Diverticular Disease: Changing Epidemiology and Management

Razik, Roshan; Nguyen, Geoffrey C.

doi:10.1007/s40266-015-0260-2

Cited by 18 publications

(16 citation statements)

References 117 publications

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“…It has been proposed that elderly may develop abnormal thickness of colonic wall and frail muscular structure which is susceptible to incremental intraluminal pressure 17 , 18 . A positive association of diverticulosis and smoking status was unveiled in our study, whose role and exact mechanism were still in controversy; however, pertaining to a proinflammatory stimulus, disturbance on colonic motility and impacts against microflora homeostasis have all been postulated to play a role 19 – 21 . Furthermore, we also noted a higher prevalence of rheumatologic disorders in patients with diverticulosis.…”

Section: Discussionmentioning

confidence: 63%

Sex differences in risk factors of uncomplicated colonic diverticulosis in a metropolitan area from Northern China

Yang

Zheng

Jiang

et al. 2018

Sci Rep

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As the world's most populated and rapidly aging country, there is limited information on sex-related differences in factors regarding uncomplicated colonic diverticulosis in China. We aimed to investigate sex differences in individual risk factor in a northern metropolis. Patients with colonic diverticulosis who underwent indicated colonoscopy were queried with respect to medical history and demographic features. Demographic information, life style factors and co-morbidities were retrieved from a prospective dataset. Multiple regression analyses were performed to determine precipitating factors of diverticula. Of 4,386 enrolled patients, colonic diverticulosis were detected in 218 cases (4.97%). Multiple logistic regression analysis implicated increasing age (OR = 1.05, 95%CI 1.03-1.06, P < 0.001), red meat ≥100 g/d (OR = 2.53, 95%CI 1.72-3.70, P < 0.001), smoking (OR = 2.14, 95%CI 1.05-4.33, P = 0.035), rheumatologic diseases (OR = 3.38, 95%CI 1.09-10.5, P = 0.035) and NSAIDs (OR = 2.11, 95%CI 1.12-3.97, P = 0.020) were significantly associated with diverticulosis in men, whilst advancing age (OR = 1.03, 95%CI 1.01-1.05, P = 0.013), BMI (OR = 1.12, 95%CI 1.04-1.19, P = 0.001), smoking (OR = 10.2, 95%CI 2.81-37.4, P < 0.001), rheumatologic diseases (OR = 8.04, 95%CI 3.05-21.2, P < 0.001), hypertension (OR = 1.76, 95%CI 1.01-3.06, P = 0.047), colonic polyps (OR = 3.12, 95%CI 1.82-5.36, P < 0.001) and antihypertensive medications (OR = 2.99, 95%CI 1.66-5.39, P < 0.001) in women. In conclusion, it is pivotal to take account of differentially sex-related factors in regard to the development of uncomplicated colonic diverticulosis.China has underwent rapid growth of aging population during recent decades; those aged ≥ 75 years accounted for 3.5% of the population in 2013, and there were 200 million elderly residents aged ≥ 65 years in 20141 . Therefore the burden of diseases, especially entity with a higher prevalence among the elderly, including uncomplicated colonic diverticulosis, is predicted to increase in the future 2,3 . As a matter of fact, the rates of diverticula have dramatically increased from 2.78% in 2011 to 4.98% in 2015 according to dataset from our endoscopy center (data not shown). Aside from aging, the pathogenesis of diverticulosis is thought to be multifactorial, including diet, colonic motility, obesity, medications and genetic factors 4 . More recently, it has been recognized that altered gut microbiota composition and abnormal immune signatures may contribute to the development and progression of uncomplicated diverticular disease 5,6 . Of note, explicit sex-specific diet-microbiota correlations have been documented in humans 7 . After reviewing current body of literature, gender was evidently associated with the presence of diverticulosis 5,[8][9][10] . Thus, it is plausible to hypothesize that sex-related differences regarding risk factors for the formation of diverticula. Collectively, we aimed to assess potential factors related to diverticulosis by capturing and analyzing demographic, env...

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Section: Discussionmentioning

confidence: 63%

Sex differences in risk factors of uncomplicated colonic diverticulosis in a metropolitan area from Northern China

Yang

Zheng

Jiang

et al. 2018

Sci Rep

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“…Therefore, it could be argued that co-morbidity is in some cases a confounder in the association between the outcomes and income and employment status. Socio-economic disparities in incidence of non-malignant emergency laparotomies could partly be attributed to differences in health behaviour, such as smoking, diet and obesity, which have all been linked to diverticular disease [22]. The results did show that prevalence of obstructive pulmonary disease and of moderate liver disease was higher among those undergoing surgery compared to the reference population, and as smoking and heavy drinking are important risk factors for these diseases, this could be an indication that health behaviour differs between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Socio-economic disparity in risk of undergoing emergency laparotomy and postoperative mortality

