@article {pmid39429357,
year = {2024},
author = {Ravichandran, KR and Munguia-Vazquez, R and Nirmalan, R},
title = {Spontaneous Colovesical Fistula With Benign Prostatic Hyperplasia and Prostatitis.},
journal = {Cureus},
volume = {16},
number = {9},
pages = {e69589},
pmid = {39429357},
issn = {2168-8184},
abstract = {We present an unusual case of colovesical fistula formed by a single diverticulum manifesting as prostatitis and urinary tract infection (UTI) before causing further complications. Diverticulitis is caused by inflammation of the colonic diverticula and manifests as fever and left lower quadrant pain. The patient also developed recurrent pneumaturia; upon examination, a colovesical fistula was observed on computed tomography (CT), which was managed successfully by laparoscopic repair. This case highlights manifestations of colovesical fistula secondary to diverticular disease and the laparoscopic approach to treatment.},
}

@article {pmid39429143,
year = {2024},
author = {Devlin, J and Reed, RN and Brody, F and Duncan, JE},
title = {Robotic Sigmoidectomy for Diverticular Disease.},
journal = {Journal of laparoendoscopic & advanced surgical techniques. Part A},
volume = {},
number = {},
pages = {},
doi = {10.1089/lap.2024.0329},
pmid = {39429143},
issn = {1557-9034},
abstract = {Introduction: Historically, colon resection was recommended after one episode of complicated diverticulitis. However, current trends favor a more individualized approach. This review examines elective sigmoidectomy for complicated diverticulitis as well as robotic approaches for diverticular disease. Methods: The literature was reviewed for timely (post 2000) and relevant articles regarding robotics and diverticulitis. The articles included large prospective series, retrospective analysis, meta-analyses and randomized controlled trials. Results: Primary anastomosis with or without protective ileostomy has emerged as an alternative to the Hartman's procedure in emergent or urgent surgery in patients without significant comorbidities. Elective sigmoidectomy after an episode of complicated diverticulitis should be decided on a case-by-case basis considering patient characteristics, continued subacute symptoms, complications from the disease, and chance of recurrence episodes. Conclusions: There are several variations techniques for robotic sigmoidectomy outlined in this article, and familiarity with all can help depending on the logistics of the case. Minimally invasive colectomy provides superior patient satisfaction and outcomes.},
}

@article {pmid39409978,
year = {2024},
author = {Tondolo, V and Marzi, F and Amodio, LE and Rizzo, G},
title = {Short-Term Postoperative Outcomes after Resective Colorectal Surgery in Elderly vs. Nonelderly Patients: A Single Centre Retrospective Analysis.},
journal = {Cancers},
volume = {16},
number = {19},
pages = {},
doi = {10.3390/cancers16193358},
pmid = {39409978},
issn = {2072-6694},
abstract = {Background/Objectives: Life expectancy for people in their 60s is 24.3 years in high-income countries. Health systems face the burden of disease in the elderly population and must assess the impact of treatments such as major surgery. The aim of this study is to quantify the impact of advanced age on short-term postoperative outcomes after resective colorectal surgery (RCRS). Methods: All patients who underwent RCRS at our institution between July 2022 and November 2023 were entered into a database. Preoperative, perioperative, and early (within 30 days) postoperative data were recorded. Patients were categorized into a young group (under 75 years, YG) and an elderly group (over 75 years, EG). A retrospective comparative analysis of postoperative outcomes was performed between the two groups; postoperative complications were graded according to the Clavien classification. Results: Fifty-three and ninety-five patients were in the EG and YG, respectively. Indications for RCRS was cancer in 83% of EG patients and 61.1% of YG patients (p = 0.006), and the clinical presentation, localization, and rate of neoadjuvant treatment in oncological patients were comparable. Another indication for RCRS was complicated diverticular disease (17% of EG patients and 38.9% of YG patients; p = 0.006). With respect to the baseline characteristics, the ASA and CCI scores were worse in the EG (p = 0.001). No significant differences in the surgical approach, mini-invasive approach, conversion rate, definitive stoma creation, or number of harvested lymph nodes were found between the two groups. Overall, EG reported a higher relative risk (RR) of short-term postoperative complications (1.64, CI: 1.03-2.63), but no significant differences were found in terms of grade ≥3 complications (RR: 0.9, CI: 0.23-3.44). In the EG, a higher risk of ICU admission (RR:2.69, CI: 1.5-4.8) and a one-day longer postoperative hospital stay (6 vs. 5 days) were reported. Conclusions: Advanced age does not seem to contraindicate RCRS, especially in colorectal cancer patients. The impact of elderly age on short-term outcomes seems to be minimal and acceptable.},
}

@article {pmid39407913,
year = {2024},
author = {Carletta, D and Popeskou, SG and Mongelli, F and Murgante, N and Di Giuseppe, M and Proietti, F and Hübner, M and Christoforidis, D},
title = {A Decade of Follow-Up to Assess the Risk of Recurrence and Surgery after a First Episode of Uncomplicated Left-Sided Diverticulitis.},
journal = {Journal of clinical medicine},
volume = {13},
number = {19},
pages = {},
doi = {10.3390/jcm13195854},
pmid = {39407913},
issn = {2077-0383},
abstract = {Background and aims: Acute uncomplicated diverticulitis (UD) of the left colon is common and mostly benign. Due to controversy over the definition of UD and the lack of adequate follow-up in most studies, good quality data to predict long-term outcomes after a first episode of UD are missing. The aim of this study was to assess the long-term risk for adverse outcomes after a first episode of UD. Methods: All consecutive patients with a CT-scan-documented first episode of acute UD (staged "uncomplicated" according to ESCP guidelines and/or modified Hinchey stages 0-1a, and/or CDD 1-2a) between January 2010 and June 2013 were included in the study. CT scans and clinical records were retrospectively reviewed. The primary endpoint was overall recurrence; the secondary endpoint was surgery for diverticular disease. Results: One hundred and five patients were included in the study with a median follow-up of 116.4 (4.9-154.7) months. Of these, 51 (48.5%) patients had a recurrence, 11 (10.4%) had 4 or more episodes. Twenty-one (20%) patients underwent sigmoidectomy, all in an elective setting, mostly due to multiple recurrent episodes. Male gender was the only independent risk factor for surgery (OR (95%CI): 0.301 (0.109-0.834), p = 0.021). Classification systems did not predict recurrence, but stage CDD 1a was protective for surgery (OR (95%CI): 0.201 (0.042-0.957), p = 0.044). Conclusions: After a decade of follow-up, almost half the patients experienced at least one recurrent episode after UD, higher than previously thought. None of those patients required emergency surgery, but one in five patients, mostly men, underwent elective sigmoidectomy for multiple recurrent episodes.},
}

@article {pmid39404716,
year = {2024},
author = {Svistunov, AА and Osadchuk, MA and Mironova, ED and Krylova, IS},
title = {[Clinical, endoscopic, laboratory and immunomorphological parameters in predicting the occurrence of colorectal cancer in patients with diverticular disease of the colon].},
journal = {Terapevticheskii arkhiv},
volume = {96},
number = {8},
pages = {732-738},
doi = {10.26442/00403660.2024.08.202818},
pmid = {39404716},
issn = {0040-3660},
mesh = {Humans ; Male ; Female ; Middle Aged ; *Colorectal Neoplasms/pathology ; Tumor Suppressor Protein p53/metabolism ; Aged ; Colonoscopy/methods ; Ki-67 Antigen/analysis/metabolism ; Adult ; },
abstract = {AIM: To define the role of clinical, endoscopic, laboratory and immunomorphological parameters in predicting the occurrence and course of colorectal cancer (CRC) in patients with diverticular disease of the colon (DDC).

MATERIALS AND METHODS: One hundred and seventy five people with DDC were examined, divided into 3 groups: group 1 - 85 patients with DDC; group 2 - 45 with DDC in combination with adenomatous polyps (AP); 3rd group - 45 with DDC with established CRC (I or II stage). The control group consisted of 30 practically healthy people. Patients and healthy people were examined according to a single program: clinical, laboratory, instrumental data and immunomorphological research methods [use of primary antibodies to p53 (mAb clone DO-7 product no. PA0057, Leica Biosystems, Leica Bond III) and Ki-67 (Ab16667, Abcam, UK)].

RESULTS: Among the main complaints in patients with DDC and CRC, constipation was more common than in patients with DDC and DDC with AP (p<0.05). In patients with DDC and colorectal neoplasia, a positive reaction to occult blood in the feces was more often verified, compared with the group with DDC (p<0.05). Higher levels of glucose and cholesterol in blood plasma, as well as body mass index were found in patients with DDC with AP and CRC, compared with the DDC group (p<0.05). A higher level of expression of Ki-67 and p53 was found in patients with DDC combined with AP and CRC, compared with patients with DDC without colorectal neoplasia (p<0.05). At the same time, in patients with DDC with CRC, the expression level of Ki-67 and p53 was higher than in patients with DDC with AP (p<0.05) Conclusion. In patients with DDC combined with AP and CRC, higher levels of glucose, plasma cholesterol, as well as body mass index were observed compared to the group of patients with DDC alone (p<0.05). Of note, the results of the determination of Ki-67 and p53 in the mucous membrane of the colon should be considered important prognostic markers for the development of CRC in patients with DDC.},
}

Humans
Male
Female
Middle Aged
*Colorectal Neoplasms/pathology
Tumor Suppressor Protein p53/metabolism
Aged
Colonoscopy/methods
Ki-67 Antigen/analysis/metabolism
Adult

@article {pmid39400547,
year = {2024},
author = {Zhan, D and Yang, Z and Li, P and Pan, J},
title = {Therapeutic targets for gastrointestinal diseases: proteome-wide Mendelian randomization and colocalization analyses.},
journal = {Postgraduate medical journal},
volume = {},
number = {},
pages = {},
doi = {10.1093/postmj/qgae140},
pmid = {39400547},
issn = {1469-0756},
abstract = {PURPOSE: This study was aimed to identify serum proteins linked with gastrointestinal diseases by proteome-wide Mendelian randomization analysis.

METHODS: We determined the casual relationship between 732 kinds of circulating proteins and the 24 kinds of gastrointestinal diseases via Mendelian randomization analysis.

