Risk Factors For Diverticulosis Research Articles

Sit or Squat? Toilet Type Is a Determinant of Diverticulosis Development.

Diverticulosis coli is a common disorder of the colon, and a luminal pressure increase in the colon is a proposed mechanism in disease pathogenesis. Toilet types used around the world can be fundamentally categorized into 2 categories: sitting toilets and squatting toilets. Squatting toilets are shown to lead to better puborectalis muscle relaxation, wider anorectal angle, and require less straining compared to sitting toilets. Stemming from this knowledge, we hypothesized that toilet type would play a role in the complex pathogenesis of diverticulosis and that squatting toilets would lower the risk of diverticula formation. This study was conducted at Antalya Training and Research Hospital between January 2023 and July 2023. A 1-page questionnaire consisting of demographic data and bowel habits as well as diverticulosis-related parameters was prepared to gather the study data. Colonoscopy results were matched with corresponding questionnaires. The study population consisted of 929 patients. Advanced age was found to be a risk factor for diverticulosis. Sitting toilet was also found to be a risk factor for diverticulosis in multivariate logistic regression analysis with an odds ratio of 3.36 (95% CI: 1.684-6.705) (P = .001). The results of this study revealed that toilet type is a determining factor in diverticulosis development, as was hypothesized during the conceptualization of the study. Revealing the potential contribution of the toilet type used to the development of a relatively common and impactful disorder like diverticulosis will lay the bedrock for future studies on the topic.

Prevalence of and Risk Factors for Incidental Colonic Diverticulosis

IntroductionThe true prevalence and pathogenesis of diverticulosis is poorly understood. Risk factors for diverticulosis are presently unclear, with most clinicians attributing its development to years of chronic constipation. Previous studies have been limited by their failure to include young, ethnically diverse patient populations. MethodsPatients who presented to the emergency department of our hospital from January-September 2019 and underwent abdominal computerized tomography (CT) scan for the evaluation of appendicitis were included. CT's were reviewed for the presence of diverticulosis. Risk factors for diverticulosis were determined for two age groups: >40 and ≤ 40. ResultsA total of 359 patients were included in the study. The median age was 38.57.1% were male. 81.6% were Hispanic. 43.5% had colonic diverticulosis on CT. 198 patients (55.1%) were ≤ age 40. The rate of diverticulosis in this group was 35.3% (n = 70). Those with diverticulosis were not significantly older (median age 29 versus 27, P = 0.061) but had a higher median body mass index (BMI) (28.4 versus 25.3, P = 0.003) compared to those without diverticulosis. On multivariate analysis, no characteristics were associated with the presence of diverticulosis for this group. Over age 40, 53.4% of patients (n = 86) had diverticulosis. Patients with diverticulosis were more likely to be Hispanic (95.3% versus 73.3%, P ≤ 0.001), less likely to be Asian (2.4% versus 16.0%, P = 0.004), had a higher median BMI (28.7 versus 25.5, P ≤ 0.001), and were more likely to use alcohol (30.2% versus 14.7%, P = 0.024) than those without diverticulosis. On multivariate analysis, characteristics associated with the presence of diverticulosis were BMI >30 (odds ratio OR 2.22, 95% confidence interval CI 1.03-4.80), Hispanic ethnicity (OR 10.05, 95% CI 1.74-58.26), and alcohol use (OR 3.44, 95% CI 1.26-9.39). ConclusionsThere was a higher rate of asymptomatic diverticulosis in the <40 cohort than previously reported in the literature. Obesity, alcohol use, and Hispanic ethnicity were associated with the presence of diverticulosis in patients > age 40, but no risk factors for diverticulosis were identified for patients ≤ age 40, suggesting that diverticular pathogenesis may differ by age. Constipation was not a risk factor for diverticulosis in either age group. The data regarding the prevalence of diverticulosis in Hispanic patients is lacking and should be the focus of future inquiry.

Genetic variants of tissue inhibitors of matrix metalloproteinase 1 (rs4898) and 2 (rs8179090) in diverticulosis.

