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Völkerer A, Wernly S, Semmler G, Flamm M, Aigner E, Datz C, Wernly B. Diverticulosis and cardiometabolic risk factors: a systematic literature review. Int J Colorectal Dis 2023; 38:236. [PMID: 37725283 PMCID: PMC10509050 DOI: 10.1007/s00384-023-04532-4] [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] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND There is a hypothesis of an association between diverticulosis and metabolic syndrome (MS) or its components, but data on this topic are inconsistent, and a systematic review has not been performed. We conducted a systematic review to investigate the possible association between cardiometabolic risk factors and diverticulosis. METHODS A systematic literature search was conducted via PubMed, Cochrane Library, and Web of Science in December 2022 to collect the necessary data. Studies that examined the association between MS or individual metabolic factors and asymptomatic diverticulosis were included in the review. RESULTS Of the potentially relevant articles identified via PubMed (477), Cochrane Library (224), and Web of Science (296), 29 articles met the inclusion criteria and were used for this work. These studies were assessed for study quality using GRADE. Overall, 6 studies were rated as "very low," 19 studies as "low," and 4 studies as "moderate." The data suggest an association between arterial hypertension, obesity, and fatty liver disease in younger patients and diverticulosis. Patient age appears to play an important role in diverticular formation. Data on diabetes mellitus is inconclusive and may require further investigation depending on the location of the diverticula. CONCLUSION Based on the synthesized data, there is an association between arterial hypertension, obesity, and fatty liver disease in younger patients. The formation of diverticula seems to be influenced by age and genetic factors. The study suggests a connection with cardiometabolic risk factors. To gain a better understanding of the role of metabolic risk factors in asymptomatic diverticulosis, targeted studies are necessary based on these findings.
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Affiliation(s)
- Andreas Völkerer
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Sarah Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Georg Semmler
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Elmar Aigner
- Clinic I for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria.
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
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Ukashi O, Pflantzer B, Barash Y, Klang E, Segev S, Ozeri DJ, Veisman I, Lahat A, Laish I, Kopylov U, Oppenheim A. Cardiovascular Risk Factors and Physical Fitness Among Subjects with Asymptomatic Colonic Diverticulosis. Dig Dis Sci 2023; 68:902-912. [PMID: 35695973 DOI: 10.1007/s10620-022-07572-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/18/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND The association between diverticular disease and atherosclerotic cardiovascular disease (ASCVD) has been demonstrated previously, mainly in symptomatic subjects. AIMS To evaluate 10 years cardiovascular risk, exercise performance and association to ASCVD among subjects with asymptomatic diverticulosis. METHODS A retrospective cross-sectional cohort of self-referred participants in a medical screening program, who underwent a screening colonoscopy. Demographics, clinical and laboratory variables, ASCVD score, and metabolic equivalents (METs) during treadmill stress test were compared between subjects with and without diverticulosis as diagnosed on screening colonoscopy. RESULTS 4586 participants underwent screening colonoscopy; 799 (17.4%) had diverticulosis. Among 50-69 yo participants, diverticulosis subjects had a higher ASCVD score compared to non-diverticulosis subjects. Exercise performance was comparable between the groups, across all age groups. Using logistic regression analysis, advanced age group (50-59 yo Adjusted odds ratio (AOR) [95% confidence interval (CI)] 2.57 (1.52-4.34), p < 0.001; 60-69 yo, AOR 2.87 (2.09-3.95), p < 0.001; ≥ 70 yo AOR 4.81 (3.23-7.15), p < 0.001; compared to < 50 yo age group), smoking [AOR 1.27 (1.05-1.55), p = 0.016], HTN [AOR 1.27 (1.03-1.56), p = 0.022], obesity [AOR 1.36 (1.06-1.74), p = 0.014] and male sex [AOR 1.29 (1.02-1.64), p = 0.036] were associated with diverticular detection during screening colonoscopy. Among males, achieving METs score ≥ 10 was inversely associated with diverticular detection during screening colonoscopy [AOR 0.64 (0.43-0.95), p = 0.027]. CONCLUSIONS Ten years probability for ASCVD estimated by the ASCVD score is higher among subjects with asymptomatic diverticulosis compared to subjects without diverticulosis. Improved exercise performance is demonstrated for the first time to correlate with decreased probability for diverticular disease in screening colonoscopy.
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Affiliation(s)
- Offir Ukashi
- Department of Gastroenterology, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel.