RESULTS: Four circulating proteins (FCGR3B, IL-12B, MAPKAPK2, and IL-23R) were associated with the occurrence of ulcerative colitis (UC), and IL23R was also correlated with risk of Crohn's disease (CD). Genetically predicted levels of IL23R were strongly correlated with the risk of UC and CD based on the high supporting evidence of colocalization analysis. Five circulating proteins (NOV, EFEMP1, ADGRE2, LCT, and SEMA3G) were associated with the risk of diverticulosis disease. With high supporting evidence of colocalization, genetically predicted levels of NOV and SEMA3G were inversely correlated with the risk of diverticulosis disease. Five circulating proteins (FUT3, FUT5, CRHBP, SULT2A1, and QPCTL) were associated with the occurrence of cholelithiasis. With high supporting evidence of colocalization, genetically predicted levels of FUT3 and CRHBP were inversely correlated with the risk of cholelithiasis.

CONCLUSIONS: The proteome-wide Mendelian randomization investigation identified several circulating proteins associated with the risk of UC, CD, diverticular disease and cholelithiasis, which reinforced the understanding of molecular pathogenesis and design of therapeutic targets.},
}

@article {pmid39399131,
year = {2024},
author = {Wu, S and Al Khaldi, M and Richard, CS and Dagbert, F},
title = {Diverticulitis: A Review of Current and Emerging Practice-Changing Evidence.},
journal = {Clinics in colon and rectal surgery},
volume = {37},
number = {6},
pages = {359-367},
pmid = {39399131},
issn = {1531-0043},
abstract = {Acute diverticulitis represents a common colorectal emergency seen in the Western world. Over time, management of this condition has evolved. This review aims to highlight recent evidence and update current recommendations. Notable evidence has emerged in certain aspects of diverticulitis. This includes disease pathogenesis, as emerging data suggest a potentially greater role for the microbiome and genetic predisposition than previously thought. Acute management has also seen major shifts, where traditional antibiotic treatment may no longer be necessary for acute uncomplicated diverticulitis. Following successful medical management of acute diverticulitis, indications for elective sigmoidectomy have decreased. The benefit of emergency surgery remains for peritonitis, sepsis, obstruction, and acute diverticulitis in certain immunocompromised patients. Routine colonoscopy, once recommended after all acute diverticulitis episodes, has been shown to be beneficial for cancer exclusion in a distinct patient population. Despite advances in research, certain entities remain poorly understood, such as smoldering diverticulitis and symptomatic uncomplicated diverticular disease. As research in the field expands, paradigm shifts will shape our understanding of diverticulitis, influencing how clinicians approach management and educate patients.},
}

@article {pmid39391124,
year = {2024},
author = {Romero, AL and Romero, J and Sah, A and Koomson, A and Arun, N},
title = {Acute Transverse Colon Diverticulitis: A Case Report and Literature Review.},
journal = {Journal of community hospital internal medicine perspectives},
volume = {14},
number = {4},
pages = {105-110},
pmid = {39391124},
issn = {2000-9666},
abstract = {Diverticular disease is a condition that ranges from asymptomatic disease to severe complications, such as abscesses, fistulas, and perforations. It is prevalent in Western countries, with up to 60% of people aged 60 having diverticula. In Asian countries, the prevalence is lower, ranging from 13 to 25%. Diverticulitis can occur in any location of the diverticula, with increasing incidence with age. Complications occur in 12% of patients with diverticulitis, with phlegmon or abscesses being the most common. Perforation is a life-threatening complication with a 1-year mortality rate of 20%. Recent studies suggest that chronic inflammation and alteration of the gut microbiome may play a role in diverticulitis, leading to a less aggressive and conservative approach to treatment. Even though diverticular disease represents a very common clinical entity, diverticula located in the transverse colon it is an extremely rare presentation. We present the case of a 39-year-old female with a history of multiple medical conditions who presented to the Emergency Room (ER) with severe diffuse abdominal pain predominantly in the right lower quadrant associated with shortness of breath. Upon physical examination, she was found to have severe pain, bilateral rhonchi, and a diffusely tender abdomen with guarding without rebound tenderness. Lab analysis showed leukocytosis, and a CT scan of the abdomen and pelvis revealed acute transverse diverticulitis which was treated medically.},
}

@article {pmid39381446,
year = {2024},
author = {Tapias, E and Rivera, EF and Finlayson, B and Rowe, DA and Mateja, HL and Umbu, LK and DeVito, PM},
title = {Perforated Jejunal Diverticulum Mimicking Diverticulitis: A Case Report of Acute Abdominal Pain in an Elderly Patient.},
journal = {Cureus},
volume = {16},
number = {9},
pages = {e68935},
pmid = {39381446},
issn = {2168-8184},
abstract = {Jejunal diverticulosis is a rare form of diverticulosis characterized by acquired pseudodiverticula in the small bowel. Although most cases are asymptomatic, the condition can present diagnostic challenges due to its atypical presentation. Complications such as perforation can lead to acute abdomen, significantly increasing morbidity and mortality. We report a rare case of perforated jejunal diverticulitis in an 84-year-old female with a known history of diverticular disease. The patient presented to the emergency department with worsening left lower quadrant abdominal pain. A computed tomography (CT) scan revealed a focus of air adjacent to the mesentery, indicative of bowel perforation. An urgent exploratory laparotomy was performed, which identified a 4-cm perforated jejunal diverticulum. The affected segment of the small bowel was resected, followed by primary side-to-side jejunal anastomosis. The patient was discharged home in stable condition following uneventful postoperative recovery. This case highlights the importance of including jejunal diverticulosis in the differential diagnosis of acute abdomen, particularly in elderly patients with a history of diverticular disease. Due to the nonspecific presentation, prompt imaging is crucial for diagnosis. Surgical intervention is often necessary in cases of perforation. Increased clinical awareness of this rare condition may help reduce diagnostic delays and improve patient outcomes.},
}

@article {pmid39361072,
year = {2024},
author = {McClelland, PH and Liu, T and Johnson, RP and Glenn, C and Ozuner, G},
title = {Iatrogenic urinary injuries in colorectal surgery: outcomes and risk factors from a nationwide cohort.},
journal = {Techniques in coloproctology},
volume = {28},
number = {1},
pages = {137},
pmid = {39361072},
issn = {1128-045X},
mesh = {Humans ; *Iatrogenic Disease ; Male ; Female ; Risk Factors ; Middle Aged ; *Postoperative Complications/etiology/epidemiology ; Aged ; Databases, Factual ; Colorectal Surgery/adverse effects ; Adult ; Laparoscopy/adverse effects/statistics & numerical data ; Urinary Tract/injuries ; Retrospective Studies ; United States/epidemiology ; Cohort Studies ; },
abstract = {BACKGROUND: Iatrogenic urinary injury (IUI) can lead to significant complications after colorectal surgery, especially when diagnosis is delayed. This study analyzes risk factors associated with IUI and delayed IUI among patients undergoing colorectal procedures.

METHODS: Adults undergoing colorectal surgery between 2012 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP[®]) database. Multivariable regression analysis was used to determine risk factors and outcomes associated with IUI and delayed IUI.

RESULTS: Among 566,036 patients, 5836 patients (1.0%) had IUI after colorectal surgery, of whom 236 (4.0%) had delayed IUI. Multiple preoperative risk factors for IUI and delayed IUI were identified, with disseminated cancer [adjusted odds ratio (aOR) 1.4, 95% confidence interval (CI) 1.2-1.5; p < 0.001] and diverticular disease [aOR 1.1, 95% CI 1.0-1.2; p = 0.009] correlated with IUI and increased body mass index [aOR 1.6, 95% CI 1.2-2.1; p = 0.003] and ascites [aOR 5.6, 95% CI 2.1-15.4; p = 0.001] associated with delayed IUI. Laparoscopic approach was associated with decreased risk of IUI [aOR 0.4, 95% CI 0.4-0.5; p < 0.001] and increased risk of delayed IUI [aOR 1.8, 95% CI 1.4-2.5; p < 0.001]. Both IUI and delayed IUI were associated with significant postoperative morbidity, with severe multiorgan complications seen in delayed IUI.

CONCLUSIONS: While IUI occurs infrequently in colorectal surgery, unrecognized injuries can complicate repair and cause other negative postoperative outcomes. Patients with complex intra-abdominal pathology are at increased risk of IUI, and patients with large body habitus undergoing laparoscopic procedures are at increased risk of delayed IUI.},
}

Humans
*Iatrogenic Disease
Male
Female
Risk Factors
Middle Aged
*Postoperative Complications/etiology/epidemiology
Aged
Databases, Factual
Colorectal Surgery/adverse effects
Adult
Laparoscopy/adverse effects/statistics & numerical data
Urinary Tract/injuries
Retrospective Studies
United States/epidemiology
Cohort Studies

@article {pmid39360292,
year = {2024},
author = {Wang, K and Wang, S and Chen, X},
title = {The Causal Effects between Mood Swings and Gastrointestinal Diseases: A Mendelian Randomization Study.},
journal = {Alpha psychiatry},
volume = {25},
number = {4},
pages = {533-540},
pmid = {39360292},
issn = {2757-8038},
abstract = {BACKGROUND: Numerous studies have examined the links between mental disorders such as depression and bipolar disorder, and gastrointestinal (GI) diseases. However, few studies have investigated the link between mood swings and GI diseases. Given the impact of mood swings on various conditions and the growing comprehension of the gut-brain axis, this study aims to explore their causal relationship using Mendelian randomization (MR) methods.

METHODS: Single-nucleotide polymorphisms (SNPs) associated with mood swings were obtained from a recent study. SNPs associated with GI diseases were identified from the FinnGen project. We conducted two-sample bidirectional MR analyses using three methods, primarily the inverse variance weighting (IVW) method. Furthermore, we performed sensitivity analyses and false discovery rate (FDR) analysis to validate the accuracy and robustness of the results.

