Diverticular Disease Of Colon Research Articles

Colonic diverticular disease in autosomal dominant polycystic kidney disease: is there really an association? A nationwide analysis.

Colonic diverticulosis, diverticulitis, and diverticular bleeding are reportedly more common in patients with autosomal dominant polycystic kidney disease (ADPKD). Other studies have questioned this association. The objectives of our study are to clarify this association using a larger patient population and to identify risk factors in general to develop diverticular disease. The Nationwide Inpatient Sample weighted discharges from 2003 to 2011 were used to assess for the prevalence of diverticular disease in the population with ADPKD compared with the general population without ADPKD. A multivariable direct logistic regression model was constructed to determine independent predictors of diverticular disease in the general population. The prevalence of diverticulosis, diverticulitis, and diverticular bleeding were considerably increased in patients with ADPKD compared with the general population without ADPKD. The prevalence of colonic surgery was less in ADPKD patients with diverticulitis. In patients with kidney transplant, the prevalence of diverticulitis was increased in the ADPKD group, but colonic surgery was not significantly different between both groups. The prevalence of diverticular bleeding was slightly elevated in patients with ADPKD, but colonic surgery was significantly increased in patients with ADPKD. NSAID use, hypertension, constipation, and ADPKD had increased odds ratios for diverticular disease during multivariate analysis. There is an increased prevalence of colonic diverticular disease in the population with ADPKD.

Gastrointestinal Pathologies in Patients After Successful Renal Transplantation

BackgroundKidney transplantation (KT) is the most desired and cost-effective modality of renal replacement therapy for patients with chronic kidney failure. KT protects the patient from complications that may develop during chronic dialysis. Unfortunately, evidence also suggests that KT patients are more prone to developing cancer than healthy persons. Many complications after renal transplantation can be prevented if they are detected early. The aim of this study was to evaluate the prevalence of gastrointestinal pathologies in patients after KT. MethodsAdult patients after KT who are under the care of the Outpatient Department of Nephrology at the Medical University of Gdańsk, Poland, received alarm symptom questionnaires and referral for testing for the presence of fecal occult blood. Then, in 58 selected patients (36 men and 22 women), endoscopic examination was performed. Mean age was 57.34 ± 10.1 (range, 35-83) years. ResultsOut of 940 patients after KT, resting under supervision of the Outpatient Department, 208 patients completed the questionnaire and 118 gave a stool sample for testing: 40 results were positive. After analyzing the questionnaires and stool results, 100 patients qualified for further investigation. The endoscopic examination had been performed so far in 58 patients and revealed gastritis and/or duodenitis in 49 patients, diverticular colon disease in 26, esophagitis in 8, colon polyps in 16, stomach polyps in 4, inflammatory bowel disease in 12, and cancers in 3. ConclusionsThe preliminary results indicate that patients after KT have significant risk of gastrointestinal pathologies and require detailed diagnostic endoscopy.

Author Correction: Colonic diverticular disease.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Diverticulosis, Diverticulitis, and Appendicitis

Colonic diverticula are herniations of colonic mucosa and submucosa through the muscularis propria. They occur where perforating arteries traverse the circular muscle layer, in parallel rows between the mesenteric and antimesenteric taenia. Colonic diverticular disease may present as diverticulosis, diverticulitis, or diverticular bleeding. Of patients with known diverticulosis, only 10% to 20% will develop diverticulitis. Diverticulitis varies in presentation and severity. This chapter discusses the diagnosis, differential diagnosis, and management of diverticulitis and its complications. Appendicitis is generally caused by obstruction of the lumen of the appendix, followed by infection. In the United States, the lifetime risk of appendicitis is about 9% for males and 7% for females. This chapter also discusses the diagnosis of appendicitis (including typical and atypical presentations and appendicitis as it presents in special groups of patients) and its management. This review contains 3 figures, 21 tables, and 76 references. Keywords: Diverticulosis, diverticulitis, gastrointestinal bleeding, appendicitis, abdominal infection, appendiceal perforation, antibiotics, appendectomy, colectomy, laparoscopy