- Department of Internal Medicine A, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Barak Pflantzer
- Department of Internal Medicine A, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yiftach Barash
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel
- DeepVision Lab, Sheba Medical Center, Ramat-Gan, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel
- DeepVision Lab, Sheba Medical Center, Ramat-Gan, Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Institute of Medical Screening, Sheba Medical Center, Ramat-Gan, Israel
| | - David J Ozeri
- Department of Internal Medicine A, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Rheumatology, Sheba Medical Center, Ramat-Gan, Israel
| | - Ido Veisman
- Department of Gastroenterology, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ido Laish
- Department of Gastroenterology, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Amit Oppenheim
- Department of Internal Medicine A, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Pathophysiology of Diverticular Disease: From Diverticula Formation to Symptom Generation. Int J Mol Sci 2022; 23:ijms23126698. [PMID: 35743141 PMCID: PMC9223421 DOI: 10.3390/ijms23126698] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 01/04/2023] Open
Abstract
Diverticular disease is a common clinical problem, particularly in industrialized countries. In most cases, colonic diverticula remain asymptomatic throughout life and sometimes are found incidentally during colonic imaging in colorectal cancer screening programs in otherwise healthy subjects. Nonetheless, roughly 25% of patients bearing colonic diverticula develop clinical manifestations. Abdominal symptoms associated with diverticula in the absence of inflammation or complications are termed symptomatic uncomplicated diverticular disease (SUDD). The pathophysiology of diverticular disease as well as the mechanisms involved in the shift from an asymptomatic condition to a symptomatic one is still poorly understood. It is accepted that both genetic factors and environment, as well as intestinal microenvironment alterations, have a role in diverticula development and in the different phenotypic expressions of diverticular disease. In the present review, we will summarize the up-to-date knowledge on the pathophysiology of diverticula and their different clinical setting, including diverticulosis and SUDD.
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Abstract
Diverticular disease is a common condition among the elderly, with a steady increase in prevalence over time. Also, it has a temporal, geographic, and ethnic variation in incidence and prevalence, the genetic component having only recently been studied. For many years, environmental factors were the main link to the etiology. Recent studies estimated the heritability in this disease and identified genetic variants associated with diverticulosis. The interaction between structural changes of the colonic wall, diet, lifestyle, and genetic factors results in the development of diverticular disease. The purpose of this article is to review the existing data about genetic influence in this disease.
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Dore MP, Pes GM, Marras G, Soro S, Rocchi C, Loria MF, Bassotti G. Risk factors associated with colonic diverticulosis among patients from a defined geographic area. Tech Coloproctol 2015; 20:177-83. [PMID: 26568053 DOI: 10.1007/s10151-015-1401-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/26/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Only a few data regarding colonic diverticulosis are available in Italy. We examined the frequency of colonic diverticulosis and its associations with risk factors in a homogeneous Northern Sardinian population undergoing colonoscopy for any reason in the last decades. METHODS This was a retrospective single-center study. Medical records of patients undergoing colonoscopy for any indication between 1995 and 2013 were reviewed. Demographic information including age, gender, geographic area (urban, rural), marital status, smoking habit, occupation, body mass index, and comorbidities were collected. Presence, number, and extension of diverticula were assessed by colonoscopy. The diagnosis of diverticulosis was defined by the presence of more than five diverticula. RESULTS A total of 4458 records were collected (39.8 % males). Analysis by birth cohorts showed a significant progressive age-related increase in the prevalence of diverticulosis. The average prevalence was 18.9 % without significant variation across the 19-year observation period. In 101 (12.1 %) subjects diverticula were single or few. Seventy-one percent of diverticula were located predominantly in the left side, 2 % in the right side, and 14.3 % were spread throughout the colon. There was a significant association with obesity but not with smoking habits, marital status, or urban versus rural environment. A strong association was observed between the presence of diverticulosis and cardiovascular and other gastrointestinal and lung disease (p < 0.0001). These associations were also confirmed by the logistic regression analysis. CONCLUSIONS In this endoscopic study, colonic diverticulosis in Northern Sardinia showed prevalence similar to other series in Western countries, and it was predominantly left sided and age related.
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Affiliation(s)
- M P Dore
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
- Baylor College of Medicine, Houston, TX, USA
| | - G M Pes
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - G Marras
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - S Soro
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - C Rocchi
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - M F Loria
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - G Bassotti
- Department of Medicine, University of Perugia, Perugia, Italy.