RESULTS: Bidirectional MR analysis revealed significant causal effects between mood swings and GI diseases according to the IVW method (odds ratio (OR): 1.213; 95% confidence interval (CI): 1.118-1.316; P = 3.490e-6; P FDR = 8.730e-5). Mood swings were linked to an increased risk for 11 of 24 diseases, including five upper GI diseases (gastroesophageal reflux disease (GERD), acute gastritis, gastroduodenal ulcer, duodenal ulcer, and functional dyspepsia), two lower GI diseases (diverticular disease of the intestine and irritable bowel syndrome (IBS)) and four hepatobiliary and pancreatic diseases (nonalcoholic fatty liver disease (NAFLD), chronic pancreatitis, acute pancreatitis, and pancreatic cancer). Inverse MR analysis showed no causal relationship between 24 GI diseases and mood swings.

CONCLUSIONS: This comprehensive MR analysis suggests that genetically predicted mood swings may be a risk factor in the development of GI diseases. Interventions for mood swings may help to treat GI diseases.},
}

@article {pmid39360096,
year = {2024},
author = {Naraynsingh, V and Maharaj, M and Rampersad, FS and Hassranah, SC and Maharajh, S},
title = {Are We Resecting Too Much Colon in Perforated Diverticulitis?.},
journal = {Cureus},
volume = {16},
number = {9},
pages = {e68473},
pmid = {39360096},
issn = {2168-8184},
abstract = {Initially, the Hartmann's procedure was done to reduce mortality in surgery cases of malignant rectal lesions, and not benign disease. However, the procedure was popularized in the management of perforated diverticular disease (PDD) in the 1970s. Herein, we present a case of a patient who had laparotomy and colostomy for PDD. During the post-operative planning for reversal of the diverting colostomy, a contrast study was done that revealed that most of the sigmoid colon was in fact healthy. In this patient, the colon was severed at the point of the perforation and exteriorized, which allowed time for the resolution of the gut inflammatory changes. Thus, Hartmann's operation would have led to the unnecessary resection of the healthy sigmoid colon and possibly condemned the patient to an irreversible stoma. In severe PDD, where a Hartmann's procedure is considered, one could sever the colon at the site of perforation and bring out a colostomy while tacking the closed, unresected distal end near the ostomy. Further contrast studies of the colon could assist in planning resection and anastomosis.},
}

@article {pmid39357768,
year = {2024},
author = {Arévalo-Pérez, R and Maderuelo, C and Lanao, JM},
title = {Development of intestinal colonic drug delivery systems for diverticular disease: a QbD approach.},
journal = {European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences},
volume = {},
number = {},
pages = {106918},
doi = {10.1016/j.ejps.2024.106918},
pmid = {39357768},
issn = {1879-0720},
abstract = {This study aimed to advance the development of intestinal colon-coated sustained-release matrix tablets of metronidazole for diverticulitis treatment, employing the Quality by Design (QbD) methodology. Comprehensive Risk analysis and Risk evaluation were conducted to assess the potential risks associated with Critical Material Attributes (CMA) and Critical Process Parameters (CPP). Ishikawa diagram, color-coded risk classification and the Risk Priority Number (RPN) were used as tools for risk evaluation. A Design of Experiments (DoE) was executed using a fractional factorial design, incorporating five key factors derived from the Risk analysis and Risk evaluation. Two levels and a central point were established for each factor, resulting in 28 batches of coated tablets. The manufacturing process involved direct compression, followed by a coating process using pH-dependent or time-dependent polymers. Characterization and dissolution studies were conducted on all batches, and the obtained results underwent analysis of variance (ANOVA). The findings demonstrated the robustness and reproducibility of both the direct compression and coating processes. Statistical analysis identified HPMC/chitosan ratio, blending time, coating polymer, and coating weight gain as factors significantly impacting drug release. A Design Space was established to delineate the interplay of these factors, offering insights into various combinations influencing drug release behavior. Thus, the design space for 10% weight gain formulations includes a range of HPMC/CH ratios between 2.7-3 and mixing times between 10-12 min; for 20% weight gain formulations it includes a range of HPMC/CH ratios up to 2 and mixing times between 10-16 min. Multiple Linear Regression between technological and biopharmaceutical variables were optimized facilitating scale-up operations. Batches with a 10% weight increase and varied HPMC viscosity grades and coating polymers achieve ∼50% drug release at 24 h; however, batches with a 20% weight increase along, with either high proportions of HPMC and short blending times or low proportions of HPMC and longer blending times, achieve slow release of metronidazole. This study contributes to optimizing metronidazole colonic delivery systems, enhancing their potential efficacy in diverticulitis treatment.},
}

@article {pmid39341992,
year = {2024},
author = {Kong, P and Xu, T and Liu, P and Tian, X},
title = {The relationship between diverticular disease of intestine and cirrhosis: a two-sample mendelian randomization study.},
journal = {Scientific reports},
volume = {14},
number = {1},
pages = {22504},
pmid = {39341992},
issn = {2045-2322},
support = {No.20201576//Health Commission Research Fund Project of Hebei Province/ ; },
abstract = {The correlation between diverticular disease of the intestine and cirrhosis is well-established, however, the presence of a genetic causal link between the two conditions remains uncertain. The study employed a two-sample Mendelian randomization approach utilizing the most recent genome-wide association study (GWAS) data to investigate the correlation between diverticulosis and liver cirrhosis. The primary analysis was conducted using the Inverse Variance Weighted (IVW) method, and was further corroborated by an array of statistical techniques including MR-Egger, Weighted Median, Weighted Mode, cML-MA, ConMix, MR-RAPS, and DIVW to ensure robustness and reliability of the findings.Heterogeneity was evaluated using Cochran's Q test, horizontal pleiotropy was assessed through MR-Egger regression, and leave-one-out analyses were performed to validate the causal relationships. The IVW method found that diverticular disease significantly reduces the risk of cirrhosis (OR = 0.849, 95% CI: 0.743-0.971, P = 0.016). All models had P-values < 0.05 and negative β values. MR-Egger regression showed no horizontal pleiotropy (P = 0.215), confirming SNP reliability. Cochran's Q values for IVW and MR-Egger were 57.23 (P = 0.39) and 55.62 (P = 0.41), indicating no heterogeneity. Sensitivity analysis with the leave-one-out method validated the robustness of the results. This research utilizes Mendelian randomization to illustrate the potential protective role of diverticulosis against liver cirrhosis. The results are analyzed through the lenses of gut microbiota and cytokine levels, providing new perspectives that may inform clinical approaches to diagnosis and treatment.},
}

@article {pmid39332890,
year = {2024},
author = {Fiori, J and Kim, S and Ayonrinde, OT},
title = {Risk of metachronous colorectal cancer in patients with diverticular disease.},
journal = {Endoscopy},
volume = {56},
number = {10},
pages = {806-807},
doi = {10.1055/a-2317-7772},
pmid = {39332890},
issn = {1438-8812},
mesh = {Humans ; *Colorectal Neoplasms/complications/pathology ; *Neoplasms, Second Primary ; Colonoscopy ; Risk Factors ; Male ; Aged ; Female ; Middle Aged ; Diverticular Diseases/complications ; },
}

Humans
*Colorectal Neoplasms/complications/pathology
*Neoplasms, Second Primary
Colonoscopy
Risk Factors
Male
Aged
Female
Middle Aged
Diverticular Diseases/complications

@article {pmid39313293,
year = {2024},
author = {Ueland, TE and Mosley, JD and Neylan, C and Shelley, JP and Robinson, J and Gamazon, ER and Maguire, L and Peek, R and Hawkins, AT},
title = {Multiancestry transferability of a polygenic risk score for diverticulitis.},
journal = {BMJ open gastroenterology},
volume = {11},
number = {1},
pages = {},
doi = {10.1136/bmjgast-2024-001474},
pmid = {39313293},
issn = {2054-4774},
abstract = {OBJECTIVE: Polygenic risk scores (PRS) for diverticular disease must be evaluated in diverse cohorts. We sought to explore shared genetic predisposition across the phenome and to assess risk stratification in individuals genetically similar to European, African and Admixed-American reference samples.

METHODS: A 44-variant PRS was applied to the All of Us Research Program. Phenome-wide association studies (PheWAS) identified conditions linked with heightened genetic susceptibility to diverticular disease. To evaluate the PRS in risk stratification, logistic regression models for symptomatic and for severe diverticulitis were compared with base models with covariates of age, sex, body mass index, smoking and principal components. Performance was assessed using area under the receiver operating characteristic curves (AUROC) and Nagelkerke's R[2].

RESULTS: The cohort comprised 181 719 individuals for PheWAS and 50 037 for risk modelling. PheWAS identified associations with diverticular disease, connective tissue disease and hernias. Across ancestry groups, one SD PRS increase was consistently associated with greater odds of severe (range of ORs (95% CI) 1.60 (1.27 to 2.02) to 1.86 (1.42 to 2.42)) and of symptomatic diverticulitis ((95% CI) 1.27 (1.10 to 1.46) to 1.66 (1.55 to 1.79)) relative to controls. European models achieved the highest AUROC and Nagelkerke's R[2] (AUROC (95% CI) 0.78 (0.75 to 0.81); R[2] 0.25). The PRS provided a maximum R[2] increase of 0.034 and modest AUROC improvement.

