Epidemiology and Pathophysiology of Diverticular Disease

Munie, Semeret; Nalamati, Surya

doi:10.1055/s-0037-1607464

Cited by 46 publications

(31 citation statements)

References 50 publications

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“…Although there was no data for the association of diabetes mellitus with diverticulitis, diabetes mellitus was associated with advanced disease severity as assessed by Hinchey and Ambrosetti scores [ 32 ]. Some possible explanations of this observation are the probable coexistence of DM with metabolic syndrome that can induce the development of diverticulitis through the release of cytokines that promote inflammation in the subcutaneous abdominal fat, as well as alterations in gut microbiota that can play a key role in inducing diverticulitis [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Proton Pump Inhibitor Use May Increase the Risk of Diverticulitis but Not It’s Severity among Patients with Colonic Diverticulosis: A Multicenter Study

Sbeit

Khoury

Kadah

et al. 2020

JCM

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Colonic diverticular disease, especially diverticulitis constitutes a major cause of hospitalization and an economic burden in developed countries. Proton pump inhibitors (PPIs) are among the commonest drugs used to treat several diseases affecting the upper gastrointestinal tract. A few studies have reported that the use of Proton Pump Inhibitors PPIs caused dysbiosis. In this study, we searched for a relationship between PPI use and the onset and severity of diverticulitis in patients with colonic diverticulosis. In a retrospective study, patients who were hospitalized for documented diverticulitis were enrolled as cases and compared with a control group of patients with uncomplicated diverticulosis. Overall, 613 patients who had a diagnosis of diverticulosis were included in the study, 217 of whom had diverticulitis. After multivariate analysis, the non-modifiable risk factors associated with diverticulitis included: age (p < 0.0001), hypertension (p < 0.0001), chronic renal failure (p = 0.007), diabetes mellitus (p < 0.0001), and left colon location (p = 0.02). However, among the modifiable factors, only PPI use (p < 0.0001) showed a significant association. Advanced disease severity (according to Hinchey classification of diverticulitis stages II–IV) was associated with aspirin use (p = 0.0004) and pan-colonic location (p = 0.02). PPI use was the only modifiable factor significantly associated with diverticulitis, but not with its severity, among patients with diverticulosis. This observation should be confirmed in future multicenter prospective studies.

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Section: Discussionmentioning

confidence: 99%

Proton Pump Inhibitor Use May Increase the Risk of Diverticulitis but Not It’s Severity among Patients with Colonic Diverticulosis: A Multicenter Study

Sbeit

Khoury

Kadah

et al. 2020

JCM

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“…Colon diverticula are blind-ended extroversions involving the mucosal and submucosal layer of the intestinal wall [ 50 ]. They represent one of the most common pathologies in inpatient and outpatient patients [ 51 ] and the most frequently encountered finding in colonoscopies [ 52 ]. They can occur anywhere in the large intestine and their distribution depends heavily on the country of origin.…”

Section: Acute Diverticulitismentioning

confidence: 99%

“…The prevalence of diverticula is very similar in men and women [ 51 ] and it is often directly proportional to the patient’s age [ 54 ]. Studies have estimated an increase in diverticula occurring in about half of people between 60 and 80 years old, up to 70% in people aged 80 [ 55 , 56 ].…”

Section: Acute Diverticulitismentioning

confidence: 99%

Microbiota and Probiotics: The Role of Limosilactobacillus Reuteri in Diverticulitis