Diverticulosis affects approximately 60% of population after 60th year of age. Diverticular disease is symptomatic diverticulosis characterized by abdominal pain, flatulence and bloating, and bowel habits change. Age and lifestyle are risk factors for diverticulosis, additionally genetic predisposition is postulated. The aim of the study was to assess whether tissue inhibitors of matrix metalloproteinase (TIMP) 1 rs4898 and TIMP2 rs8179090 genetic variants are related to colonic diverticulosis. The study included 220 patients, 100 with colon diverticulosis diagnosed on colonoscopy and 120 controls. TIMP1 rs4898 and TIMP2 rs8179090 variants were examined using PCR-restriction fragments length polymorphism from a blood sample. Allele T of TIMP1 rs4898 was more frequent in male patients with diverticulosis than in controls (P < 0.01), whereas in women there were no differences in its distribution, both in heterozygotes and homozygotes or in homozygotes separately, proving a recessive effect. TIMP2 s8179090 allele G frequency was 0.95 in cases and controls, there were no CC homozygotes identified, and no associations with diverticulosis showed. TIMP1 rs4898 allele T may be a genetic determinant of the risk of diverticulosis in men.

Frequency of Bowel Movements and Risk of Diverticulitis

The etiology of diverticulitis is poorly understood. The long-held belief that constipation and low-fiber diet are risk factors for diverticulosis has recently been challenged by studies that suggest that more frequent bowel movements predispose to diverticulosis. We aim to prospectively explore the association between bowel movement frequency and incident diverticulitis. We studied participants of the Nurses' Health Study (NHS) and Health Professional Follow-up Study (HPFS). Participants' medical history, lifestyle factors and diet were used in Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios(HRs) and 95% confidence intervals(CI). In the NHS during over 24 years of follow-up encompassing 1,299,922 person-years, we documented 5,214 incident cases of diverticulitis, and in the HPFS over 14 years encompassing 368,661 person-years of follow-up, we documented 390 incident cases of diverticulitis. We observed an inverse association between the frequency of bowel movements and risk of diverticulitis. In the NHS, compared with women who had daily bowel movements, those with more than once daily bowel movements had a HR of 1.30 (95% CI, 1.19, 1.42) and those with less frequent bowel movements had a HR of 0.89 (95% CI, 0.82, 0.95; p-trend<0.0001). In the HPFS, the corresponding HRs were 1.29 (95% CI, 1.04, 1.59) and 0.61 (95% CI, 0.36, 1.03; p-trend=0.003). The association between bowel movements and diverticulitis was not modified by categories of age, BMI, physical activity, laxative use or fiber intake. More frequent bowel movements appear to be a risk factor for subsequent diverticulitis both in men and women. Further studies are needed to understand the potential mechanisms that may underlie this association.

Hypertension control and risk of colonic diverticulosis.

Background:The prevalence of diverticulosis has increased in our aging population, but the risk factors for diverticulosis are not fully understood. The role of hypertension in the risk of diverticulosis remains uncertain. This study investigated whether hypertension is associated with asymptomatic colorectal diverticulosis.Methods:This study enrolled asymptomatic patients who received a colonoscopy as part of a health check. Hypertension was defined by actual measured blood pressure. Logistic regression models were used to examine the relationship between hypertension and diverticulosis. In addition, we established three logistic regression models for covariate adjustment, and further stratified patients with hypertension into three subgroups based on their type of hypertension.Results:The study group consisted of 2748 participants, including 141 participants with diverticulosis and 2607 participants without diverticulosis. After adjustments for potential covariates, the odds ratio (OR) for having diverticulosis was 1.83 (95% confidence interval, 1.21–2.75, p = 0.004) in the hypertension group compared with the group without hypertension. In subgroup analyses, hypertension without antihypertensive medication use, and hypertension despite the use of antihypertensive medication were also significantly associated with the occurrence of asymptomatic diverticulosis (OR = 1.73, p = 0.028; OR = 2.07, p = 0.013, respectively). Current normal blood pressure under antihypertensive drug therapy was not associated with diverticulosis (OR = 1.74, p = 0.092).Conclusions:Our findings suggest a positive association between hypertension and diverticulosis. Participants with poorly controlled blood pressure were found to have a higher risk of asymptomatic diverticulosis. Our study presents epidemiologic evidence for future prevention strategies against diverticulosis.