CONCLUSION: Associations between a diverticular disease PRS and severe presentations persisted in diverse cohorts when controlling for known risk factors. Relative improvements in model performance were observed, but absolute change magnitudes were modest.},
}

@article {pmid39296474,
year = {2024},
author = {Bhojani, F and Ahmed Memon, W and Ahmad, MN and Muhammad Zohaib Uddin, M and Khan, S and Nadeem, N and Khan, F and Zafar, U},
title = {Cholecystocolonic fistula secondary to ascending colon diverticular disease: A case report.},
journal = {Clinical case reports},
volume = {12},
number = {9},
pages = {e9405},
pmid = {39296474},
issn = {2050-0904},
abstract = {Cholecystocolonic fistula occurring as a complication of colonic diverticular disease is a rarely encountered clinical entity in which the patient may remain asymptomatic or present with vague abdominal or systemic symptoms. Imaging studies are usually not very reliable or effective in detecting direct communication between gallbladder and colon. However, indirect signs such as pneumobilia, gallstones, gallbladder adherent to colon and colonic diverticulosis may help reach the diagnosis. Treatment of cholecystocolonic fistula in symptomatic patients is usually surgical. However, in asymptomatic patients or patients with risk factors and comorbidities, non-surgical options such as conservative management or biliary stenting can be considered.},
}

@article {pmid39273627,
year = {2024},
author = {Cappelletti, M and Pallotta, L and Vona, R and Tinari, A and Pisano, A and Casella, G and Crocetti, D and Carlomagno, D and Tattoli, I and Giordano, C and Matarrese, P and Severi, C},
title = {The Unexplored Role of Mitochondria-Related Oxidative Stress in Diverticular Disease.},
journal = {International journal of molecular sciences},
volume = {25},
number = {17},
pages = {},
doi = {10.3390/ijms25179680},
pmid = {39273627},
issn = {1422-0067},
support = {000106_22_RS__SEVER PROGETTI ATENEO MEDI 2021 SEVERI//Sapienza University/ ; },
mesh = {Humans ; *Oxidative Stress ; *Mitochondria/metabolism ; Male ; Female ; Middle Aged ; Acetylcysteine/pharmacology ; Aged ; Diverticular Diseases/metabolism ; Membrane Potential, Mitochondrial ; Antioxidants/pharmacology/metabolism ; },
abstract = {The pathophysiology of diverticular disease (DD) is not well outlined. Recent studies performed on the DD human ex vivo model have shown the presence of a predominant transmural oxidative imbalance whose origin remains unknown. Considering the central role of mitochondria in oxidative stress, the present study evaluates their involvement in the alterations of DD clinical phenotypes. Colonic surgical samples of patients with asymptomatic diverticulosis, complicated DD, and controls were analyzed. Electron microscopy, protein expression, and cytofluorimetric analyses were performed to assess the contribution of mitochondrial oxidative stress. Functional muscle activity was tested on cells in response to contractile and relaxant agents. To assess the possibility of reverting oxidative damages, N-acetylcysteine was tested on an in vitro model. Compared with the controls, DD tissues showed a marketed increase in mitochondrial number and fusion accompanied by the altered mitochondrial electron transport chain complexes. In SMCs, the mitochondrial mass increase was accompanied by altered mitochondrial metabolic activity supported by a membrane potential decrease. Ulteriorly, a decrease in antioxidant content and altered contraction-relaxation dynamics reverted by N-acetylcysteine were observed. Therefore, the oxidative stress-driven alterations resulted in mitochondrial impairment. The beneficial effects of antioxidant treatments open new possibilities for tailored therapeutic strategies that have not been tested for this disease.},
}

Humans
*Oxidative Stress
*Mitochondria/metabolism
Male
Female
Middle Aged
Acetylcysteine/pharmacology
Aged
Diverticular Diseases/metabolism
Membrane Potential, Mitochondrial
Antioxidants/pharmacology/metabolism

@article {pmid39254206,
year = {2024},
author = {Ueland, TE and Vimalathas, P and Sweeting, RS and Shroder, MM and Younan, SA and Hawkins, AT},
title = {Social Determinants of Health in Diverticulitis: A Systematic Review.},
journal = {Diseases of the colon and rectum},
volume = {},
number = {},
pages = {},
doi = {10.1097/DCR.0000000000003425},
pmid = {39254206},
issn = {1530-0358},
abstract = {BACKGROUND: There is growing interest in social determinants of health for surgical populations. Within diverticulitis, no systematic collation of available evidence has been performed.

OBJECTIVE: To assess frequency, variety, and association directions for social determinants of health in colonic diverticular disease.

DATA SOURCES: Four electronic databases were queried: PubMed, Embase, Cochrane, and Web of Science.

STUDY SELECTION: Included studies reported symptomatic left-sided colonic diverticular disease with respect to a social determinant of health according to the Healthy People 2030 initiative or applicable proxy variable. Studies with non-English full text, cohort size fewer than 50, pediatric cohorts, and exclusively non-left sided disease were excluded.

MAIN OUTCOME MEASURES: Quality assessment through modified Newcastle-Ottawa scale, frequency of variables reported, and effect size trends for common comparisons.

RESULTS: Among 50 included studies, 40 were good and 10 were fair in quality. Social determinants of health in diverticulitis were identified across Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context domains. The two most common variables were self-reported race and ethnicity (n = 33) and insurance (n = 22). Among 18 unique studies reporting comparisons of white versus any other self-reported race and ethnicity, twelve identified a disparity disadvantaging non-white groups with effect sizes (95% confidence interval ranging from 1.23 [1.10 -1.37] to 5.35 [1.32 - 21.61]). Among 15 unique studies reporting a non-private versus private insurance comparison, nine identified non-private insurance as a risk factor with effect sizes (95% confidence intervals ranging from 1.15 [1.02 - 1.29] to 3.83 [3.01 - 4.87]).

LIMITATIONS: Retrospective studies, heterogeneity across cohort and variable definitions.

CONCLUSIONS: Social determinants of health domains are associated with a variety of diverticulitis outcomes. Additional studies are needed to address infrequently reported domains and identify optimal strategies for intervening in clinical settings.

PROSPERO ID: CRD42023422606.},
}

@article {pmid39251923,
year = {2024},
author = {Wang, Y and Bi, Y and Wang, Y and Ji, F and Zhang, L},
title = {Genetic estimation of causalities between educational attainment with common digestive tract diseases and the mediating pathways.},
journal = {BMC gastroenterology},
volume = {24},
number = {1},
pages = {304},
pmid = {39251923},
issn = {1471-230X},
abstract = {BACKGROUND: The association between education, intelligence, and cognition with digestive tract diseases has been established. However, the specific contribution of each factor in the pathogenesis of these diseases are still uncertain.

METHOD: This study employed multivariable Mendelian randomization (MR) to assess the independent effects of education, intelligence, and cognition on gastrointestinal conditions in the FinnGen and UK Biobank European-ancestry populations. A two-step MR approach was employed to assess the mediating effects of the association.

RESULTS: Meta-analysis of MR estimates from FinnGen and UK Biobank showed that 1- SD (4.2 years) higher education was causally associated with lower risks of gastroesophageal reflux (OR: 0.58; 95% CI: 0.50, 0.66), peptic ulcer (OR: 0.57; 95% CI: 0.47, 0.69), irritable bowel syndrome (OR: 0.70; 95% CI: 0.56, 0.87), diverticular disease (OR: 0.69; 95% CI: 0.61, 0.78), cholelithiasis (OR: 0.68; 95% CI: 0.59, 0.79) and acute pancreatitis (OR: 0.54; 95% CI: 0.41, 0.72), independently of intelligence and cognition. These causal associations were mediating by body mass index (3.7-22.3%), waist-to-hip ratio (8.3-11.9%), body fat percentage (4.1-39.8%), fasting insulin (1.4-5.5%) and major depression (6.0-12.4%).

CONCLUSION: Our findings demonstrate a causal and independent association between education and six common digestive tract diseases. Additionally, our study highlights five mediators as crucial targets for preventing digestive tract diseases associated with lower education levels.},
}

@article {pmid39241130,
year = {2024},
author = {Dorohavtseva, HA and Dorofieiev, AE and Dyadyk, OO and Myroshnychenko, MS},
title = {Morphological and functional features of the colonic mucus barrier in patients with symptomatic uncomplicated diverticular disease and acute uncomplicated diverticulitis.},
journal = {Wiadomosci lekarskie (Warsaw, Poland : 1960)},
volume = {77},
number = {7},
pages = {1331-1337},
doi = {10.36740/WLek202407105},
pmid = {39241130},
issn = {0043-5147},
mesh = {Humans ; Male ; Female ; *Intestinal Mucosa/pathology/metabolism ; Middle Aged ; Aged ; Mucus/metabolism ; Colon/pathology/metabolism ; Diverticulitis, Colonic/pathology/metabolism ; Acute Disease ; Adult ; Mucin-2/metabolism ; Goblet Cells/pathology/metabolism ; },
abstract = {OBJECTIVE: Aim: The purpose was to identify the morphological and functional features of the colonic mucus barrier in patients with symptomatic uncomplicated diverticular disease and acute uncomplicated diverticulitis.

PATIENTS AND METHODS: Materials and Methods: In the research, three groups were formed. Group 1 included fragments of the mucous membrane of the large intestine, which were collected from 12 people during autopsies. The results of autopsies and histological examination of the material did not reveal any gastrointestinal pathology. Group 2 included biopsies of the mucous membrane of the large intestine from the area of the diverticulum of 34 patients with symptomatic uncomplicated diverticular disease. Group 3 included biopsies of the mucous membrane of the large intestine of 26 patients with acute uncomplicated diverticulitis. Histological (hematoxylin and eosin staining), histochemical (PAS reaction) and immunohistochemical (mouse monoclonal antibodies to Mucin 2 (MUC2) and Mucin 4 (MUC4)) staining methods were used. A morphometric study was also carried out.

RESULTS: Results: In patients with diverticular disease, the authors identified disturbances in the morphofunctional state of the mucus barrier of the colon, the structure and function of goblet cells contained in its mucous membrane, characterized by a decrease in the thickness of the mucus layer covering the surface of the mucous membrane; a decrease in the size and number of goblet cells with a decrease in their mucus-producing ability; a change in the mucin profile, characterized by a violation of the content of MUC2 and MUC4. These changes were greatest in patients with acute uncomplicated diverticulitis compared with patients with symptomatic uncomplicated diverticular disease.