Møller

Jeppesen

Gögenur

et al. 2019

Scand J Public Health

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Aims: Socio-economic disparities in health and access to care are well documented, but socio-economic disparities in surgical care and outcomes have received less attention. The aim of the study was to determine if there are socio-economic disparities in the risk of undergoing emergency laparotomy and postoperative mortality in a universal health-care system with free and equal access to care. Methods: This was a nationwide case-control study including patients undergoing non-malignant emergency laparotomy involving resection, ostomy or open drainage between 2003 and 2014 and population references matched 1:1 on age and sex. Socio-economic disparities in one-year postoperative mortality were explored through a cohort study including all patients. Exposure measures were register-based household disposable income, educational level and employment status. Analyses were adjusted by age, sex, country of origin, marital status and co-morbidity. Results: A total of 11,962 cases and 11,962 population references were included. The highest odds ratios (OR) for undergoing surgery were found among those with the lowest income (OR=1.51; 95% confidence interval (CI) 1.39–1.63), those with elementary school education (OR=1.33; 95% CI 1.22–1.46) and those on early-retirement pension (OR=3.49; 95% CI 3.07–3.98). One-year postoperative mortality was highest among those with lowest income (hazard ratio (HR)=1.51; 95% CI 1.35–1.69), those with elementary school education (HR=1.39; 95% CI 1.22–1.59) and those on early-retirement pension (HR=2.12; 95% CI 1.73–2.61). Conclusions: Socio-economic disparities in health exist in relation to non-malignant emergency laparotomies and still exist after adjustment for confounders, including co-morbidity, indicating that mechanisms other than differences in disease burden are involved. There is a substantial need for exploration of mechanisms and preventive measures.

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“…Desde otra mirada, se puede esperar una mayor prevalencia de ED mientras más industrializado sea un país 11 , sin embargo, información reciente ha revelado un incremento en la proporción de ED colónica a través del mundo 8 . Asimismo, estudios epidemiológicos señalan que esta condición afecta a un 50% de las personas a los 50 años, 60% de las personas a los 60 años y a un 70% de las personas a los 70 y 80 años 18 , quedando en evidencia que su incidencia incrementa con la edad 19 , siendo probablemente asociado a una reducción de la fuerza de tracción de la pared colónica 12 .…”

Section: Etiología Y Epidemiología De La Edunclassified

“…Asimismo, estudios epidemiológicos señalan que esta condición afecta a un 50% de las personas a los 50 años, 60% de las personas a los 60 años y a un 70% de las personas a los 70 y 80 años 18 , quedando en evidencia que su incidencia incrementa con la edad 19 , siendo probablemente asociado a una reducción de la fuerza de tracción de la pared colónica 12 . La gran mayoría (80%) de pacientes con diverticulosis no van a desarrollar complicaciones, ya que muchos de ellos se mantendrán asintomáticos durante su vida y el diagnóstico será solo un hallazgo endoscópico con baja significancia clínica 11 .…”

Section: Etiología Y Epidemiología De La Edunclassified

Enfermedad diverticular: nuevas perspectivas en el tratamiento dieto-terapéutico

D²,

S³

2019

Rev. chil. nutr.

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RESUMENLa enfermedad diverticular corresponde a una condición habitual en el territorio occidental, siendo el hallazgo más frecuente en población de zonas urbanizadas. Respecto a su origen, se ha planteado la influencia de factores ambientales y genéticos, incluyendo en su etiología una inadecuada ingesta de fibra dietética, disbiosis de la microbiota intestinal y niveles alterados de vitamina D. A su vez, la enfermedad diverticular sintomática no complicada (EDNC) corresponde a un tipo de diverticulosis crónica cuyas características asemejan al síndrome de intestino irritable, lo que resalta la importancia en la comprensión de esta condición. Recientemente, se ha discutido la forma en que se aborda la enfermedad diverticular y en el siguiente escrito se expondrá evidencia sobre la patogénesis y su actual manejo. ABSTRACTDiverticular disease corresponds to a habitual condition in the western territory, being frequently found among the population of urban areas. Regarding its origin, the influence of environmental and genetic factors, including the etiology of dietary fiber intake, intestinal microbiota dysbiosis and altered levels of vitamin D have been recognized. Symptomatic uncomplicated diverticular disease corresponds to a type of chronic diverticulosis whose characteristics resemble irritable bowel syndrome, highlighting the importance of understanding this condition. Recently, the treatment of the disease has been discussed and the following review presents evidence on pathogenesis and its management.

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Diverticular Disease: Changing Epidemiology and Management

Cited by 18 publications

References 117 publications

Sex differences in risk factors of uncomplicated colonic diverticulosis in a metropolitan area from Northern China

Sex differences in risk factors of uncomplicated colonic diverticulosis in a metropolitan area from Northern China

Socio-economic disparity in risk of undergoing emergency laparotomy and postoperative mortality

Enfermedad diverticular: nuevas perspectivas en el tratamiento dieto-terapéutico

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