Diverticular Disease of the Colon

Summary Introduction In the past decade, approaches to understanding epidemiology and treating diverticular disease have changed significantly. Many of the principles used earlier have lost their relevance at the moment. In the near future, we can expect an increase in cases of the disease, given the general population aging. Moreover, the number of surgical operations performed on diverticulosis increases annually. The number of complications are worsening the prognosis for a given disease increasing the risk of death results. The aim of the study A detailed scientific review is presented on the topic “Diverticular Colon Disease”. The paper primarily uses the guidelines of World Journal of Emergency Surgery (2016), as well as Guidelines of the American Association of Gastroenterologists and Clinical guidelines for the diagnosis and treatment of adult patients with diverticular colon disease developed by the expert committee of the All–Russian Public Organization “Association of Coloproctologists of Russia”. The work gives the definition of a diverticulum, diverticulosis, and diverticulitis of the colon. The issues of prevalence and frequency of occurrence of this pathology in various age and ethnic groups in developed and developing countries are reflected. The modern views on the etiology and pathogenesis of the disease are disclosed, taking into account the views of modern scholars and international guidelines. Finally, the work analyses case report on the complicated diverticular disease. Material and Methods The search for sources was performed in the PUBMED, PUBMED Central, Google Scholar and E–Library databases by keywords: colon diverticulosis, diverticulitis, as well as their Russian counterparts. The selection of sources was mainly limited to 2000–2020. Authors declare that the research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects. Informed consent was not received due to the nature of the study. Results and Conclusion In the past decade, approaches to understanding epidemiology and treating diverticular disease has changed. Many of the principles used earlier have lost their relevance at the moment. At the same time, a careful study of the etiological factors, pathophysiological mechanisms and cause–effect relationships in the development of this pathology is required. Improving diagnostic methods, early prevention and new approaches to treatment can reduce the risk of death in this disease.

Publisher Correction: Colonic diverticular disease

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Colonic diverticular disease.

Diverticula are outpouchings of the intestinal wall and are common anatomical alterations detected in the human colon. Colonic diverticulosis (the presence of diverticula in the colon; referred to as diverticulosis) remains asymptomatic in most individuals but ~25% of individuals will develop symptomatic diverticulosis, termed colonic diverticular disease (also known as diverticular disease). Diverticular disease can range in severity from symptomatic uncomplicated diverticular disease (SUDD) to symptomatic disease with complications such as acute diverticulitis or diverticular haemorrhage. Since the early 2000s, a greater understanding of the pathophysiology of diverticulosis and diverticular disease, which encompasses genetic alterations, chronic low-grade inflammation and gut dysbiosis, has led to improvements in diagnosis and management. Diagnosis of diverticular disease relies on imaging approaches, such as ultrasonography, CT and MRI, as biomarkers alone are insufficient to establish a diagnosis despite their role in determining disease severity and progression as well as in differential diagnosis. Treatments for diverticular disease include dietary fibre, pharmacological treatments such as antibiotics (rifaximin), anti-inflammatory drugs (mesalazine) and probiotics, alone or in combination, and eventually surgery. Despite being effective in treating primary disease, their effectiveness in primary and secondary prevention of complications is still uncertain.

Colonic diverticular disease.

Colonic diverticular disease.

LAPAROSCOPIC PERITONEAL LAVAGE IN TREATMENT OF PURULENT AND FECAL PERITONITIS AS COMPLICATIONS OF THE COLONIC DIVERTICULAR DISEASE

Summary. The incidence of diverticular colon disease has increased significantly. Complications are found in 40-42 % of patients, the frequency of perforation of the diverticulum is about 3.3 %.
 Materials and methods. The article presents the results of the treatment of 129 patients who were operated on for peritonitis complicated forms of diverticular colon disease .
 Research results. The study found that surgical treatment of patients with complication in the Hinchey III-IV stage is best performed by the method of laparoscopic peritoneal lavage.
 Discussion of research results. The laparoscopic approach has demonstrated a number of advantages: a smaller wound size, a shorter period of disability, an early recovery of enteral nutrition, and a shorter hospital stay.
 Conclusions. Performing laparoscopic peritoneal lavage in patients with perforated diverticulitis complicated by purulent peritonitis is an alternative to Hartmann surgery or bowel resection with primary anastomosis.

Colon Cancer and Diverticular Disease Association: a Case-Control Study.