- Clinica di Gastroenterologia ed Epatologia, Ospedale Santa Maria della Misericordia, Piazzale Menghini, 1, 06156, San Sisto, Perugia, Italy.
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Reichert MC, Lammert F. The genetic epidemiology of diverticulosis and diverticular disease: Emerging evidence. United European Gastroenterol J 2015; 3:409-18. [PMID: 26535118 DOI: 10.1177/2050640615576676] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Diverticular disease (DD) is one of the most prevalent gastrointestinal disorders. The pathogenesis of diverticulosis and DD is controversially discussed. Current studies call the traditional concept of a fibre-deficient diet causing the development of diverticula into question. Data from two recent twin studies have provided conclusive evidence for a strong genetic component to diverticulosis. Although genomewide association studies have provided new insights into the polygenic architecture of human diseases, genomic research in diverticulosis and DD has just been started. This is an astonishing fact given the high morbidity and mortality of the disease, as well as the substantial economic burden on health care systems. For this review, we provide an update of the molecular pathobiology and summarise recent evidence supporting the hypothesis that distinct, yet unidentified genetic variants contribute to the development of diverticulosis and DD.
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Affiliation(s)
- Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
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Bhopal RS, Cezard G, Bansal N, Ward HJT, Bhala N. Ethnic variations in five lower gastrointestinal diseases: Scottish health and ethnicity linkage study. BMJ Open 2014; 4:e006120. [PMID: 25335961 PMCID: PMC4208048 DOI: 10.1136/bmjopen-2014-006120] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Our objective was to augment the limited evidence mainly from local, clinical studies of ethnic differences in gastrointestinal disorders. Our question was: are there ethnic variations in hospitalisation/death for lower gastrointestinal disorders in Scotland? SETTING Scotland. POPULATION This retrospective-cohort linked 4.65 (of 4.9) million people in the 2001 census of Scotland (providing data on ethnicity, country of birth and indicators of socioeconomic deprivation) to 9 years of National Health Service hospitalisation and death records. PRIMARY AND SECONDARY OUTCOME MEASURES AND ANALYSIS For appendicitis, we studied all ages; for irritable bowel syndrome, ulcerative colitis, Crohn's disease and diverticular disease, we included those ≥20 years. Using Poisson regression (robust variance) we calculated, by ethnic group and sex, first-hospitalisation/death age-adjusted rates per 100,000 person-years, and relative risks (RRs) with 95% CIs multiplied by 100, so the White Scottish reference population had an RR=100. RESULTS There were ethnic variations; for example, for irritable bowel syndrome, RRs (95% CIs) were comparatively high in Other White British women (128.4 (111.0 to 148.6)), and low in Pakistani women (75.1 (60.6 to 93.1)). For appendicitis, RRs were high in men in Other White British (145.2 (127.8 to 164.9)), and low in most non-White groups, for example, Pakistanis (73.8 (56.9 to 95.6)). For ulcerative colitis, RRs were high in Indian (169.8 (109.7 to 262.7)) and Pakistani (160.8 (104.2 to 248.2)) men. For Crohn's disease, the RR was high in Pakistani men (209.2 (149.6 to 292.6)). For diverticular disease, RRs were high in Irish men (176.0 (156.9 to 197.5)), and any Mixed background women (144.6 (107.4 to 194.8)), and low in most non-White groups, for example, Chinese men (47.1 (31.0 to 71.6) and women (46.0 (30.4 to 69.8)). CONCLUSIONS Appendicitis and diverticular disease were comparatively low in most non-White groups, while ulcerative colitis and Crohn's disease were mostly higher in South Asians. Describing and understanding such patterns may help clinical practice and research internationally.
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Affiliation(s)
- Raj S Bhopal
- Edinburgh Ethnicity and Health Research Group (EEHRG), Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Genevieve Cezard
- Edinburgh Ethnicity and Health Research Group (EEHRG), Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Narinder Bansal
- Edinburgh Ethnicity and Health Research Group (EEHRG), Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
- Cardiovascular Epidemiology Unit, Department of Public Health & Primary Care, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, UK
| | - Hester J T Ward
- Edinburgh Ethnicity and Health Research Group (EEHRG), Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
- Public Health and Intelligence, NHS National Services Scotland, Gyle Crescent, Edinburgh, UK
| | - Neeraj Bhala
- Gastroenterology and Liver Units, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
- Department of Gastroenterology, Wellington Regional Hospital, Capital and Coast District Health Board, Newtown, Wellington, New Zealand
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