CONCLUSION: Conclusions: The identified disturbances in the morphofunctional state of the mucus barrier of the colon, structural and functional changes in goblet cells may be one of the mechanisms for the development of acute uncomplicated diverticulitis and symptomatic uncomplicated diverticular disease.},
}

Humans
Male
Female
*Intestinal Mucosa/pathology/metabolism
Middle Aged
Aged
Mucus/metabolism
Colon/pathology/metabolism
Diverticulitis, Colonic/pathology/metabolism
Acute Disease
Adult
Mucin-2/metabolism
Goblet Cells/pathology/metabolism

@article {pmid39226090,
year = {2024},
author = {Hawkins, AT and Fa, A and Younan, SA and Ivatury, SJ and Bonnet, K and Schlundt, D and Gordon, EJ and Cavanaugh, KL},
title = {Decision Aid for Colectomy in Recurrent Diverticulitis: Development and Usability Study.},
journal = {JMIR formative research},
volume = {8},
number = {},
pages = {e59952},
doi = {10.2196/59952},
pmid = {39226090},
issn = {2561-326X},
mesh = {Humans ; *Colectomy/methods ; *Decision Support Techniques ; Recurrence ; Diverticulitis/surgery ; Female ; Male ; Middle Aged ; Adult ; Patient Education as Topic/methods ; Aged ; },
abstract = {BACKGROUND: Diverticular disease is a common gastrointestinal diagnosis with over 2.7 million clinic visits yearly. National guidelines from the American Society of Colon and Rectal Surgeons state that "the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized." However, tools to individualize this decision are lacking.

OBJECTIVE: This study aimed to develop an online educational decision aid (DA) to facilitate effective surgeon and patient communication about treatment options for recurrent left-sided diverticulitis.

METHODS: We used a modified design sprint methodology to create a prototype DA. We engaged a multidisciplinary team and adapted elements from the Ottawa Personal Decision Guide. We then iteratively refined the prototype by conducting a mixed methods assessment of content and usability testing, involving cognitive interviews with patients and surgeons. The findings informed the refinement of the DA. Further testing included an in-clinic feasibility review.

RESULTS: Over a 4-day in-person rapid design sprint, including patients, surgeons, and health communication experts, we developed a prototype of a diverticulitis DA, comprising an interactive website and handout with 3 discrete sections. The first section contains education about diverticulitis and treatment options. The second section clarifies the potential risks and benefits of both clinical treatment options (medical management vs colectomy). The third section invites patients to participate in a value clarification exercise. After navigating the DA, the patient prints a synopsis that they bring to their clinic appointment, which serves as a guide for shared decision-making.

CONCLUSIONS: Design sprint methodology, emphasizing stakeholder co-design and complemented by extensive user testing, is an effective and efficient strategy to create a DA for patients living with recurrent diverticulitis facing critical treatment decisions.},
}

Humans
*Colectomy/methods
*Decision Support Techniques
Recurrence
Diverticulitis/surgery
Female
Male
Middle Aged
Adult
Patient Education as Topic/methods
Aged

@article {pmid39209318,
year = {2024},
author = {Kim, KO},
title = {Recent updates on classification and unsolved issues of diverticular disease: a narrative review.},
journal = {Journal of Yeungnam medical science},
volume = {},
number = {},
pages = {},
doi = {10.12701/jyms.2024.00542},
pmid = {39209318},
issn = {2799-8010},
abstract = {Recently, a paradigm shift has occurred in the classification of diverticular disease and the understanding of its pathogenesis. Diverticular disease is now defined as a variety of clinically significant conditions such as diverticulitis, diverticular bleeding, symptomatic uncomplicated diverticular disease, and segmental colitis associated with diverticulosis. Low-grade inflammation, visceral hypersensitivity, abnormal intestinal motility, and genetic factors have emerged as the key contributors to the pathogenesis of diverticular disease. Routine antibiotic use is no longer recommended for all cases of diverticulitis, and simple recurrence is not an indication for surgical treatment. Early colonoscopy with proper preparation is recommended for the treatment of diverticular bleeding, although recent studies have not shown significant efficacy in preventing recurrence. The roles of dietary fiber, nonabsorbable antibiotics, 5-aminosalicylates, and probiotics in the prevention of diverticular disease are controversial and require further investigation.},
}

@article {pmid39209191,
year = {2024},
author = {Kader, R and Hadjinicolaou, AV and Burr, NE and Paul, B and Ahmad, OF and Lasse, P and Manish, C and Roland, V and Danail, S and Lovat, LB},
title = {SYSTEMATIC REVIEW AND META-ANALYSIS: THE THREE-YEAR POST-COLONOSCOPY COLORECTAL CANCER RATE AS PER THE WEO METHODOLOGY.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {},
number = {},
pages = {},
doi = {10.1016/j.cgh.2024.07.039},
pmid = {39209191},
issn = {1542-7714},
abstract = {BACKGROUND AND AIMS: In 2018, the World Endoscopy Organization (WEO) introduced standardised methods for calculating post-colonoscopy colorectal cancer-3yr rates (PCCRC-3yr). This systematic review aimed to calculate the global PCCRC-3yr according to the WEO methodology, its change over time, and to measure the association between risk factors and PCCRC occurrences.

METHODS: We searched five databases from inception until January 2024 for PCCRC-3yr studies that strictly adhered to the WEO methodology. The overall pooled PCCRC-3yr was calculated. For risk factors and time-trend analyses, the pooled PCCRC-3yr and odds ratio (OR) of subgroups were compared.

RESULTS: Several studies failed to adhere to the WEO methodology. Eight studies from four Western European and two Northern American countries were included, totalling 220,106 detected-colorectal cancers (CRC) and 18,148 PCCRCs between 2002-2017. The pooled Western World PCCRC-3yr was 7.5% (95%CI 6.4%-8.7%). The PCCRC-3yr significantly (p<0.05) decreased from 7.9% (95%CI 6.6%-9.4%) in 2006 to 6.7% (95%CI 6.1%-7.3%) in 2012 (OR 0.79 (95%CI 0.72-0.87)). There were significantly higher rates for people with inflammatory bowel disease (PCCRC-3yr 29.3%, OR 6.17 (95%CI 4.73-8.06)), prior CRC (PCCRC-3yr 29.8%, OR 3.03 (95% CI 1.34-4.72)), proximal CRC (PCCRC-3yr 8.6%, OR 1.51 (95%CI 1.41-1.61), diverticular disease (PCCRC 3-yr 11.6%, OR 1.74 (95%CI 1.37-2.10)) and female sex (PCCRC-3yr 7.9%, OR 1.15 (95%CI 1.11-1.20)).

CONCLUSION: According to the WEO methodology, the Western World PCCRC-3yr was 7.5%. Reassuringly, this has decreased over time, but further work is required to identify the reasons for PCCRCs, especially in higher-risk groups. We devised a WEO methodology checklist to increase its adoption and standardise the categorisation of patients in future PCCRC-3yr studies.},
}

@article {pmid39202053,
year = {2024},
author = {Völkerer, A and Wernly, S and Semmler, G and Flamm, M and Radzikowski, K and Datz, L and Götz, N and Hofer, H and Aigner, E and Datz, C and Wernly, B},
title = {Association between Cardiovascular Risk Assessment by SCORE2 and Diverticulosis: A Cross-Sectional Analysis.},
journal = {Journal of personalized medicine},
volume = {14},
number = {8},
pages = {},
doi = {10.3390/jpm14080862},
pmid = {39202053},
issn = {2075-4426},
abstract = {BACKGROUND: The aim of this retrospective observational study was to examine the relationship between SCORE2 and the occurrence of colonic diverticula in a screening population without cardiovascular or gastrointestinal symptoms. SCORE2, recognized and supported by the European Society of Cardiology for cardiovascular risk assessment, served as the primary metric for the analysis in this investigation.

METHODS: We studied 3935 asymptomatic individuals undergoing screening colonoscopy. SCORE2 was calculated for each participant and categorized into three groups based on the following projected 10-year cardiovascular disease risk: SCORE2 0-4.9%, SCORE2 5-9.9%, and SCORE2 ≥ 10%. Logistic regression was used to assess the relationship between SCORE2 and diverticulosis.

RESULTS: SCORE2 was associated with the presence of diverticulosis (OR 1.09, 95%CI 1.07-1.10; p < 0.001) in univariable logistic regression, translating into an RR of 1.07 per unit increase. The association persisted after multivariable adjusting for metabolic syndrome (aOR 1.08; 95%CI 1.06-1.10; p < 0.001). Patients with high cardiovascular risk had higher rates of diverticulosis compared to those with lower risk: high risk (OR 2.00, 95%CI 1.71-2.33; p < 0.001); very high risk (OR 2.53, 95%CI 2.10-3.05; p < 0.001). This association remained after adjusting for metabolic syndrome: high risk (aOR 1.86, 95%CI 1.59-2.18; p < 0.001); very high risk (aOR 2.27, 95%CI 1.88-2.75; p < 0.001).

CONCLUSIONS: A higher SCORE2 was found to be a suitable screening parameter for diverticular disease. This suggests a potential link between cardiovascular risk factors and colon diverticula development, warranting further research on whether optimizing cardiovascular risk factors could positively influence diverticular disease.},
}

@article {pmid39200891,
year = {2024},
author = {Marasco, G and Bruni, A and Nardone, OM and Lopetuso, LR},
title = {Insights into Probiotic Prescription among Gastroenterologists and Other Healthcare Professionals: Evidence from an Italian Survey.},
journal = {Journal of clinical medicine},
volume = {13},
number = {16},
pages = {},
doi = {10.3390/jcm13164749},
pmid = {39200891},
issn = {2077-0383},
support = {Aggei Campus 2023//Noos/ ; },
abstract = {Background: Probiotics, which are live microorganisms that provide health benefits, have been extensively studied for their various clinical applications. However, despite their potential, high-quality data supporting their use in several gastrointestinal diseases are often lacking, and prescription behaviors can widely differ. This study aimed to assess different behaviors in probiotics knowledge and prescriptions among Italian gastroenterologists and healthcare professionals (HPs). Methods: A web-based electronic survey was distributed to all participants at the National Meeting of the Italian Young Gastroenterologist and Endoscopist Association (AGGEI) held in 2023. The survey investigated probiotic prescription practices for several gastrointestinal conditions, such as acute diarrhea, irritable bowel syndrome, inflammatory bowel disease, and diverticular disease. Results: Among 200 participants, 142 completed the survey, of whom 59 were gastroenterologists and 83 were HPs (surgeons, nutrition biologists, and other physicians). Significant differences were observed in the prescription of probiotics for the treatment of acute diarrhea and H. pylori. Both groups prescribed probiotics in monthly cycles for patients with IBS, although the majority prescribed multistrain formulations. Gastroenterologists were more likely to prescribe cyclic courses for IBS, while HPs tended to continue therapy by changing the probiotic strain in case of inefficacy. For ulcerative colitis, gastroenterologists prescribed probiotics more but for shorter durations. In Crohn's disease, gastroenterologists prescribed probiotics less and were less likely to prescribe multistrain formulations. Regarding SUDD, gastroenterologists tended to prescribe probiotics less frequently, although without a significant difference, with similar rates of preference for multistrain formulations. Conclusions: This survey highlights heterogeneous behaviors in probiotic prescription between gastroenterologists and HPs, with gastroenterologists more aligned with guidelines and available scientific evidence. Hence, enhancing probiotic education among healthcare professionals and gastroenterologists is crucial. Further studies are needed to better understand probiotics' role in gastrointestinal disorders through large-scale randomized controlled trials.},
}

