Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades.

Shepherd, N A

doi:10.1136/gut.38.6.801

Cited by 112 publications

(65 citation statements)

References 21 publications

(8 reference statements)

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“…Mesalazine is widely and effectively used for the treatment of IBD. Inflammation seems to play an important pathogenic role in diverticulitis, diverticular disease-associated chronic colitis and symptomatic uncomplicated diverticular disease [18,20,30] . Inflammation in such diseases seems to be generated by a heightened production of proinflammatory cytokines, reduction in anti-inflammatory cytokines, and enhanced intramucosal synthesis of nitric oxide.…”

Section: Therapymentioning

confidence: 99%

“…The use of mesalazine in the treatment of such diseases is advisable based on its anti-inflammatory properties, as it can reduce mucosal hyperemia, edema, erosion and other inflammatory signs observed near and often well away from the diverticular orifices themselves [18][19][20]30] . Several studies showed promising results of mesalazine in the prevention and treatment of symptoms in symptomatic uncomplicated disease [31][32][33][34] .…”

Section: Therapymentioning

confidence: 99%

“…Postulates include mucosal prolapse, relative ischemia, bacterial overgrowth, increased exposure to intraluminal toxins and antigens secondary to fecal stasis [19,20] . Some of these factors are similar to those implicated in the pathogenesis of inflammatory bowel disease (IBD) and this colitis may be considered a 'bridge' disease between classic IBD and diverticulitis [21] .…”

Section: Causes and Pathogenesismentioning

confidence: 99%

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Diverticular Disease in the Elderly

Comparato

Pilotto

Franzè

et al. 2007

Dig Dis

125

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There are few diseases whose incidence varies as greatly worldwide as that of diverticulosis. Its prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those ≧65 years of age. Of patients with diverticula, 80–85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15–20% of patients develop symptomatic diverticular disease. Traditional concepts regarding the causes of colonic diverticula include alterations in colonic wall resistance, disordered colonic motility and dietary fiber deficiency. Currently, inflammation has been proposed to play a role in diverticular disease. Goals of therapy in diverticular disease should include improvement of symptoms and prevention of recurrent attacks in symptomatic, uncomplicated diverticular disease, and prevention of the complications of disease such as diverticulitis. Diverticulitis is the most usual clinical complication of diverticular disease, affecting 10–25% of patients with diverticula. Most patients admitted with acute diverticulitis respond to conservative treatment, but 15–30% require surgery. Predictive factors for severe diverticulitis are sex, obesity, immunodeficiency and old age. Surgery for acute complications of diverticular disease of the sigmoid colon carries significant rates of morbidity and mortality, the latter of which occurs predominantly in cases of severe comorbidity. Postoperative mortality and morbidity are to a large extent driven by patient-related factors.

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Section: Therapymentioning

confidence: 99%

Section: Therapymentioning

confidence: 99%

Section: Causes and Pathogenesismentioning

confidence: 99%

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Diverticular Disease in the Elderly

Comparato

Pilotto

Franzè

et al. 2007

Dig Dis

125

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“…In addition to other pelvic disease and to infectious or inflammatory bowel disease, special forms of inflammatory or otherwise abnormal mucosa coexisting with diverticulosis must be considered, in order to avoid a too liberal ‘definition’ of diverticulitis, e.g. NSAID colitis, ischemia [7], diverticular colitis [8,9,10,11,12], mesenteric inflammatory veno-occlusive disease [13], coexistence of Crohn’s disease and diverticulosis or diverticulitis [14,15,16,17], and prolapsing mucosal folds in diverticular disease [18,19]. Not taking care for these differentiations makes it very difficult to compare patients, rationales and results from the literature.…”

Section: What Is Recurrent Diverticulitis?mentioning

confidence: 99%

The Gastroenterologist’s View

Lembcke¹

2012

Dig Dis

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The traditional view that recurrent episodes of diverticulitis lead to progressively complicated disease resulting in a disadvantageous course, more difficult, complicated operations and lethal outcomes did not stand the test of evidence. Only a minority of patients with acute diverticulitis will ever require surgery, and if so, this occurs during or early after the first episode. Complications and recurrence of disease after surgery are enumerable. Strong indicators favoring sigmoid colectomy are major abscess, free air, and fistula, i.e. perforating disease. This occurs predominantly at the initial presentation, frequently in younger or immunosuppressed patients. Important differential diagnoses must be considered both for initial diagnosis of diverticulitis and for recurrent episodes. Conservative management of recurrent diverticulitis is safe and best guided by gastroenterological expertise. Sophisticated ultrasound experience as a part of this competence allows detailed evaluation of the local status and the best evidence in the literature for diagnosing diverticulitis is on US. In practice, however, the question of perforating diverticulitis is adequately answered by subtle CT scan. Medical therapy is usually the treatment of choice for recurrent diverticulitis. Avoidance of drugs bearing the hazard of perforation (e.g. NSAIDs) is emphasized, and smoking is strongly discouraged. A mathematical model based on published data shows that patients with recurrent diverticulitis overall (only) profit from surgery if they are hit by four episodes during the course of disease. This is where theory and reality (should) meet.

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“…An inverse observation has been that removal of an inflamed but not uninflamed appendix under the age of 20 is significantly associated with protection against development of UC [13]. Diverticulitis may also be associated with colitis [14]but in this case the colitis is adjacent to the inflamed diverticula and is either UC-like or Crohn’s colitis-like (figure 1). …”

Section: Newer Associations Of Colitismentioning

confidence: 99%

Nitric Oxide Damage to Colonocytes in Colitis-by-Association: Remote Transfer of Nitric Oxide to the Colon

Roediger

2002

Digestion

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New observations of (1) colitis-by-association, (2) the carriage of nitric oxide by haemoglobin, (3) nitric oxide inactivation of CoA, (4) the damage caused to colonocytes by a combination of nitric oxide/sulphide/hydrogen peroxide and (5) colonic extraction of nitric oxide from the circulation, has led to new views on colonocyte damage in colitis. These observations should assist to define initiating factors that lead to release of damaging agents (nitric oxide/hydrogen peroxide) and to delineate protective mechanisms against colonocyte damage. Overall, the production, release, disposal and inactivation of nitric oxide are related to damage to colonocytes and consequent ulceration in colitis.

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Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades.

Cited by 112 publications

References 21 publications

Diverticular Disease in the Elderly

Diverticular Disease in the Elderly

The Gastroenterologist’s View

Nitric Oxide Damage to Colonocytes in Colitis-by-Association: Remote Transfer of Nitric Oxide to the Colon

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