Prevalence of colonic diverticulosis in mainland China from 2004 to 2014.

The aim of this study was to determine the prevalence of colonic diverticulosis in mainland China. Sixty two thousand and thirty-four colonoscopies performed between Jan 2004 and Dec 2014 were reviewed retrospectively. The overall diverticulosis prevalence was 1.97% and out of this, 85.3% was right-sided. Prevalence does not change, significantly, on trends between the period 2004–2014. The peak of prevalence of diverticulosis was compared between the female group aged >70 years to the male one of 41–50 years. The other peak, otherwise, was compared between the group of 51–60 years with the right-sided diverticulosis to the one of >70 years with left-sided disease. Multivariate analysis suggested that the male gender could be a risk factor for diverticulosis in the group aged ≤70 years, but not for the older patients. In addition, among men was registered an increased risk factor for right-sided diverticulosis and, at the same time, a protective one for left-sided localization. In conclusion, the prevalence of colonic diverticulosis is very low in mainland China and it does not change significantly on trends over the time. Both the prevalence of this condition and its distribution changes according to the age and the genders. These findings may lead the researchers to investigate the mechanisms causing this kind of disease and its distribution in regard of the age and the gender.

Mo1870 Measuring Anti-Vinculin and Anti-CdtB Antibodies in Two Animal Models of Post-Infectious IBS

Diverticulosis is a common GI condition among older adults in the United States. However, limited information exists on the etiologic risk factors for diverticulosis. We hypothesized that the gut microbiome and chronic inflammation contribute to the development of diverticulosis.We evaluated the association between gut bacteria, mucosal inflammation and diverticulosis in a case-control study. Methods:Participants (n=196) were consented patients who underwent screening colonoscopy at UNC Hospitals. Subjects were classified as case if diverticula were present or control if no diverticula were present. The abundance of specific bacteria in the sigmoid mucosa was determined by qPCR based on the bacterial 16s rRNA gene for Bacteroides, Bifidobacterium, Clostridium, E. coli, Lactobacillus, and Eubacteria.Mucosal mRNA gene expression of cytokines of IL-6, IL-10, IL-17, and TNF-α and housekeeping gene HMBS were assessed by qRT-PCR. Immune cells in the lamina propria were stained for CD4, CD8, CD57 and Mast cell tryptase (MCT) by immunohistochemistry (IHC). The IHC stained sections were digitally imaged using the Aperio ScanScope XT. Analysis of biomarkers was performed using Definiens Tissue Studio software with the Composer_ Nuclei_and_Simulated_Cells algorithm. The percent cells with strong (+3), medium (+2) and weak (+1) positive signal, was used to compare biomarker levels among tissue samples. Statistical analysis included t-test and logistic regression to compare cases and controls as well as Spearman correlation to assess association between bacteria and inflammation. Results:We observed a higher relative abundance of Clostridium, Bacteroides, Bifidobacterium, E. coli, and Eubacteria in cases compared to controls. Cases had lower density of CD8 compared to controls. Although the cytokine gene expression levels of IL-6, IL-10, IL-17, and TNF-α did not differ between cases and controls, there was a significant positive correlation between CD57 expression and IL-6 (r=0.23, p=0.03), CD57 and TNFα (r0.33, p=0.001) and CD57 and IL-10 (r=0.22, p= 0.03) among cases. The association between bacterial abundance and immune cell density also varied depending on case-control status. Among cases, MCT expression showed positive correlations with Bacteroides (r=0.21, p= 0.05), Clostridium (r=0.18, p=0.08) and inverse correlation with Bifidobacteria (r=-0.26, p= 0.01). Among controls, CD57 expression was inversely correlated with Lactobacillus (r=0.19, p=0.06). Conclusions: Our findings suggest that gut bacteria and inflammation are associated with diverticulosis. This data combined with further research could have clinical implications for the prevention and treatment of diverticulosis.

