Diverticular Disease Of Colon Research Articles

The role of microbiota and its modulation in colonic diverticular disease.

Diverticular disease (DD) is a common condition in Western countries. The role of microbiota in the pathogenesis of DD and its related symptoms has been frequently postulated since most complications of this disease are bacteria-driven and most therapies rely on microbiota modulation. Preliminary data showed fecal microbial imbalance in patients with DD, particularly when symptomatic, with an increase of pro-inflammatory and potentially pathogenetic bacteria. In addition, bacterial metabolic markers can mirror specific pathways of the disease and may be even used for monitoring treatment effects. All treatments currently suggested for DD can affect microbiota structure and metabolome compositions. Sparse evidence is available linking gut microbiota perturbations, diverticular disease pathophysiology, and symptom development. We aimed to summarize the available knowledge on gut microbiota evaluation in diverticular disease, with a focus on symptomatic uncomplicated DD, and the relative treatment strategies.

Colonic diverticular disease: clinical presentation, diagnosis, treatment, and prevention Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientific Society of Russia, and the North- West Society of Gastroenterologists and Hepatologists

Clinical guidelines are intended for gastroenterologists, internists, and general practitioners and focus primarily on the management of patients with symptomatic uncomplicated diverticular disease, as well as on the primary and secondary prevention of acute diverticulitis and other complications of diverticular disease. Clinical guidelines were developed by the Russian Scientific Medical Society of Internal Medicine, the Gastroenterological Scientifi c Society of Russia, and the North-West Society of Gastroenterologists and Hepatologists. One of the reasons for creating new clinical guidelines is that the current guidelines on diverticular disease (2021) pay much more attention to complications of diverticular disease and surgical treatment of acute and chronic complications of the disease.

Trends and Disparities in Colonic Diverticular Disease Hospitalizations in Patients With Morbid Obesity: A Decade-Long Joinpoint Analysis.

Objective We aimed to describe epidemiologic trends in outcomes of colonic diverticular disease (CDD) hospitalizations in morbidly obese patients. Methods We searched the United States National Inpatient Sample databases from 2010 through 2019, obtained the incidence rate of morbid obesity (MO) among CDD hospitalizations, and used Joinpoint analysis to obtain trends in these rates adjusted for age and sex. Hospitalizations involving patients less than 18 years of age were excluded. Trends in mortality rate, mean length of hospital stay (LOS), and mean total hospital chargewere analyzed. Multivariate regression analysis was used to obtain trends in adjusted mortality, mean LOS, and mean total hospital charge. Results We found an average annual percent change of 7.5% (CI = 5.5-9.4%, p < 0.01) in the adjusted incidence of MO among hospitalizations for CDD over the study period. We noted a 7.2% decline in mortality (p = 0.011) and a 0.1 days reduction in adjusted LOS (p < 0.001) over the study period. Hospitalizations among the middle-aged and elderlyhad adjusted odds ratios of 7.18 (95% CI = 2.2-23.3, p = 0.001) and 24.8 (95% CI = 7.9-77.9, p < 0.001), respectively, for mortality compared to those in young adults. The mean LOS was 0.29 days higher in females compared to males (p < 0.001). Conclusion The incidence of MO increased among CDD hospitalizations while mortality and mean LOS reduced over the study period. Outcomes were worse in older patients, with an increased mean LOS in females compared to males.

DIAGNOSTIC AND TREATMENT OF DIVERTICULAR DISEASE OF THE COLON

The purpose of the work: to analyse clinical cases and the results of treatment of patients with diverticulosis of the large intestine in order to prevent complications.&#x0D; Materials and methods.&#x0D; The results of diagnosis and treatment of 75 patients with diverticulosis of the large intestine for the years 2016-2022, who were in the Clinical highly specialised surgical center with minimally invasive technologies in the Vinnytsia Regional Clinical Hospital named after M. I. Pyrogov of the Vinnytsia Regional Council.&#x0D; Research results and their discussion.&#x0D; We analysed the results of diagnosis and treatment of 75 patients with diverticulosis of the large intestine for the years 2016-2022, who were in the Clinical highly specialised surgical center with minimally invasive technologies in the Vinnytsia Regional Clinical Hospital named after M. I. Pyrogov of the Vinnytsia Regional Council. Colon diverticular disease was clinically and instrumentally confirmed and the following forms of the disease were established: diverticular bleeding - in 46 (61.33%), intestinal perforation with the development of diffuse fecal peritonitis - in 2 (2.66%), diverticulitis - in 12 (16%), asymptomatic diverticulosis - in 2 patients (2.66%), and in 13 patients there was a combination: diverticulitis and paracolic abscess - in 8 (10.66%), diverticulitis and limited purulent peritonitis - in 2 (6.66 %), diverticulitis and intestinal obstruction - in 3 (4%). There were 36 (48%) male patients, 39 (52%) female patients. The age of the patients ranged from 40 to 90 years. The average age was 65±2 years.