To determine if there is an association between diverticular disease and colon cancer diagnoses with a secondary outcome of assessing other known risk factors for colon cancer. Colon cancer and diverticular disease have many shared symptoms and risk factors; the association between the two has been debated for many years. 36 cases of colon cancer and 144 age- and sex-matched controls were identified from records at an outpatient endoscopy center in Georgia. These cases and controls then were subject to a retrospective chart review to obtain any known risk factor data points for both diverticular disease and colon cancer. A traditional conditional logistic regression and a stepwise conditional logistic regression model were used to analyze the data using significant data points (P < 0.05). The final stepwise model found that systolic blood pressure (aOR = 1.027, 95% CI = 1.001 to 1.053), history of polyps (aOR = 0.106, 95% CI = 0.029 to 0.387), exercise (aOR = 0.311, 95% CI = 0.029 to 0.387), and history of diverticular disease (aOR = 0.269, 95% CI = 0.091 to 0.795) were protective factors significantly associated with colon cancer. Presence and history of the removal of colorectal polyps, presence or history of diverticular disease, and exercise pose as protective factors against development of colon cancer.

Лапароскопія у лікуванні пацієнтів з ускладненою дивертикулярною хворобою товстої кишки

SummaryPurpose – to study the results of treatment of colon diverticular disease bylaparoscopy.Materials and methods. During 2004–2020 the treatment of 221 patients hospitalized inthe Department of Abdominal, Emergency Surgery and Coloproctology Clinic of the MilitaryMedical Clinical Center of the Southern Region of Odessa was analysed. Patients underwent263 surgeries for diverticular colon disease (DCD) and its complications. There were 118 men(53.4%) and 103 women (46.6%). Complicated forms of DCD were diagnosed in 186 (84.5%)patients. 164 (62.4%) operations were performed as an emergency, of which 102 (61.7%) wereperformed using video endoscopic equipment.Results and discussion. 49 patients were treated in 2 stages. At the first stage,during the hospitalization of patients with urgent indications with a clinical picture ofacute abdomen, radical surgery was not performed. The purpose of this stage was tosave live and stabilize the patient’s condition. Preference was given to minimallyinvasive operations (diagnostic laparoscopy, laparoscopic peritoneal lavage,sigmostomy). In the second stage, radical interventions were performed in the intervalsfrom 9 days to 6 months after the first operation including left hemicolectomy orsigmoidectomy. In 19 patients, radical operations of the second stage were performedwithout discharge from the hospital after first stage treatment.Conclusions. 1. Surgical treatment of patients with complicated DCD is better tocarry out using video endoscopic equipment, as evidenced by the shorter duration of theoperation (73.4±6.2) minutes compared with open surgery – (118.4±7.3) minutes andless bed-day – (6.1± 0.7) days compared to open transactions – (11.3±1.2) days.2. Repeated planned radical operations on DCD is better to perform laparoscopically, as evidenced by fewer complications (6.7% compared to open operations –10.1%)3. Two-stage treatment of complicated DCD is considered the best approach if thesecond stage (left hemicolectomy) is performed routinely within 10 days to 6 monthsafter surgery for urgent indications.

Possible increased risk of colonic diverticular disease from alcohol intoxication or abuse.

Alcohol consumption has been suggested as a potential risk factor for diverticular diseases. This study investigated the association between alcohol intoxication or abuse and colonic diverticular disease (CDD).Using the National Health Insurance Research Database of Taiwan from January 1, 2000, to December 31, 2008, 51, 866 subjects newly diagnosed with alcohol intoxication were enrolled in this study as the alcohol intoxication cohort. The control (nonalcohol intoxication) cohort was frequency-matched 1:4 by age, sex and index year. Data were analyzed using a Cox proportional hazards model.The overall incidence of CDD (per 10,000 person-years) for the alcohol intoxication and control cohorts was 16.4 and 3.46, respectively. Compared with patients in the control cohort (95% confidence interval [CI] = 2.76–3.74), those with alcohol intoxication exhibited a 3.21-fold risk of CDD; the risk was particularly higher in male patients (adjusted hazard ratio [aHR] = 3.19, 95% CI = 2.72–3.74) and in those aged <45 years (aHR = 4.95, 95% CI = 3.91–6.27). The alcohol intoxication still had higher risk of CDD than nonalcohol intoxication, regardless of subjects without comorbidity (aHR = 3.38, 95% CI = 2.77–4.11) or with (aHR = 2.85, 95% CI = 2.25–3.61).There was a significant relationship between alcohol intoxication or abuse and CDD.