Mo1869 Gut Bacteria and Inflammation Are Associated With Diverticulosis

Diverticulosis is a common GI condition among older adults in the United States. However, limited information exists on the etiologic risk factors for diverticulosis. We hypothesized that the gut microbiome and chronic inflammation contribute to the development of diverticulosis.We evaluated the association between gut bacteria, mucosal inflammation and diverticulosis in a case-control study. Methods:Participants (n=196) were consented patients who underwent screening colonoscopy at UNC Hospitals. Subjects were classified as case if diverticula were present or control if no diverticula were present. The abundance of specific bacteria in the sigmoid mucosa was determined by qPCR based on the bacterial 16s rRNA gene for Bacteroides, Bifidobacterium, Clostridium, E. coli, Lactobacillus, and Eubacteria.Mucosal mRNA gene expression of cytokines of IL-6, IL-10, IL-17, and TNF-α and housekeeping gene HMBS were assessed by qRT-PCR. Immune cells in the lamina propria were stained for CD4, CD8, CD57 and Mast cell tryptase (MCT) by immunohistochemistry (IHC). The IHC stained sections were digitally imaged using the Aperio ScanScope XT. Analysis of biomarkers was performed using Definiens Tissue Studio software with the Composer_ Nuclei_and_Simulated_Cells algorithm. The percent cells with strong (+3), medium (+2) and weak (+1) positive signal, was used to compare biomarker levels among tissue samples. Statistical analysis included t-test and logistic regression to compare cases and controls as well as Spearman correlation to assess association between bacteria and inflammation. Results:We observed a higher relative abundance of Clostridium, Bacteroides, Bifidobacterium, E. coli, and Eubacteria in cases compared to controls. Cases had lower density of CD8 compared to controls. Although the cytokine gene expression levels of IL-6, IL-10, IL-17, and TNF-α did not differ between cases and controls, there was a significant positive correlation between CD57 expression and IL-6 (r=0.23, p=0.03), CD57 and TNFα (r0.33, p=0.001) and CD57 and IL-10 (r=0.22, p= 0.03) among cases. The association between bacterial abundance and immune cell density also varied depending on case-control status. Among cases, MCT expression showed positive correlations with Bacteroides (r=0.21, p= 0.05), Clostridium (r=0.18, p=0.08) and inverse correlation with Bifidobacteria (r=-0.26, p= 0.01). Among controls, CD57 expression was inversely correlated with Lactobacillus (r=0.19, p=0.06). Conclusions: Our findings suggest that gut bacteria and inflammation are associated with diverticulosis. This data combined with further research could have clinical implications for the prevention and treatment of diverticulosis.

P-033 YI Patients With Ulcerative Colitis Do Not Have a Decreased Risk of Diverticulosis