Colovesical fistula in a patient with diverticular disease and foreign body of the colonj

A clinical observation of a 50-year-old patient with colonic diverticular disease with perforation of one diverticulum by a fish bone and the formation of a colovesical fistula is presented in the article. The history of the disease, clinical picture, the course of the disease, results of pre-hospital and hospital examination, methods of treatment of the patient were analyzed. The presented material is illustrated by MSCT images, photographs made during the surgical treatment, results of histological examination. Surgical treatment included lower midline laparotomy, resection of the sigmoid colon and bladder with complete removal of the fistula with a diverticulum and bone inside it as a single block, formation of a colostomy, suturing the bladder defect tightly with urethral drainage with a Foley catheter. There were no complications during the operation and in the early postoperative period, the patient was discharged at the usual time. At a later date, a reconstructive operation was performed with the restoration of the passage of intestinal contents, without complications. A review of the literature on the diagnosis and treatment of patients with colovesical fistulas is presented.

An overview of diverticular pathophysiology and its treatment

Diverticula are protrusions that resemble sacs in the colon's wall. Acute or chronic problems are experienced by 4% of diverticula patients. Diverticulosis development has been linked in large part to the western way of life. Colonic diverticular disease has become more common. Obesity, smoking, and inadequate fibre consumption are risk factors for the illness. Most of the time, surgery is not necessary to treat this; however, if the bleeding is significant, angiography and endovascular intervention may be helpful. Ureteral catheters should be considered when a patient has undergone radiation therapy, resurgery, or preoperative imaging reveals an abnormal anatomy. Oral antibiotics can help prevent surgical site infections after an elective colon resection, according to studies. Using nonabsorbable oral antibiotics like erythromycin, neomycin, and metronidazole reduces surgical site infections overall.

Colovesical fistula due to diverticular disease of sigmoid colon: a case report

Background Nowadays, diverticular disease of the colon is an increasingly common diagnosis and is a leading cause of colovesical fistula. This disease causes many complications affecting quality of life even causing death. Case report We report a 42-year-old man who was successfully treated for a colovesical fistula due to diverticulitis of the sigmoid colon presenting with septic shock. Conclusions Treatment of colovesical fistula due to diverticular disease requires control of infection and surgical reconstruction of gastrointestinal tract and closure of bladder fistula. Key words: diverticular disease, sigmoid colon, colovesical fistula

Mortality risk increased in colonic diverticular disease: a nationwide cohort study

There are limited population cohort data on overall and cause-specific mortality in colonic diverticular disease. To measure overall and cause-specific mortality in colonic diverticular disease, compared to matched reference individuals and siblings. Population-based cohort study ("the ESPRESSO study") in Sweden. There were 97,850 cases with a medical diagnosis of diverticular disease (defined by international classification of disease codes) and colorectal histology identified in 1987-2017 from histopathology reports. The mortality risk between individuals with colonic diverticular disease and matched reference individuals (n=453/634) from the general population was determined. Cox regression models adjusted for comorbidity estimated hazard ratios (HRs) for all-cause mortality. During follow-up, there were 32,959 deaths in individuals with colonic diverticular disease (44/1000 person-years) compared with 127,153 in matched reference individuals (34/1000 person-years), resulting in an HR of 1.27 (95%CI 1.25-1.29). Also compared to siblings, colonic diverticular disease patients were at increased risk of death, HR 1.39 (95%CI 1.33-1.45). Mortality risks were further increased in colonic diverticular disease patients with a colorectal biopsy showing any mucosal inflammation HR 1.36; (95%CI 1.33-1.38), with the most significant increase during the first year after diagnosis HR 2.18; (95%CI 2.05-2.32). Mortality in colonic diverticular disease is increased over reference individuals in the general population. The presence of mucosal inflammation on colorectal biopsies is a predictor of increased risk of mortality.

