Colonic wall changes in patients with diverticular disease – Is there a predisposition for a complicated course?

Ulmer, Tom Florian; Rösch, R.; Mossdorf, Anne; Alizai, H. P.; Binnebösel, Marcel; Neumann, UP

doi:10.1016/j.ijsu.2014.03.014

Cited by 15 publications

(14 citation statements)

References 41 publications

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“…The augmented cell proliferation in the intestinal crypts of cachectic patients, compared with the colon of weight stable cancer patients, suggests an attempt to repair the mucosa, injured by local inflammation, similarly to what occurs in colonic diverticulitis …”

Section: Discussionmentioning

confidence: 99%

“…27 The augmented cell proliferation in the intestinal crypts of cachectic patients, compared with the colon of weight stable cancer patients, suggests an attempt to repair the mucosa, injured by local inflammation, similarly to what occurs in colonic diverticulitis. 28 The differentiation of epithelial cells is also affected during chronic colitis, as atrophy of the mucous glands and mucin depletion have been suggested as diagnostic markers for UC. 29 The epithelium responds to crypt epithelial damage during inflammation, especially with increased proliferation, in detriment of cell differentiation.…”

Section: Discussionmentioning

confidence: 99%

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Cancer cachexia induces morphological and inflammatory changes in the intestinal mucosa

Costa

Paula

Matos-Neto

et al. 2019

J cachexia sarcopenia muscle

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BackgroundCachexia is a multifactorial and multiorgan syndrome associated with cancer and other chronic diseases and characterized by severe involuntary body weight loss, disrupted metabolism, inflammation, anorexia, fatigue, and diminished quality of life. This syndrome affects around 50% of patients with colon cancer and is directly responsible for the death of at least 20% of all cancer patients. Systemic inflammation has been recently proposed to underline most of cachexia‐related symptoms. Nevertheless, the exact mechanisms leading to the initiation of systemic inflammation have not yet been unveiled, as patients bearing the same tumour and disease stage may or may not present cachexia. We hypothesize a role for gut barrier disruption, which may elicit persistent immune activation in the host. To address this hypothesis, we analysed the healthy colon tissue, adjacent to the tumour.MethodsBlood and rectosigmoid colon samples (20 cm distal to tumour margin) obtained during surgery, from cachectic (CC = 25) or weight stable (WSC = 20) colon cancer patients, who signed the informed consent form, were submitted to morphological (light microscopy), immunological (immunohistochemistry and flow cytometry), and molecular (quantification of inflammatory factors by Luminex® xMAP) analyses.ResultsThere was no statistical difference in gender and age between groups. The content of plasma interleukin 6 (IL‐6) and IL‐8 was augmented in cachectic patients relative to those with stable weight (P = 0.047 and P = 0.009, respectively). The number of lymphocytic aggregates/field in the gut mucosa was higher in CC than in WSC (P = 0.019), in addition to those of the lamina propria (LP) eosinophils (P < 0.001) and fibroblasts (P < 0.001). The area occupied by goblet cells in the colon mucosa was decreased in CC (P = 0.016). The M1M2 macrophages percentage was increased in the colon of CC, in relation to WSC (P = 0.042). Protein expression of IL‐7, IL‐13, and transforming growth factor beta 3 in the colon was significantly increased in CC, compared with WSC (P = 0.02, P = 0.048, and P = 0.048, respectively), and a trend towards a higher content of granulocyte‐colony stimulating factor in CC was also observed (P = 0.061). The results suggest an increased recruitment of immune cells to the colonic mucosa in CC, as compared with WSC, in a fashion that resembles repair response following injury, with higher tissue content of IL‐13 and transforming growth factor beta 3.ConclusionsThe changes in the intestinal mucosa cellularity, along with modified cytokine expression in cachexia, indicate that gut barrier alterations are associated with the syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cancer cachexia induces morphological and inflammatory changes in the intestinal mucosa

Costa

Paula

Matos-Neto

et al. 2019

J cachexia sarcopenia muscle

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“…Despite the significant burden of the pathology, the pathogenesis is poorly understood and several etiological factors may play a role in the onset of this disease. 5–7…”

Section: Introductionmentioning

confidence: 99%

“…8 Moreover, various studies pointed out the role of the enteric nervous system (ENS) in the pathophysiology of DD. 7…”