Diverticulosis is common in patients after age 60, with a prevalence of up to 40%. Studies outside the United States (U.S.) have described a lower prevalence of diverticular disease in patients with inflammatory bowel disease (IBD) than in non-IBD. The aim of this study was to assess the prevalence and risk factors for diverticulosis in ulcerative colitis (UC) in a US tertiary center. We performed a retrospective review in patients over 50 years of age who underwent screening or surveillance colonoscopy from January 2006 to December 2013. Pathology was reviewed for all patients to eliminate cases of segmental colitis associated with diverticula (SCAD). We first assessed the prevalence of diverticulosis in UC patients compared to patients without IBD. Then we performed a nested case-control study comparing UC patients with diverticulosis (cases) to UC patients without diverticulosis (controls) to identify clinical predictors (disease extent or disease duration) of diverticulosis. Cases were matched 1:1 fashion based on age and gender. Cases were excluded if there was lack of data or a matched control. Statistical analysis included a Student’s t-test, Chi-squared test, relative risk (RR) and adjusted RR using logistic regression. We identified 573 UC patients and 16,695 patients without IBD who underwent colonoscopy. 25.1% of UC patients had diverticulosis, and 46.7% of non-IBD patients had diverticulosis, P < 0.01. UC patients were younger (61.1 years versus 62.8 years, P < 0.01) and less likely to be female (46.3% versus 59.4%, P < 0.01). On univariate analysis the RR of diverticulosis = 0.56 (95% CI, 0.49–0.64). On multivariate analysis adjusting for age and gender, RR of diverticulosis =1.03 (95% CI, 1.02–1.03). In the nested case-control study, 118 patients with UC with diverticulosis (cases) were matched to 118 patients with UC without diverticulosis (controls). The mean age of cases was 65.1 years (SD 8.9 year), and 42.3% were female, this was similar in the control group. The majority of diverticula were limited to the sigmoid/descending colon (68.6%). There were no differences between cases and controls in disease duration (16.7 year versus 18.7 year, P = 0.27) or extent of disease (pancolitis 50% versus 60.1%, P = 0.24). In this US-based study, UC patients had similar rates of diverticulosis as non-IBD patients undergoing screening or surveillance colonoscopy. There were no identified predictors for the development of diverticulosis in patients with UC. These results are different than previously reported data in IBD patients in other countries and may represent unique dietary factors that contribute to the development of diverticulosis.

Patients With Ulcerative Colitis Do not Have a Decreased Risk of Diverticulosis

Introduction: Diverticulosis is common in patients after age 60, with a prevalence of up to 40%. Studies outside the United States (U.S.) have described a lower prevalence of diverticular disease in patients with inflammatory bowel disease (IBD) than in non-IBD patients. The aim of this study was to assess the prevalence and risk factors for diverticulosis in ulcerative colitis (UC) in a U.S. tertiary center. Methods: We performed a retrospective review in patients over 50 years of age who underwent screening or surveillance colonoscopy from January 2006 to December 2013. Pathology was reviewed for all patients to eliminate cases of segmental colitis associated with diverticula (SCAD). We first assessed the prevalence of diverticulosis in UC patients compared to patients without IBD. Then we performed a nested case-control study comparing UC patients with diverticulosis (cases) to UC patients without diverticulosis (controls) to identify clinical predictors (disease extent or disease duration) of diverticulosis. Cases were matched 1:1 fashion based on age and gender. Cases were excluded if there was lack of data or a matched control. Statistical analysis included a Student’s t-test, chi-squared test, relative risk (RR) and adjusted RR using logistic regression. Results: We identified 573 UC patients and 16,695 patients without IBD who underwent colonoscopy. Of the patients, 25.1% of UC patients had diverticulosis, and 46.7% of non-IBD patients had diverticulosis, p<0.01. UC patients were younger (61.1 years vs. 62.8 years; p<0.01) and less likely to be female (46.3% vs. 59.4%; p<0.01). On univariate analysis the RR of diverticulosis= 0.56 (95% confidence interval [CI]: 0.49-0.64). On multivariate analysis adjusting for age and gender, RR of diverticulosis=1.03 (95% CI: 1.02-1.03). In the nested case-control study, 118 patients with UC with diverticulosis (cases) were matched to 118 patients with UC without diverticulosis (controls). The mean age of cases was 65.1 years (SD 8.9 years), and 42.3% were female, this was similar in the control group. The majority of diverticula were limited to the sigmoid/descending colon (68.6%). There were no differences between cases and controls in disease duration (16.7 years vs. 18.7 years; p=0.27) or extent of disease (pancolitis 50% vs. 60.1%; p=0.24). Conclusion: In this U.S.-based study, UC patients had similar rates of diverticulosis as non-IBD patients undergoing screening or surveillance colonoscopy. There were no identified predictors for the development of diverticulosis in patients with UC. These results are different than previously reported data in IBD patients in other countries and may represent unique dietary factors that contribute to the development of diverticulosis.

Covering the Cover

Covering the Cover

S1226 Risk Factors for Diverticulosis in the Era of Screening Colonoscopy

S1226 Risk Factors for Diverticulosis in the Era of Screening Colonoscopy