Pathophysiology, Symptoms and Evolving Treatment for Colonic Diverticular Disease: A Review

The review on diverticulitis disease, is the most prevalent non-cancerous pathology of the colon is diverticular disease and diverticulitis. It has long been thought to be a disease of the elderly, linked to cultural and dietary patterns. Our understanding of this condition, as well as the therapy protocols, has progressed. To give an updated assessment of the epidemiology, pathophysiology, and classification of diverticulitis, as well as to highlight developments in medicinal and surgical management. Treatment of Diverticular Disease represented an important challenge in clinical practice, especially concerning the management of symptomatic uncomplicated diverticular disease (SUDD) and the primary and secondary prevention of acute diverticular disease (AD). Antibiotics and supportive treatments are the mainstays of non-operative treatment, while antibiotics may be skipped in moderate cases. Acute surgery is required for the most severe and refractory cases, whereas elective resections should be considered for chronic, smoldering, or recurrent forms, as well as their associated complications (stricture, fistula, etc.) and patients with factors that are highly predictive of recurrent attacks. Diverticulitis isn't just a condition that affects the elderly. Our growing understanding of diverticulitis as a clinical entity has resulted in a more nuanced approach to its medicinal and surgical therapy. For more than 70% of patients, non-surgical care is still the best option. In the acute, chronic, or elective-prophylactic environment, a segmental colectomy remains the most effective surgical treatment for those with non-relenting, persistent, or recurrent symptoms, as well as those with severe disease and sequelae.

A series of emergency presentations of diverticular disease of colon

Diverticular disease of the colon is commonly prevalent in developed countries, especially in the western population. This is mainly attributed towards their food habits which include less dietary fibre which is the primordial cause of diverticular disease. Its incidence is gradually increasing in developing countries, especially in southern parts of India due to rapid change in food habits which are moving towards western culture. Majority of the patients with diverticular disease may remain asymptomatic. Diverticular disease presents to the hospital with a wide variety of symptoms such as lower abdominal pain, fever, malaise, bleeding per rectum which manifests because of its complications. Hence the early presentations of diverticular disease should not be missed and proper evaluation should be carried out in suspicious cases to prevent complications which can be deadly. Here we present a series of cases that are received in our emergency department as a complication of diverticular disease. This is a case series in which we study the emergency presentations of diverticular diseases admitted in Rajiv Gandhi government general hospital. Here diverticular disease is proven by a series of investigations that include evaluation of acute abdomen such as x ray abdomen erect, ultrasound abdomen, contrast enhanced computed tomography and histopathological examination with appropriate management.

The relationship between Parkinson's disease and gastrointestinal diseases.

An increasing number of studies have provided evidence for the hypothesis that the pathogenesis of Parkinson’s disease (PD) may derive from the gut. Firstly, Lewy pathology can be induced in the enteric nervous system (ENS) and be transported to the central nervous system (CNS) via the vagal nerve. Secondly, the altered composition of gut microbiota causes an imbalance between beneficial and deleterious microbial metabolites which interacts with the increased gut permeability and the gut inflammation as well as the systemic inflammation. The activated inflammatory status then affects the CNS and promotes the pathology of PD. Given the above-mentioned findings, researchers start to pay attention to the connection between PD and gastrointestinal diseases including irritable bowel syndrome, inflammatory bowel disease (IBD), microscopic colitis (MC), gastrointestinal infections, gastrointestinal neoplasms, and colonic diverticular disease (CDD). This review focuses on the association between PD and gastrointestinal diseases as well as the pathogenesis of PD from the gut.