et al. 2021

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The microbiota is the set of commensal microorganisms, residing in the organism, helping proper functioning of organs and systems. The role that the microbiota plays in maintaining the health of vertebrates is widely accepted, particularly in the gastrointestinal system, where it is fundamental for immunity, development, and conversion of nutrients. Dysbiosis is an alteration of the microbiota which refers to a disturbed balance, which can cause a number of pathologies. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. In particular, Lactobacilli are a group of Gram-positive bacteria, which are able to produce lactic acid through glucose metabolism. They are present in different microenvironments, ranging from the vagina, to the mouth, to different tracts of the small intestine. In the present review, we will discuss the use of Limosilactobacillus in human health in general and more specifically in diverticulitis. In particular we analyze the role of Limosilactobacillus reuteri and its anti-inflammatory action. For this review, articles were identified using the electronic PubMed database through a comprehensive search, conducted by combining key terms such as “diverticulitis”, “Limosilactobacillus reuteri”, “human health and disease”, “probiotics”. We selected all the articles published in the last 10 years and screened 1017 papers. Articles referenced in the screened papers were evaluated if considered interesting for our topic. Probiotics have proven to be effective in modulating the microbiota of the gastrointestinal system and, therefore, in promoting the health of the individual. The importance of probiotics in treating diverticular disease and acute diverticulitis can be further understood if taking into consideration some pathophysiological aspects, associated to the microbiota. L. reuteri plays an important role in human health and disease. The effectiveness of L. reuteri in stimulating a correct bowl motility partly explains its effectiveness in treating diverticulitis. The most important action of L. reuteri is probably its immunomodulating activity. Levels of IL-6, IL-8, and Tumor necrosis factor (TNF-alpha) are reduced after supplementation with different strands of Lactobacilli, while T-regulatory cells increase in number and activity. Anyway, new mechanisms of action of probiotics come to light from the many investigations currently taking place in numerous centres around the world and to improve how exactly probiotic administration could make the difference in the management of diverticular disease and acute diverticulitis.

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“…Diverticular Disease (DD) is defined as clinically significant and symptomatic colonic diverticulosis and includes diverticular bleeding, diverticulitis, and Symptomatic Uncomplicated Diverticular Disease (SUDD) [1]. DD prevalence increases significantly with age, ranging from 10-20% in those younger than 40 years up to 50 to 70% in those older than 70-80 years [2,3]. While diverticulitis occurs in around 5% (1.7% complicated) of patients with diverticulosis [4], admission rate is steadily increasing overall and at a higher rate in younger patients [5].…”

Section: Introductionmentioning

confidence: 99%

“…Along with the different clinical presentations and populations affected by DD, diagnosis and treatments have consistently changed. To standardize the treatments, several classifications have been proposed through the years, and several algorithms developed focusing on clinical features and patient's quality of life more than anatomical and pathological landmarks [1,2,[6][7][8]. Moreover, different surgical treatments have been proposed [8][9][10][11][12], while the surgical approach has been shifting to a minimally invasive approach even in the emergency setting [13,14].…”

Section: Introductionmentioning

confidence: 99%

The Diverticular Disease Registry (DDR Trial) by the Advanced International Mini-Invasive Surgery Academy Clinical Research Network: Protocol for a Multicenter, Prospective Observational Study

Origi

Achilli

Calini

et al. 2021

International Journal of Surgery Protocols

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Diverticular disease is an increasingly common issue, with a variety of clinical presentations and treatment options. However, very few prospective cohort studies explore outcomes between the different presentations and treatments. The Diverticular Disease Registry (DDR Trial) is a multicenter, prospective, observational cohort study on behalf of the Advanced International Mini-Invasive Surgery (AIMS) academy clinical research network. The DDR Trial aims to investigate the short-term postoperative and long-term quality of life outcomes in patients undergoing surgery or medical treatments for diverticular disease. DDR Trial is open to participation by all tertiary-care hospitals. DDR Trial has been registered at ClinicalTrials.gov (NCT 04907383). Data collection will be recorded on Research Electronic Data Capture (REDCap) starting on June 1 st , 2021 and will end after 5 years of recruitment. All adult patients with imaging-proven colonic diverticular disease (i.e., symptomatic colonic diverticulosis including diverticular bleeding, diverticulitis, and Symptomatic Uncomplicated Diverticular Disease) will be included. The primary outcome of DDR Trial is quality of life assessment at 12-month according to the Gastrointestinal Quality of Life Index (GIQLI). The secondary outcome is 30-day postoperative outcomes according to the Clavien-Dindo classification. DDR Trial will significantly advance in identifying the optimal care for patients with diverticular disease by exploring outcomes of different presentations and treatments.

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Epidemiology and Pathophysiology of Diverticular Disease

Cited by 46 publications

References 50 publications

Proton Pump Inhibitor Use May Increase the Risk of Diverticulitis but Not It’s Severity among Patients with Colonic Diverticulosis: A Multicenter Study

Proton Pump Inhibitor Use May Increase the Risk of Diverticulitis but Not It’s Severity among Patients with Colonic Diverticulosis: A Multicenter Study

Microbiota and Probiotics: The Role of Limosilactobacillus Reuteri in Diverticulitis

The Diverticular Disease Registry (DDR Trial) by the Advanced International Mini-Invasive Surgery Academy Clinical Research Network: Protocol for a Multicenter, Prospective Observational Study

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