Increasing Left-Side Acute Colonic Divertiulitis in Japan

Abstract

Introduction: Recent evidence shows that inflammation is the main pathogenic mechanism for Colonic Diverticular Disease (CDD).(1) Mesalazine administration has shown clinical improvement in controlled studies (2,3). There are little data about histological changes after mesalazine therapy in CDD. In this study, we have evaluated if exist difference in colonic mucosa histology in patients with non-complicated symptomatic CDD (NCSCDD) treated with or without mesalazine. Objective: To evaluate the colonic mucosa histology from patients with NCSCDD treated with and without Mesalazine Methods: 27 adult (18 year or more) patients, 10 male and 17 female, with NCSCDD were included in this study. In addition to the clinical examination, the patients underwent an ova and parasite examination of stools, stool culture and imaging exams for the diagnosis of CDD. Patients on antibiotics and anti-inflammatory, currently or recently; and carriers of acute diverticulitis, cancer or other organic diseases were excluded. The patients were separated in 2 groups: Mesalazine Group (MG) 11 patients that had mesalazine administrated p.o. 800 mg, t.i.d. for 60 days; Control Group (CG) 16 patients that had only fiber supplements for 60 days. At the end of 60 days, colonoscopy was performed, with biopsy at the diverticulum's edges. On the histopathologic examination, a Histopathogical Score (HS) was used for histological evaluation and quantification regarding to epithelial cells, crypts, lamina propria mononuclear cells and lamina propria neutrophils (Max score =12 min sore=0). For statistical analysis, non paired t test and Fisher exact test were used, with statistical significance for p<0,05. Results: HS showed statistical significant results when compared MG x CG score (Mean+/SD, SEM), (0,45 +/0,69, 0,21) x (2,0 +/1,83, 0,46), (p=0.012).Also statistical significant results were seen when compared for absence (-) or presence (+) of inflammation signs : CG 13 (+) and 3 (-) X MG 3 (+) and 8 (-) p=0.0147 Colonic mucosal inflammation was absent on most of the patients of MG, fact that didn't happen on the CG. Conclusion:. The use of mesalazine on NCSCDD is associated with the normalization of the peridiverticular histology. 1 Di Mario F. et al., J Clin Gastroenterol. 2006 2 Gatta L.et al.,J Clin Gastroenterol. 2010 3 Tursi A and Papagrigoriadis S., Aliment Pharmacol Ther. 2009