Polymorphic dermal vasculitis flare up after COVID-19: case report

Several types of antiviral vaccines have been developed to control the spread of the disease since COVID-19 pandemic onset. Currently, many countries are taking measures aimed at increasing vaccination rates for herd immunity formation. However, with increased number of vaccinated individuals, there are more reports of possible adverse events after vaccination, including chronic dermatoses aggravation.&#x0D; The article describes a clinical case of polymorphic dermal vasculitis (hemorrhagic and urticaria types combination) flare up after COVID-19 vaccination in a 73-year-old woman, who was admitted to Department of Dermatology and Venereology (Sechenov University) with complaints of skin rashes in the trunk, upper and lower extremities and intense itching. The presence of comorbid diseases (ischemic heart disease; atrial fibrillation; chronic gastritis; diverticular colon disease; chronic kidney disease) and wide range of drugs intake on a regular basis made it difficult to diagnose. Due to appropriate therapy, clinical remission was achieved 2.5 months after treatment onset as a complete rashes regression on the trunk and upper extremities. The patient was given recommendations to maintain achieved therapeutic effect.&#x0D; The Discussion section provides up to date statistical data on the frequency of skin reactions adverse events after various COVID-19 vaccines administration and discusses possible hypotheses for such side reactions manifestation. Recommendations are given to practicing dermatologist about possible chronic dermatoses exacerbation after vaccine administration. When deciding on vaccination, potential risks should be assessed individually and each patient should be informed accordingly. Despite developed management protocols for patients with a new coronavirus infection, treatment options are still limited. The clinical experience accumulated during the pandemic period shows that COVID-19 vaccination significantly reduces disease severity, minimizes lethal outcome and restrains pandemic outbreak. Therefore, there are no certain dermatological diseases as absolute contraindications to COVID-19 vaccination.

Diagnosis and Treatment of Colonic Diverticular Disease

Colonic diverticulosis is one of the most common conditions of the digestive system and patients generally remain asymptomatic. However, about 20% of patients develop symptomatic diverticular disease such as acute diverticulitis or diverticular hemorrhage, and these have become a huge burden on healthcare systems worldwide. Recent understanding of the pathophysiology of diverticulosis and diverticular disease suggests the role of multiple factors including genetic and environment. Based on this understanding, a preventive strategy to reduce the risk factors of diverticulosis and diverticular disease is highly recommended. The diagnosis of the acute diverticulitis relies on imaging modalities such as an abdominal-pelvic CT scan together with symptoms and signs. Treatment of diverticular disease should be individualized and include modification of lifestyle, use of antibiotics, and surgery. Recent guidelines recommend pursuing less aggressive treatment for patients with acute diverticulitis. This review will provide an overview of both the existing and evolving understanding regarding colonic diverticulosis and diverticular disease and can help clinicians in the management of their patients with diverticular disease.

Right-sided diverticulitis in a Western population.

While left-sided colonic diverticular disease is common in Western Caucasian populations, right-sided colonic disease (RCD) is rare. The present study aimed to determine the rate of RCD and to identify the symptoms, clinical features, treatment, and outcomes in a single medical center in Israel. Data for this descriptive retrospective analysis were collected from the electronic medical records of all patients diagnosed with colonic diverticulitis from January 2014 to June 2019. During the study period, 1000 patients with diverticulitis were admitted to our institution, of which 99 had RCD (10%). Mean age was 50.2years. The main presenting symptom was acute onset of right-sided abdominal pain. The diagnosis was made almost exclusively by computed tomography scan and the cecum was the most frequent site. The clinical course was benign, without major complications for most patients (90.1%). Nine patients presented with abscess (n = 1), covered perforation (n = 7), or partial obstruction (n = 1). All patients were treated with intravenous antibiotics with a median length of hospital stay of 3days and a median 9days of antibiotic treatment. Only 1 patient underwent diagnostic laparoscopy due to suspected intestinal perforation. Three patients experienced disease recurrence after a median follow-up of 48months. Upon recovery, half of the patients underwent colonoscopy; no further pathology was found in any. Unlike sigmoid colon diverticulitis, the incidence of RCD in Western populations is low. The clinical course is benign, with conservative treatment without the need for surgery. The complication and recurrence rates are low.

Желудочно-кишечный тракт в плену у COVID-19: влияние новой коронавирусной инфекции на течение и исходы дивертикулярной болезни толстой кишки

A feature of COVID-19 is the high frequency of gastroenterological symptoms caused by the defeat of the digestive organs by the SARS-CoV-2 coronavirus, as well as the exacerbation of chronic gastroenterological pathology against the background of infection and its aggressive therapy. Unfortunately, COVID-19 has a significant impact on the course and outcome of diverticular colon disease. The article presents the variants and frequency of exacerbation of diverticular disease against the background of viral infection.

