Right-Sided Diverticulosis and Disparities from Left-Sided Diverticulosis in the Vietnamese Population Living in Boston, Mass., USA: A Retrospective Cohort Study

Abstract

Objective: To report the prevalence, clinical differences and complications of right-sided diverticulosis (RD) and to investigate the potential disparities from left-sided diverticulosis (LD) in the Vietnamese population. Subjects and Methods: A retrospective cohort study was conducted using medical records of Vietnamese-born patients from 2000 to 2013 in a community teaching hospital in Boston, Mass., USA. By simple randomization, a randomized control group of 299 Caucasian patients was also selected from the same time frame [167 males (M) and 132 females (F)]. Colonoscopy reports were reviewed for demographics (age and gender), indication and anatomical location of the colonic diverticulosis (CD), concomitant colonic findings, symptoms, and endoscopic complications. Results: A total of 207 patients were included in the Vietnamese cohort (mean age 61.6 ± 8.9 years). The mean age at first screening colonoscopy was 58.2 ± 7.2 years (114 F/92 M, 55.7/44.4%). Our study identified 104 (50.5%) patients with LD (57 M/47 F), 65 (31.1%) with RD (35 M/30 F) and 38 (18.4%) with both LD and RD (23 M/15 F); 133 (64%) were asymptomatic. A total of 21 (33%) patients with RD were symptomatic. The mean age of the control group was 61.6 ± 8.1 years. The average age at first screening colonoscopy was 52.8 ± 6.4 years. Of the 299 in the Caucasian group, 254 (84.9%) had LD (114 M/140 F), 9 (3.0%) had RD (2 M/7 F) and 36 (12%) had both LD and RD (16 M/20 F); 225 (75%) were asymptomatic and came in for screening colonoscopies. A total of 2 patients (22%) with RD were symptomatic. Conclusion: RD was common in this Vietnamese population, and the prevalence was higher than in the Caucasian control group.

Diverticulosis today: unfashionable and still under-researched

“…In Hispanic patients with incidental colorectal wall thickening on CT, diverticulosis was found in 43% of patients [Padda et al 2007]. In Vietnamese patients living in Boston, Massachusetts, diverticulosis was left sided in 50.5%, right sided in 31.1%, and both left and right sided in 18.4% of the studied population [Mehrzad et al 2015]. Diverticulosis prevalence can vary among the same group of patients.…”

Analysis of risk factors for colonic diverticular bleeding and recurrence

“…[ 2 , 3 ] The colonic distribution of diverticula vary between countries, with diverticula found primarily in the left-sided colon in Western countries and the right-sided colon in Asia. [ 4 – 6 ]…”

Relationship between colonic diverticulosis and colon neoplasms in Japanese patients

“…Left‐sided CD is predominant in Western patients, 19,20 though individuals of African descent have a greater percentage of diverticula in the proximal colon and lower in the distal colon as compared with Caucasians 45 . In Asian countries, right‐sided CD is predominant as compared to the left‐sided or bilateral‐sided CD, suggesting ethnic differences, though cases of left‐sided and bilateral‐sided CD, more common in Western populations, have recently been increasing 18,21,30,46 . Therefore, the combination of right‐sided CD and distal colon cancer often seen in Asians may decrease in the near future.…”

“…However, controversy remains regarding that correlation, as noted in some investigations 14–16 . Interestingly, CD location in the proximal colon is more common in Asian populations 17,18 as compared to the distal colon in Western cases, 19–21 a noteworthy difference. Because of ethnic differences, the correlation between CNs and CD in patients in Asian countries may be originally different from that of those in Western countries.…”