A cross sectional study of colonic diverticulosis in the London Bangladeshi population

Abstract

Background: Diverticular disease is the most common morphological abnormality of the colon and the fifth most important gastrointestinal disease in terms of cost in the Western world. Tower Hamlets is the poorest borough in London containing a large Bangladeshi community. We observed that emergency admissions with complications of colonic diverticulosis were minimal in the Bangladeshi community. The objective was to compare the background prevalence of colonic diverticulosis in Bangladeshis with other ethnicities in patients undergoing colonoscopy at a single centre in Tower Hamlets. Methods: Four thousand four hundred and fifty-four consecutive colonoscopy reports over a 2-year period were retrospectively analysed. Patients under 40 years of age and repeat colonoscopies were excluded, leaving 3151 patients (mean age: 63 years; 48% male). Demographics including ethnicity and medical background were retrieved from the electronic patient record system and findings correlated with the prevalence of other 'Western' diseases in the cohort. Results: Six hundred and thirty out of 3151 (20%) colonoscopies were performed on Bangladeshis. The prevalence of colonic diverticulosis was significantly lower in Bangladeshis (17/630: 2.7%) than Caucasians (673/1869: 36%), Indians/Pakistanis (16/161: 9.9%), Oriental (15/44: 34%) and Black (90/369: 24.4%) patient groups ( 2 p < 0.0001 for all comparisons). The prevalence of classical sigmoid diverticulosis in the Bangladeshi cohort was only 1.0%, despite significantly more Bangladeshi patients undergoing colonoscopy for abdominal pain (p < 0.0001, 2 ) and diarrhoea (p < 0.0034, 2 ). There was also a significantly greater incidence of type 2 diabetes mellitus and ischaemic heart disease (p < 0.0001, 2 ) in Bangladeshi patients. Conclusions: There is a negligible prevalence of colonic diverticulosis in the Bangladeshi population of London who undergo colonoscopy. This is in spite of a high incidence of type 2 diabetes and ischaemic heart disease. The effect of diet and genetics on the prevalence of colonic diverticulosis in Bangladeshis is not known and merits further investigation.

Ethnic variations in five lower gastrointestinal diseases: Scottish Health and Ethnicity Linkage Study

“…There was an exceptionally low rate of disease in Bangladeshis in Tower Hamlets in London, despite the evidence of a high sugar, low fibre diet (and high rates of diabetes and heart disease) leading researchers to question the validity of the fibre hypothesis. 11 …”

“…We found lower risk in Indian, Pakistani and Chinese groups, in alignment with previous publications. 10 11 17 Diverticulitis was also rare in Turkish immigrants in the Netherlands 36 and less common in non-Western immigrants in Sweden, though risks increased after settlement. 17 In a Malaysian clinic based case series of 410 patients, diverticula were more common in Chinese (15%) than Indians (9%), but this was not so in our data.…”

Atypical Presentation of Colonic Diverticular Disease

“…Although diverticular disease is principally a condition that has become widespread in the 20th and 21st centuries, Fleischmancoined the term, divertikel in 1815 &Klebs in 1869 1st realized that diverticula are acquired and thought to be caused by constipation 11 .…”

“…It has been found to have a close relationship between the incidence and economic development of a country. The increasing incidence has been noticeable since the 20th century 11 . Although a cross sectional study shows the prevalence of colonic diverticulosis was significantly lower in Bangladeshis compared with other ethnic groups 12 , but as a result of developing industrialization here, it currently has an intermediate incidence rate.…”

Pathophysiology of Diverticular Disease: From Diverticula Formation to Symptom Generation

“…The Japanese population living in Hawaii shows the canonical predominance of right-sided diverticula, although adopting a Westernized diet [ 15 ]. A study carried out on the London Bangladeshi population displayed a very low prevalence of colonic diverticulosis in this ethnic group (2.7%), compared to Caucasian (36%), Indian/Pakistani (10%), Oriental (34.9%), and Black (24.4%) individuals living in the same region [ 16 ]. A similar observation, corroborating the contribution of genetic factors to DD pathophysiology, emerges by comparing the incidence of diverticulosis in Turkish migrants in the Netherlands (7.5%) with the native Dutch population (50%) [ 17 ].…”