Colonic diverticulosis - diagnostic and therapeutic difficulties

Objectives. The objectives of this study are to highlight the diagnostic and therapeutic difficulties in patients with complicated acute colonic diverticulosis. Methods. The study group comprised 40 patients hospitalized to the Second Surgical Clinic of the Emergency County Hospital in Craiova, Romania, through the emergency service between 2015 and 2021. Regarding the sex distribution of the patients with colonic diverticular disease studied, there was a predominance of males. The distribution of patients was as follows: 22 patients with acute colonic diverticulitis, out of whom 21 patients suffered from left acute colonic diverticulitis and 1 patient suffered from right acute colonic diverticulitis. Results. The diagnosis of acute colonic diverticulitis was made by corroborating the data obtained on the objective clinical examination with the data obtained by exploring the abdomen by means of computed tomography, which revealed a thickening of the colon wall (acute sigmoid diverticulitis predominated). The treatment applied to patients with acute diverticulitis was conservative and in patients with acute perforated colonic diverticulitis, the treatment of choice was the surgical one. Mortality was 7.5% of all the cases. Conclusions. In patients with perforated colonic diverticular disease, the administered treatment consisted in Hartmann segmental colectomy, wound care, peritoneal drainage. The reintegration of the colon in the digestive transit was performed after 3-6 months.

Lactobacillus paracasei CNCM I 1572: A Promising Candidate for Management of Colonic Diverticular Disease.

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.

Early elective versus elective sigmoid resection in diverticular disease: not only timing matters—a single institutional retrospective review of 133 patients

PurposeThe optimal timing of elective surgery in patients with the colonic diverticular disease remains controversial. We aimed to analyze the timing of sigmoidectomy in patients with diverticular disease and its influence on postoperative course with respect to the classification of diverticular disease (CDD).MethodsPatients who underwent elective laparoscopic sigmoidectomy were retrospectively enrolled and subdivided into two groups based on the time interval between the last attack and surgery: group A, early elective (≤ 6 weeks), and group B, elective (> 6 weeks). Multivariate regression models were used to identify factors which predict conversion to laparotomy, postoperative course, and length of hospital stay.ResultsA total of 133 patients (group A (n = 88), group B (n = 45)) were included. Basic demographic data did not differ between groups except for a higher rate of diabetes in group B (p = 0.009). The conversion rate was significantly higher in group A in comparison to group B (group A vs. group B: n = 23 (26.1%) vs. n = 3 (6.7%), p = 0.007). Logistic regression analysis revealed the timing of surgery and CDD stage as significant predictors for intraoperative conversion. Moreover, the postoperative course was influenced by high age as well as intraoperative conversion and length of hospital stay by conversion, preoperative CRP levels, and elective surgery.ConclusionsBoth, timing of surgery and the disease stage, influence the conversion rates in laparoscopic sigmoidectomy for diverticular disease. Accordingly, patients with complicated acute or chronic sigmoid diverticulitis should be operated in the inflammation-free interval.

Experience in the Treatment of Diverticular Colon Disease

The results of the treatment of 645 patients with the large intestine diverticulum (women 65,4%, men 34,6%) are analyzed. As many as 54,4% of the patients were hospitalized in case of emergency, 45,6% of the patients in planned cases. The conservative treatment was given to 82,5% of the patients, the operative theatment to 24,8% of the patients. In the hyperkinetic type of intestine motility, preference was given to low invasive operations conserving organs (in 28 cases the Reilly and Hodgson laparoscopic seromyotomt were carried out, in 17 cases through miniaccess), in the hypokinetic type the various kinds of large intestine resections were carried out (in 20 cases). In cases of emergency depending on the general state of a patient, nature and incidence of the pathologic process, the possibility of choosing various intervention methods is presented (in 29 cases the primary resection with anastomosis was carried out).

Colonic diverticular disease during pregnancy

Colonic diverticular disease consists in the presence of several diverticula in the colon. A diverticulum is a sac-like bag of varying sizes, resulting from hernias of the colonic mucosa outside the lumen. At the level of the digestive tract diverticula are most frequently found in the sigmoid colon. This pathology is rarely found in young people, so it is not considered when making a differential diagnosis in pregnant women with abdominal pain. This article will present two case reports of diverticulitis in pregnancy, published in the literature, as well as their diagnosis and management.