@article {pmid39192934,
year = {2024},
author = {Uwumiro, FE and Olakunde, T and Fagbenro, A and Fadeyibi, I and Okpujie, V and Osadolor, AO and Emina, J and Odjighoro, GO and Obi, NJ and Erhus, E and Umenzeakor, K},
title = {Trends in Diverticular Disease Hospitalizations and Racial Disparities in Outcomes Across the United States.},
journal = {Cureus},
volume = {16},
number = {7},
pages = {e65572},
doi = {10.7759/cureus.65572},
pmid = {39192934},
issn = {2168-8184},
abstract = {Objective This study evaluated trends and racial disparities in hospitalization, clinical outcomes, and resource utilization for diverticular disease (DD) between 2017 and 2020. Methods We performed a retrospective analysis using the NIS database from 1 January 2017 to 31 December 2020 to study hospitalizations for DD (CCSR code: DIG013). Our primary outcomes were hospitalization rates, all-cause mortality, total charges, and length of stay. Secondary outcomes included in-hospital complications and discharge status. Outcomes were stratified by race and ethnicity (White, Black, Hispanic, Asian or Pacific Islanders and Native Americans). Data were weighted and adjusted for clustering, stratification, and other relevant factors. The normality of the continuous data distribution was confirmed using Kolmogorov-Smirnov, and descriptive statistics were used to summarize variables. Demographic characteristics were compared using χ[2] and Student's t-test, with significance set at P<0.05. We used stepwise multivariable logistic regression to estimate adjusted odds ratios for study outcomes by race and ethnicity, controlling for demographic and clinical factors and correcting for multicollinearity. Missing data were treated with multiple imputations, trend analyses were performed using Jonckheere-Terpstra tests, and costs were adjusted for inflation using the GDP price index. Analyses were conducted with Stata 17MP. Results A total of 1,266,539 hospitalizations for DD were included for analysis. Approximately 953,220 (75.3%) were White patients and 313,319 (24.7) did not belong to the White race. A total of 747,868 (59%) were women compared to 518,671 (41%) men. Compared to patients who were not of the White race, White patients were younger (63.5 vs. 66.8 years; p<0.001). Hospitalizations for DD increased by 1.2% from 323,764 to 327,770 hospitalizations (2017-2019) and decreased by 11.8% from 327,770 to 289,245 admissions in 2020. Mortality rates were higher among White patients than in those not of the White race (16,205 (1.7%) vs 5,013 (1.6%)). However, no significant difference was observed in mortality odds between both sets of patients (aOR, 0.953; 95% CI 0.881-1.032; P=0.237). Mortality rates showed an uptrend over the study period (4,850 (1.5%) in 2017 to 5,630 (1.9%) in 2020; Ptrend<0.001). DD accounted for 7,016,718 hospital days, 2,102,749 procedures, and US$ 6.8 billion in hospital costs. Mean hospital costs increased from US$54,705 to US$72,564 over the study period (P<0.000). Patients who were not of the White race incurred higher mean hospital charges than White patients ($67,635 ± $6,700 vs $59,103 ± $3,850; P<0.001). Black race correlated with lower odds of bowel perforation, routine home discharge, and bowel resection (P<0.001). Conclusion During the study period, hospitalization and mortality rates and resource utilization for DD increased. Patients from other races incurred higher hospital costs than White patients. White Americans were more likely to be discharged to skilled nursing, intermediate care, and other facilities. Additionally, White patients were less likely to develop bowel abscesses compared to patients who were not White. Compared to White American patients, Black patients had fewer DD hospitalizations complicated by bowel perforations or requiring bowel resections. In contrast, DD admissions among Hispanic patients were more likely to require bowel resections than those among White American patients.},
}

@article {pmid39180058,
year = {2024},
author = {Hua, X and McGoldrick, J and Nakrour, N and Staller, K and Chung, DC and Xavier, RJ and Khalili, H},
title = {Gut microbiome structure and function in asymptomatic diverticulosis.},
journal = {Genome medicine},
volume = {16},
number = {1},
pages = {105},
pmid = {39180058},
issn = {1756-994X},
support = {R01 AG068390/AG/NIA NIH HHS/United States ; DK043351//Center for the study of inflammatory bowel disease/ ; },
mesh = {Humans ; *Gastrointestinal Microbiome ; Male ; Female ; Middle Aged ; Aged ; Metagenomics/methods ; Colonoscopy ; Metagenome ; Bacteria/classification/genetics ; },
abstract = {BACKGROUND: Colonic diverticulosis, the most common lesion found in routine colonoscopy, affects more than 50% of individuals aged ≥ 60 years. Emerging evidence suggest that dysbiosis of gut microbiota may play an important role in the pathophysiology of diverticular disease. However, specific changes in microbial species and metabolic functions in asymptomatic diverticulosis remain unknown.

METHODS: In a cohort of US adults undergoing screening colonoscopy, we analyzed the gut microbiota using shotgun metagenomic sequencing. Demographic factors, lifestyle, and medication use were assessed using a baseline questionnaire administered prior to colonoscopy. Taxonomic structures and metabolic pathway abundances were determined using MetaPhlAn3 and HUMAnN3. We used multivariate association with linear models to identify microbial species and metabolic pathways that were significantly different between asymptomatic diverticulosis and controls, while adjusting for confounders selected a priori including age at colonoscopy, sex, body mass index (BMI), and dietary pattern.

RESULTS: Among 684 individuals undergoing a screening colonoscopy, 284 (42%) had diverticulosis. Gut microbiome composition explained 1.9% variation in the disease status of asymptomatic diverticulosis. We observed no significant differences in the overall diversity of gut microbiome between asymptomatic diverticulosis and controls. However, microbial species Bifidobacterium pseudocatenulatum and Prevotella copri were significantly enriched in controls (q value = 0.19 and 0.14, respectively), whereas Roseburia intestinalis, Dorea sp. CAG:317, and Clostridium sp. CAG: 299 were more abundant in those with diverticulosis (q values = 0.17, 0.24, and 0.10, respectively). We observed that the relationship between BMI and diverticulosis appeared to be limited to carriers of Bifidobacterium pseudocatenulatum and Roseburia intestinalis (Pinteraction = 0.09).

CONCLUSIONS: Our study provides the first large-scale evidence supporting taxonomic and functional shifts of the gut microbiome in individuals with asymptomatic diverticulosis. The suggestive interaction between gut microbiota and BMI on prevalent diverticulosis deserves future investigations.},
}

Humans
*Gastrointestinal Microbiome
Male
Female
Middle Aged
Aged
Metagenomics/methods
Colonoscopy
Metagenome
Bacteria/classification/genetics

@article {pmid39174483,
year = {2024},
author = {Forss, A and Ma, W and Thuresson, M and Sun, J and Ebrahimi, F and Bergman, D and Olén, O and Sundström, J and Ludvigsson, JF},
title = {Diverticular disease and risk of incident major adverse cardiovascular events: A nationwide matched cohort study.},
journal = {European heart journal. Quality of care & clinical outcomes},
volume = {},
number = {},
pages = {},
doi = {10.1093/ehjqcco/qcae074},
pmid = {39174483},
issn = {2058-1742},
abstract = {BACKGROUND: An increased risk of cardiovascular disease (CVD) has been reported in patients with diverticular disease (DD). However, there are knowledge gaps about specific risks of each major adverse cardiovascular event (MACE) component.

METHODS: This nationwide cohort study included Swedish adults with DD (1987-2017, N=52,468) without previous CVD. DD was defined through ICD codes in the National Patient Register and colorectal histopathology reports from the ESPRESSO study. DD cases were matched by age, sex, calendar year and county of residence to ≤5 population reference individuals (N=194,525). Multivariable-adjusted hazard ratios (aHRs) for MACE up until December 2021 were calculated using stratified Cox proportional hazard models.

RESULTS: Median age at DD diagnosis was 62 years and 61% were females. During a median follow-up of 8.6 years, 16,147 incident MACE occurred in individuals with DD, and 48,134 in reference individuals (incidence rates (IRs)=61.4 vs. 43.8/1,000 person-years) corresponding to an aHR of 1.24 (95%CI=1.22-1.27), equivalent to one extra case of MACE for every 6 DD patients followed for 10 years. The risk was increased for ischemic heart disease (IR=27.9 vs. 18.6; aHR=1.36, 95%CI=1.32-1.40), congestive heart failure (IR=23.2 vs. 15.8; aHR=1.26, 95%CI=1.22-1.31), and stroke (IR=18.0 vs. 13.7; aHR=1.15, 95%CI=1.11-1.19). DD was not associated with cardiovascular mortality (IR=18.9 vs. 15.3; aHR=1.01, 95%CI=0.98-1.05). Results remained robust in sibling-controlled analyses.

CONCLUSIONS: Patients with DD had a 24% increased risk of MACE compared with reference individuals, but no increased cardiovascular mortality. Future research should confirm these data and examine underlying mechanisms and shared risk factors between DD and CVD.},
}

@article {pmid39170693,
year = {2024},
author = {Su, T and Peng, X and Gan, Y and Wu, H and Ma, S and Zhi, M and Lu, Y and Dai, S and Yao, J},
title = {Associations of genetically predicted iron status with 24 gastrointestinal diseases and gut microbiota: a Mendelian randomization study.},
journal = {Frontiers in genetics},
volume = {15},
number = {},
pages = {1406230},
pmid = {39170693},
issn = {1664-8021},
abstract = {BACKGROUND: Iron status has been implicated in gastrointestinal diseases and gut microbiota, however, confounding factors may influence these associations.