Section: Introductionmentioning

confidence: 99%

Bacterial stimuli activate nitric oxide colonic mucosal production in diverticular disease. Protective effects of L. casei DG ® (Lactobacillus paracasei CNCM I‐1572)

et al. 2017

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Background: Micro-inflammation and changes in gut microbiota may play a role in the pathogenesis of diverticular disease (DD). Objective: The objective of this article is to evaluate the expression of nitric oxide (NO)-related mediators and S100B in colonic mucosa of patients with DD in an ex vivo model of bacterial infection. Methods: Intestinal biopsies obtained from patients with diverticulosis, symptomatic uncomplicated diverticular disease (SUDD) and SUDD with previous acute diverticulitis (SUDDþAD) were stimulated with the probiotic L. casei DG Õ (LCDG) and/ or the pathogen enteroinvasive Escherichia coli (EIEC). S100B, NO release and iNOS expression were then evaluated. Results: Basal iNOS expression was significantly increased in SUDD and SUDDþAD patients. Basal NO expression was significantly increased in SUDDþAD. No differences in S100B release were found. In all groups, iNOS expression was significantly increased by EIEC and reduced by LCDG. In all groups, except for SUDDþAD, EIEC significantly increased NO release, whereas no increase was observed when LCDG was added to biopsies. EIEC did not induce significant changes in S100B release. Conclusions: Colonic mucosa of patients with DD is characterized by a different reactivity toward pathogenic stimuli. LCDG plays a role in counteracting the pro-inflammatory effects exerted by EIEC, suggesting a beneficial role of this probiotic in DD.

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“…This is also due to the fact that it is often possible to have available full-thickness samples of colonic tissue from CDD patients, since the number of surgical procedures performed on these patients worldwide is still consistent. 6 Concerning the pathophysiologic basis of the disease, there is evidence that CDD patients often display abnormalities in colonic neuromuscular function; 5 with dysfunction involving elastosis of the taeniae coli, 7 the collagen content of the viscus' wall, 8 the neurotransmitter and neurotrophic system, 9,10 the muscular component [11][12][13] and the enteric nervous system (ENS). [14][15][16] All these abnormalities probably act in a synergistic manner to cause at least some of the symptoms that are related to the colonic motor dysfunction often observed in these patients.…”

Section: Introductionmentioning

confidence: 99%

Myenteric plexitis: A frequent feature in patients undergoing surgery for colonic diverticular disease

et al. 2015

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Background: Diverticular disease of the colon is frequent in clinical practice, and a large number of patients each year undergo surgical procedures worldwide for their symptoms. Thus, there is a need for better knowledge of the basic pathophysiologic mechanisms of this disease entity. Objectives: Because patients with colonic diverticular disease have been shown to display abnormalities of the enteric nervous system, we assessed the frequency of myenteric plexitis (i.e. the infiltration of myenteric ganglions by inflammatory cells) in patients undergoing surgery for this condition. Methods: We analyzed archival resection samples from the proximal resection margins of 165 patients undergoing left hemicolectomy (60 emergency and 105 elective surgeries) for colonic diverticulitis, by histology and immunochemistry. Results: Overall, plexitis was present in almost 40% of patients. It was subdivided into an eosinophilic (48%) and a lymphocytic (52%) subtype. Plexitis was more frequent in younger patients; and it was more frequent in those undergoing emergency surgery (50%), compared to elective (28%) surgery (p ¼ 0.007). All the severe cases of plexitis displayed the lymphocytic subtype. Conclusions: In conclusion, myenteric plexitis is frequent in patients with colonic diverticular disease needing surgery, and it might be implicated in the pathogenesis of the disease.

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Colonic wall changes in patients with diverticular disease – Is there a predisposition for a complicated course?

Cited by 15 publications

References 41 publications

Cancer cachexia induces morphological and inflammatory changes in the intestinal mucosa

Cancer cachexia induces morphological and inflammatory changes in the intestinal mucosa

Bacterial stimuli activate nitric oxide colonic mucosal production in diverticular disease. Protective effects of L. casei DG ® (Lactobacillus paracasei CNCM I‐1572)

Myenteric plexitis: A frequent feature in patients undergoing surgery for colonic diverticular disease

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