Ultrasound diagnosis of chronic paracolic inflammatory mass in diverticular disease

To evaluate the feasibility of ultrasound in diagnosis of chronic paracolic inflammatory mass in patients with diverticular disease. We analyzed ultrasonic findings in 216 patients with chronic inflammatory complications of colonic diverticular disease. Chronic paracolic inflammatory mass as the most common and significant chronic complication of diverticular disease was analyzed in 116 patients. Ultrasonic findings were compared with specimen assessment, intraoperative data, irrigoscopy, colonoscopy, endoscopic ultrasound and computed tomography data. Sensitivity of ultrasound for diagnosis of chronic paracolic inflammatory mass was 76,7%, specificity - 100%, overall accuracy - 87,5%. CT and endoscopic ultrasound were the most informative among different diagnostic tools (sensitivity 79,6% and 77,8%, respectively). Ultrasonic examination and computed tomography are the most valuable methods for diagnosis of chronic paracolic inflammatory mass in patients with diverticular disease. Ultrasound is a first-line method for diagnosis and follow-up of complicated diverticular disease due to its availability, safety and unnecessary special preparation of patients.

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

Introduction:diverticular disease (DD) was thought to be more prevalent in the western countries, especially the white populations, but the recent increase in incidence among African and Asian population, was reported. Up to our knowledge, there is no previous study of DD in Sudan.Methods:this is a descriptive cross-sectional study conducted at the department of endoscopy in four Sudanese hospitals in the period from October 2017 to February 2019. We included all patients who underwent colonoscopy during the study period. The main objective is to study the presentation and the anatomical pattern of diverticular disease among the Sudanese population.Results:prevalence of DD in the included population was 7.5% (104/1393). The mean age was 66.4 ± 12.5 years with the percentage of males in our study is 77.1% and females were 22.9%. Presenting complains were: abdominal pain in all patients, constipation in 78.8% and rectal bleeding in 57.7%. Regarding anatomical distribution: 63.5% have left colonic DD, 19.2% in the right colon and 17.3% involving the entire colon. There was a significant correlation between the left side DD and following clinical presentations: mucus per-rectum (p = 0.015) and weight loss (p = 0.048). Other endoscopic findings of significance were internal pile in 21.2% and colo-rectal polyp in 15.4%.Conclusion:the prevalence of DD in the included population, is 7.5% which is consistent with recent literature from the Middle East, Africa and Asia but still less than the prevalence in the western countries and left side colon is predominantly affected.

Prevalence and Distribution of Colonic Diverticular Disease from Ordu in Turkey

Objective: Diverticulosis of the colon is the most frequent anatomical alteration diagnosed at colonoscopy. Most cases of diverticulosis in Western countries involve left side of the colon, while diverticulosis is predominantly present on the right side of the colon in Asian countries. With the aim of this study is to contribute to epidemiologic studies on colonic diverticula in Turkey located in Europe and Asian continent. We analyzed the data of patients undergoing colonoscopy with regard to age, gender, anatomic localization of diverticula retrospectively in the Ordu State Hospital in the Black Sea region.Methods: We retrospectively reviewed a consecutive series of patients with regard to age, gender, location of diverticula and other colonoscopic lesions from an electronic endoscopic database who had undergone colonoscopy at the endoscopy unit of the Ordu State Hospital between 2016 and 2018. If diverticula were observed that distribution type was defined as cecum, ascending colon, transverse colon, descending colon, entire colon and sigmoid colon. In addition, we recorded that the additional diagnoses established in colonoscopic evaluations.Results: We screened 2626 female (51.1%) and 2511 male (48.9%); totally 5137 patients from an electronic endoscopic database who had undergone colonoscopy. 227 (47.4%) female, 252 (52.6%) male, a total of 479 patients who had diverticulosis were included in this study. The mean age was determined female and male 65.44±12.01 (min 31-max 91), 64.91±10.97 (min 27-max 89) respectively and no statistically significant difference between two groups (p&amp;gt;0.05). A total of 479 patients who had diverticulosis were divided into two groups: age ≤ 50 (10.4%) and 50&amp;gt; 429 (89.6%). No significant difference was found with regard to diverticulosis localization between two groups (p&amp;gt;0.05). The other colonoscopic diagnoses are as follows; hemorrhoid (40.7%), polyp (40.2%), inflammatory bowel disease (4.7%) colorectal cancer (0.9%), angiodysplasia (2.3%), ulcer (0.9%), anal fissure (1.9%), parasitosis (1.9%), terminal ileitis (0.5%), nonspecific colitis (3.7%), bowel surgery (1.9%) and submucosal lesion (0.5%). Conclusion: Diverticular disease is a worldwide condition that affect elderly people with an increasing incidence in younger patients as well as in developing countries that have started adopting Western diets. So that in the future diverticular disease will induce a significant economic burden in terms of healthcare cost in Turkey. Despite its prevalence, its pathophysiology still remains poorly understood. There is a significant need for more studies to improve our understanding about diverticular disease.