OBJECTIVE: We performed Mendelian randomization (MR) to investigate the associations of iron status, including blood iron content, visceral iron content, and iron deficiency anemia with the incidence of 24 gastrointestinal diseases and alterations in gut microbiota.

METHODS: Independent genetic instruments linked with iron status were selected using a genome-wide threshold of p = 5 × 10-6 from corresponding genome-wide association studies. Genetic associations related to gastrointestinal diseases and gut microbiota were derived from the UK Biobank, the FinnGen study, and other consortia.

RESULTS: Genetically predicted higher levels of iron and ferritin were associated with a higher risk of liver cancer. Higher levels of transferrin saturation were linked to a decreased risk of celiac disease, but a higher risk of non-alcoholic fatty liver disease (NAFLD) and liver cancer. Higher spleen iron content was linked to a lower risk of pancreatic cancer. Additionally, higher levels of liver iron content were linked to a higher risk of NAFLD and liver cancer. However, certain associations lost their statistical significance upon accounting for the genetically predicted usage of cigarettes and alcohol. Then, higher levels of iron and ferritin were associated with 11 gut microbiota abundance, respectively. In a secondary analysis, higher iron levels were associated with lower diverticular disease risk and higher ferritin levels with increased liver cancer risk. Higher levels of transferrin saturation were proven to increase the risk of NAFLD, alcoholic liver disease, and liver cancer, but decrease the risk of esophageal cancer. MR analysis showed no mediating relationship among iron status, gut microbiota, and gastrointestinal diseases.

CONCLUSION: This study provides evidence suggesting potential causal associations of iron status with gastrointestinal diseases and gut microbiota, especially liver disease.},
}

@article {pmid39143638,
year = {2024},
author = {Yokota, H and Akamine, Y and Kobayashi, M and Kitabayashi, T and Horie, M and Endo, T and Yamada, T and Kikuchi, M},
title = {Naldemedine-induced perforation of a diverticulum in the sigmoid colon of a patient with opioid-related constipation: a case report.},
journal = {Journal of pharmaceutical health care and sciences},
volume = {10},
number = {1},
pages = {50},
pmid = {39143638},
issn = {2055-0294},
abstract = {BACKGROUND: Naldemedine is an orally available peripherally acting μ-opioid receptor antagonist approved to treat opioid-induced constipation (OIC). It is contraindicated for patients with known or suspected gastrointestinal obstruction to protect against naldemedine-induced perforation. Here, we report a clinical case of suspected perforation of a diverticulum in the sigmoid colon associated with naldemedine.

CASE PRESENTATION: The patient was a 65-year-old man with a history of oral cancer who had been prescribed oxycodone (20 mg/day) for cancer pain. On day 0, the patient started naldemedine 0.2 mg once daily before bedtime for OIC. The dose of oxycodone was increased for pain control up to 60 mg/day. On day 35 of naldemedine treatment, the patient developed fever and abdominal pain, and his frequency of defecation had decreased. Initial laboratory results showed a C-reactive protein (CRP) level of 28.5 mg/dL and white blood cell (WBC) count of 13,500/µL. On day 37, the patient still had tenderness in his lower abdomen. Abdominal computed tomography revealed free air in the abdominal cavity suggesting an intestinal perforation. A Hartmann procedure was performed. Histopathological findings showed numerous diverticula in the sigmoid colon, some of which were perforated.

CONCLUSIONS: These results suggest that the effects of OIC may have compressed the intestinal tract, which was followed by naldemedine-activation of peristalsis, which led to the onset of intestinal perforation. In patients with pre-existing diverticular disease, we should monitor for increased WBC counts and CRP levels after the initiation of treatment with naldemedine, and consider performing appropriate tests early in the event of abdominal complaints.},
}

@article {pmid39138701,
year = {2024},
author = {Barzi, KV and Galli, R and Denhaerynck, K and Rosenberg, R and von Strauss Und Torney, M},
title = {Quality of life with diverticular disease: translation and validation of the German version of the diverticulitis quality of life questionnaire (DV-QOL).},
journal = {Techniques in coloproctology},
volume = {28},
number = {1},
pages = {98},
pmid = {39138701},
issn = {1128-045X},
mesh = {Humans ; *Quality of Life ; Female ; Male ; Middle Aged ; Surveys and Questionnaires/standards ; Aged ; *Translations ; Reproducibility of Results ; Prospective Studies ; Language ; Adult ; Switzerland ; Diverticulitis/psychology ; Germany ; Factor Analysis, Statistical ; Aged, 80 and over ; Recurrence ; },
abstract = {BACKGROUND: The DV-QoL is a 17-item questionnaire measuring health-related quality of life in patients affected by symptomatic diverticular disease, covering four domains: physical symptoms, concerns, feelings, and behavioral changes. Given the lack of a diverticulitis-specific questionnaire to be used for German-speaking patients, we prospectively validated the German version of the DV-QoL.

METHODS: German-speaking patients with CT-confirmed history of recurrent diverticular disease admitted to a Swiss surgical department completed the German version of the DV-QoL, along with short form-36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI). Reliability was examined using exploratory and confirmatory factor analysis, a Martin-Loef test, and Cronbach's alpha. For convergent validity testing, correlations were calculated with the GIQLI and SF-36. Discriminant validity tests included age and gender.

RESULTS: We included 121 patients, of whom 77 were admissions for elective surgery and 44 presented with acute diverticulitis treated conservatively. The DV-QoL's total score showed good correlations with the GIQLI (r = - 0.77) and its subscales (r = - 0.76 to - 0.45), as well as with the SF-36's subscales (r = - 0.30 to - 0.57). No relationships were found with age or gender (p < 0.05). The Cronbach's alpha coefficient was 0.89 over all items and 0.69, 0.90, 0.78, and 0.77 for the four separated domains (physical symptoms, cognitions/concerns, feelings, and behavioral changes, respectively). A nonsignificant Martin-Loef test indicated unidimensionality (p = 1), further supported by the exploratory factor analysis, which showed an item information sharing of 65%.

CONCLUSION: The German DV-QoL questionnaire can be used as a valid and reliable disease-specific measure for quality of life in patients with recurrent diverticular disease.},
}

Humans
*Quality of Life
Female
Male
Middle Aged
Surveys and Questionnaires/standards
Aged
*Translations
Reproducibility of Results
Prospective Studies
Language
Adult
Switzerland
Diverticulitis/psychology
Germany
Factor Analysis, Statistical
Aged, 80 and over
Recurrence

@article {pmid39132315,
year = {2024},
author = {Yan, W and Zhou, J and Jiang, M and Kong, Y and Qin, H and Qi, Y and Wang, S and Tai, J},
title = {Obstructive sleep apnea and 19 gastrointestinal diseases: a Mendelian randomization study.},
journal = {Frontiers in psychiatry},
volume = {15},
number = {},
pages = {1256116},
pmid = {39132315},
issn = {1664-0640},
abstract = {BACKGROUND: Alterations gastrointestinal diseases (GDs) were reported in individuals with obstructive sleep apnea (OSA), however, the genetic background between OSA and GDs is still unclear.

METHODS: This investigation employed Mendelian randomization (MR) analyses to evaluate the causal effect between OSA and 19 types of GDs (gastroesophageal reflux disease (GERD), ulcerative colitis, celiac disease, Crohn's disease, chronic gastritis, irritable bowel syndrome, primary biliary cholangitis, diverticular disease, gastroduodenal ulcer, acute pancreatitis, non-alcoholic fatty liver disease, primary sclerosing cholangitis, cirrhosis, calculus of bile duct, calculus of gallbladder, pancreatic cancer, gastric cancer, colorectal cancer, and esophageal cancer). The inverse-variance weighted (IVW) method was used to evaluate the main effects model of causality.

RESULTS: This MR study suggests that OSA may play a causal role inflammation-related GDs (GERD, PIVW=5.94×10[-9]; gastroduodenal ulcer, PIVW=1×10[-4]; chronic gastritis, PIVW=0.0214; ulcerative colitis, PIVW=0.0296), and gallstones (calculi of the gallbladder, PIVW=0.0429; calculi of the bile duct, PIVW=0.0068). After accounting for obesity, type 2 diabetes, smoking, and alcohol consumption, the multivariate MR (MVMR) analysis identified that OSA is an independent risk factor for GERD, gastroduodenal ulcer, and calculus of the bile duct. The reverse MVMR analysis showed a causal effect of GERD on OSA. Besides, we did not find that the predisposition to OSA was associated with 4 cancers.

CONCLUSION: This MR analysis provides compelling evidence of an independent causal relationship between genetically predicted OSA and an elevated risk of inflammation-related GDs. Besides, no causal association was observed between OSA and cancers. Further studies should be carried out to verify our findings.},
}

@article {pmid39130890,
year = {2024},
author = {Johnson, MH and Nair, GA and Mack, CK and O'leary, S and Thang, CJ and Mao, RD and Shah, NR and Phatak, UR},
title = {Diverticulosis and Diverticulitis on YouTube: Is Popular Information the Most Reliable?.},
journal = {Cureus},
volume = {16},
number = {7},
pages = {e64322},
pmid = {39130890},
issn = {2168-8184},
abstract = {Background Patients utilize online health information to inform their medical decision-making. YouTube is one of the most popular media platforms with abundant health-related resources, yet the quality of the disseminated information remains unclear. This study aims to evaluate the quality and reliability of content pertaining to diverticulosis and diverticulitis on YouTube. Methods One author queried the terms "diverticulosis," "diverticulitis," "acute diverticulitis," and "chronic diverticulitis" on YouTube. The first 50 videos per search were selected for analysis. Duplicates, non-English videos, or procedural content were excluded. Video characteristics including view count, likes, comments, duration, days since upload, view ratio, video power index, and video sources (professional organizations (POs), health information websites (HIWs), and entertainment/independent users (EIUs)) were collected. Videos were scored using the mDISCERN and Global Quality Score (GQS). Results Sixty-four videos were included. DISCERN scores significantly differed between POs (n=20, mean=4.35), HIWs (n=29, mean=2.97), and EIUs (n=15, mean=1.83). GQS also significantly differed between POs (n=20, mean=4.47), HIWs (n=29, mean=3.62), and EIUs (n=15, mean=2.5). Video characteristics significantly differed between groups, with most user engagement seen in EIUs. Conclusion POs and HIWs disseminate higher quality health information about diverticular disease on YouTube. The higher viewer engagement with EIUs is concerning, as these sources were found to have lower quality content. Although YouTube has the capability to provide valuable information on diverticulosis and diverticulitis, enhanced content screening is needed to ensure accuracy and validation.},
}

