed to be associated with abnormal bowel habits rather than presence of diverticula.
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Maselli MA, Trisolini P, Petitta C, Lorusso D, Cicenia A, Scirocco A, Pezzolla F, Severi C. Myogenic regional responsiveness to cholinergic and vipergic stimulation in human colon. Neurogastroenterol Motil 2012; 24:867-e399. [PMID: 22672206 DOI: 10.1111/j.1365-2982.2012.01927.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Differences in the actions of enteric neurotransmitters on colonic circular and longitudinal muscle layers have not been clearly determined, nor the possible existence of intrinsic myogenic phenotypes that might contribute to regional differences in human colon motor activity. The aim of this study was to analyze the direct pharmaco-mechanical coupling of carbachol (CCh) and vasoactive intestinal polypeptide (VIP) on human colonic smooth muscle strips and cells. METHODS Circular and longitudinal muscle strips and cells were obtained from 15 human specimens of ascending and sigmoid colon. Both isometric tension on muscle strips and contraction and relaxation on cells were measured in response to increasing CCh and VIP concentrations. KEY RESULTS Circular muscle strips of ascending colon were more sensitive to the effect of CCh than that of sigmoid colon, EC(50) values being, respectively, 4.15μmolL(-1) and 8.47μmolL(-1) (P<0.05), although there were no differences in maximal responses. No regional differences were observed in longitudinal muscle strips or in smooth muscle cells. Maximal responses to CCh were higher on circular than longitudinal muscle strips and cells throughout the colon. A greater sensitivity to VIP was observed in ascending colon compared with sigmoid colon, both in circular (EC(50:) 0.041 and 0.15μmolL(-1) , respectively, P<0.01) and longitudinal (EC(50:) 0.043 and 0.09μmolL(-1) , respectively, P<0.05) strips, and similar differences were observed in longitudinal smooth muscle cells (EC(50:) 44.85 and 75.24nmolL(-1) , respectively, P<0.05). CONCLUSIONS & INFERENCES Regional myogenic differences in pharmaco-mechanical coupling between the enteric neurotransmitters and smooth muscle contribute to the complex regional motor patterns of human colon.
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Affiliation(s)
- M A Maselli
- Experimental Pharmacology Laboratory, Scientific Institute of Gastroenterology S. de Bellis, Castellana Grotte, Bari, Italy.
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Abstract
Although diverticular disease of the colon (diverticulosis) is a frequent finding in Western countries, its pathophysiologic grounds are still only partially understood. Traditionally considered as an age-related condition, colonic diverticulosis is probably the final result of several factors concurring together to determine the anatomo-functional abnormalities eventually causing outpouching of the viscus' mucosa. Among these factors, a relevant role seems to be played by an abnormal neuromuscular function of the large bowel, as shown by abnormal myoelectrical and motor function repeatedly described in these patients, as well as by altered visceral perception. These anomalies might be related to the recent demonstration of derangement of enteric innervation (especially involving interstitial cells of Cajal and enteric glial cells), mucosal neuropeptides, and mucosal inflammation. The latter may have a role of paramount importance in the development of visceral hypersensitivity, responsible for abdominal pain in a subset of patients.
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Affiliation(s)
- Gabrio Bassotti
- Gastroenterology and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
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Abstract
Colonic diverticulosis is a common condition and although the majority of patients are asymptomatic up to 20% experience altered bowel habit and abdominal pain. The mechanisms underlying these symptoms are unclear but several theories now exist. This article briefly outlines a model of GI perception and then highlights past and current theories that may explain the development of symptoms in patients with diverticulosis.
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Affiliation(s)
- John Simpson
- Department of General Surgery, University Hospital/QMC, Nottingham, UK.
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