Diverticular disease of colon. Unresolved issues

Diverticular disease of the colon is one of the common diseases of the intestine, which is caused by the formation of bag-shaped diverticula in the wall of the colon. The article discusses the clinic, diagnosis, treatment of various clinical forms of diverticular disease. A review of clinical trials of the efficacy of the nonabsorbable antibiotic Rifaximin-alpha is presented. The concept of a microbiome and its functions is given. The article substantiates the appointment of dietary fiber for diverticular disease.

Долгосрочная эффективность рифаксимина в лечении симптоматической неосложненной дивертикулярной болезни толстой кишки

Долгосрочная эффективность рифаксимина в лечении симптоматической неосложненной дивертикулярной болезни толстой кишки

One - stage laparoscopic treatment of chronic inflammatory complications of diverticular colon disease

Introduction. Diverticulosis of the colon is one of the most common diseases of the intestine. In recent years, there has been an increasing tendency for diverticular disease (DD) to manifest itself at earlier age, as well as to the more frequent development of complications in young and middle - aged people. Most interventions for planned surgical treatment of DD complications are performed by two - stage access for laparotomy. One - stage laparoscopic intervention is a relatively new approach to treatment. Case report. 40-year - old man was hospitalized in the surgical department with complaints of air release during urination and aching pain in the lower part of abdomen. Outpatient examination excluded the pathology of the prostate gland and revealed infiltration between the urinary bladder and sigmoid colon. A complex examination, including cystoscopy, colonoscopy, multispiral computed tomography with contrast, showed the presence of chronic paracolic infiltration and blad - derntestinal fistula, which complicated the latent course of colon DD. Laparoscopic opening the abscess, resection of the sigmoid colon, the formation of descendo - rectal anastomosis was performed in one - step. Intra - and postoperative complications were not observed, dynamic observation and control examination after 6 months showed no symptoms. Discussion. One - stage laparoscopic surgery in the treatment of chronic inflammatory complications of colon DD is currently available procedure, which allows in a short time to relieve patients from symptoms and has good immediate and long - term results. The condition for the use of this technique is a sufficient experience of laparoscopic surgery of the abdominal cavity, retroperitoneal space and pelvis.

Cyclic rifaximin and soluble dietary fiber therapy for symptomatic diverticular disease: effective prevention of complications

The article discusses the current issues of managing patients with colonic diverticular disease. The prevalence of pathology is steadily increasing, which is due to the more frequent diagnosis of the disease and the increase in life expectancy of the population. Meanwhile, the wrong approaches to the management of this category of patients can result in the development of serious complications that often result in fatal outcomes. The paper presents data on the efficacy of rifaximin therapy of colonic diverticular disease, including using cyclic courses that significantly reduce the risk of complications. Particular attention is paid to the role of dietary fiber in the prevention of the inflammation development in the diverticular disease, including dietary fiber combined with rifaximin.

IBS-like manifestations in large intestine diverticular disease

The article is devoted to the diverticular colon disease, its uncomplicated form, the connection with age. Symptoms allowing to define presence at this form of disease of IBS-like symptoms – pains and infringements of the psycho-emotional status are highlighted. The results of psychometric research and psychiatrist’s consultation of 102 patients are presented. The role of obesity in the genesis of diverticular disease is highlighted. The significance of spasmolytic therapy, in particular mebeverine, is presented.