@article {pmid39129950,
year = {2024},
author = {Zheng, NS and Ma, W and Shung, DL and Strate, LL and Chan, AT},
title = {Sex, Race, and Ethnicity Differences in Patients Presenting With Diverticular Disease at Emergency Departments in the United States: A National Cross-Sectional Study.},
journal = {Gastro hep advances},
volume = {3},
number = {2},
pages = {178-180},
pmid = {39129950},
issn = {2772-5723},
}

@article {pmid39129357,
year = {2024},
author = {Tursi, A and Piovani, D and Brandimarte, G and Di Mario, F and Elisei, W and Picchio, M and Figlioli, G and Bassotti, G and Allegretta, L and Annunziata, ML and Bafutto, M and Bianco, MA and Colucci, R and Conigliaro, R and Dumitrascu, DL and Escalante, R and Ferrini, L and Forti, G and Franceschi, M and Graziani, MG and Lammert, F and Latella, G and Lisi, D and Maconi, G and Compare, D and Nardone, G and Camara de Castro Oliveira, L and Enio, CO and Papagrigoriadis, S and Pietrzak, A and Pontone, S and Stundiene, I and Poškus, T and Pranzo, G and Reichert, MC and Rodino, S and Regula, J and Scaccianoce, G and Scaldaferri, F and Vassallo, R and Zampaletta, C and Zullo, A and Spaziani, E and Bonovas, S and Papa, A and Danese, S and , },
title = {Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international st.},
journal = {Intestinal research},
volume = {},
number = {},
pages = {},
doi = {10.5217/ir.2024.00046},
pmid = {39129357},
issn = {1598-9100},
abstract = {BACKGROUND/AIMS: Patients with diverticular disease (DD) frequently have abnormal bowel movements. However, it is unknown whether the entity of these alterations is associated with the severity of DD. We aimed to assess bowel habits and their relationship with the severity of DD according to Diverticular Inflammation and Complication Assessment (DICA) classification, Combined Overview on Diverticular Assessment (CODA) score, and fecal calprotectin (FC).

METHODS: An international, multicenter, prospective cohort study was conducted in 43 centers. A 10-point visual analog scale (VAS) was used to assess the severity of constipation and diarrhea. The association of constipation and diarrhea with DICA classification, CODA score, and basal FC was tested using non-parametric tests. Survival methods for censored observations were applied to test the association of constipation and diarrhea with the incidence of acute diverticulitis over a 3-year follow-up.

RESULTS: Of 871 patients with DD were included in the study. Of these, 208 (23.9%) and 199 (22.9%) reported a VAS score for constipation and diarrhea at least 3 at baseline, respectively. Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P< 0.001). Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.04-1.27; P=0.004; and HRdiarrhea =1.14; 95% CI, 1.03-1.26; P=0.014, respectively).

CONCLUSIONS: In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.},
}

@article {pmid39122849,
year = {2024},
author = {Bourgan, LM and Emole, A and Khalil, ME and Londeree, JJ and Frezza, EE},
title = {Colo-salpingeal fistula: a rare gynecologic manifestation of diverticular disease.},
journal = {Archives of gynecology and obstetrics},
volume = {},
number = {},
pages = {},
pmid = {39122849},
issn = {1432-0711},
abstract = {INTRODUCTION: Diverticulitis can be complicated by fistulas between the colon and neighboring structures, which predispose to significant morbidity and mortality. Fistulas involving the female urogenital tract often present with urogynecologic symptoms, such as vaginal discharge or recurrent urinary tract infections. While colo-vaginal fistulas, a more common variant, often present with vaginal flatulence, colo-salpingeal fistulas are exceedingly rare and have not been reported with this symptomatology. We describe a case of colo-saplingeal fistula presenting with vaginal flatulence, requiring multidisciplinary collaboration for diagnosis and management.

CASE: A 63-year-old woman presented with vaginal flatulence in the setting of persistent diverticulitis. Computed tomography (CT) scan revealed sigmoid diverticulitis, a submucosal abscess abutting the uterus, and air within the endometrial cavity, raising suspicion for a colo-uterine fistula. Following transient symptomatic relief with medical management and antibiotics, recurrence of symptoms prompted surgical intervention. Laparoscopic exploration allowed diagnosis of the colo-salpingeal fistula. Sigmoid colectomy and left salpingo-oophorectomy were performed with a minimally invasive surgical approach, resulting in an uncomplicated recovery with remission of symptoms.

DISCUSSION: This rare case highlights novel gynecologic symptoms for a colo-salpingeal fistula, contrasted with reported presentations through a comprehensive literature review. This case underscores the importance of recognizing gynecologic symptoms related to diverticular disease, which may be subtle, but provide important considerations for prognosis and treatment. A multidisciplinary approach to care from diagnosis through surgery allowed for successful recognition and minimally invasive treatment of this anomalous condition before further complications could arise. Ultimately, surgical approaches to diverticulitis-associated gynecologic fistulas should be individualized.},
}

@article {pmid39099908,
year = {2024},
author = {Tsaramanidis, SC and Gkoutziotis, I and Zacharioudakis, G and Fouza, A and Mpallas, K},
title = {Hinchey III Diverticulitis in a 31-Year-Old Patient With Williams Syndrome: A Case Report.},
journal = {Cureus},
volume = {16},
number = {7},
pages = {e63898},
pmid = {39099908},
issn = {2168-8184},
abstract = {Williams syndrome was first reported by Williams and Beuren in 1961-1962. It is a genetic disorder that is caused by a sporadic microdeletion of chromosome 7, which includes the elastin gene. The development of gastrointestinal pathology, such as diverticular disease, is associated with the deletion of this specific gene. Almost one-third of patients with Williams syndrome develop diverticular disease. The first episode of diverticulitis appears in 8% of patients, diagnosed with Williams syndrome, before the age of 40. According to the literature, in the case of complicated diverticulitis (Hinchey III) in patients with WS, the treatment is mainly surgical resection of sigmoid and colostomy (Hartmann procedure) or anastomosis. We present an interesting case with a 31-year-old male, with Williams syndrome and Hinchey III diverticulitis, who underwent laparoscopic lavage and primary closure of the perforation. To our knowledge, this is the first case in literature that a patient with Williams syndrome and complicated diverticulitis (Hinchey III) was treated this way and the results until now are encouraging.},
}

@article {pmid39093005,
year = {2024},
author = {Ritieni, C and Sbarigia, C and Scalamonti, S and Annibale, B and Carabotti, M},
title = {Symptomatic uncomplicated diverticular disease: a critical appraisal.},
journal = {Expert review of gastroenterology & hepatology},
volume = {},
number = {},
pages = {},
doi = {10.1080/17474124.2024.2388797},
pmid = {39093005},
issn = {1747-4132},
abstract = {INTRODUCTION: Symptomatic uncomplicated diverticular disease (SUDD) is a clinical condition included in the spectrum of symptomatic diverticular disease. The symptom profile associated with SUDD is highly heterogeneous, as there are currently discordant definitions, that encompass many clinical scenarios.

AREAS COVERED: We conducted a narrative review to assess the symptom profile and diagnostic criteria of SUDD based on the available evidence. A thorough literature search was performed on PubMed following the SANRA scale. Abdominal pain, regardless of its duration and location, emerges as the cardinal symptom of SUDD, suggesting that it should be central to its diagnosis. Although abdominal bloating and changes in bowel habits are commonly reported, they do not appear to be specifically attributable to SUDD. Other issues considered are the possible overlap with irritable bowel syndrome and the identification of a subcategory of SUDD patients with chronic symptoms following an episode of acute diverticulitis.

EXPERT OPINION: The future agenda should include the development of shared diagnostic criteria for SUDD, including well-defined inclusion and exclusion clinical features and symptom patterns.},
}

@article {pmid39078491,
year = {2024},
author = {Brière, R and Simard, AJ and Rouleau-Fournier, F and Letarte, F and Bouchard, P and Drolet, S},
title = {Correction to: Retrospective study on the feasibility and safety of laparoscopic surgery for complicated fistulizing diverticular disease in a high-volume colorectal center.},
journal = {Langenbeck's archives of surgery},
volume = {409},
number = {1},
pages = {232},
doi = {10.1007/s00423-024-03425-6},
pmid = {39078491},
issn = {1435-2451},
}

@article {pmid39073537,
year = {2024},
author = {Konyukova, AK and Mikhaleva, LM and Kozlova, MA and Areshidze, DA and Pechnikova, VV and Shapovaliants, SG and Mikhalev, AI and Bolikhov, KV and Shulaev, AV},
title = {[Pathological changes in the muscular tissue of the colon in diverticular disease].},
journal = {Arkhiv patologii},
volume = {86},
number = {4},
pages = {13-22},
doi = {10.17116/patol20248604113},
pmid = {39073537},
issn = {0004-1955},
mesh = {Humans ; Male ; Female ; Middle Aged ; Aged ; Adult ; *Colon/pathology/surgery ; Muscle, Smooth/pathology ; Aged, 80 and over ; Sex Factors ; },
abstract = {UNLABELLED: The high incidence of colonic diverticular disease (DD) in the general population is a serious public health problem. According to statistics, DD is among the top five most common colorectal diseases. Complicated course of DD is observed in 12-15% of patients, and in 10.7% of cases can lead to death. Algorithms and recommendations for predicting the complicated course of DD for further prevention have not been developed.

OBJECTIVE: Comparative analysis of clinical data and structural characteristics of the colonic muscular tissue in patients with different course of DD and without colonic diverticula to identify morphological predictors of a complicated DD.

MATERIAL AND METHODS: A comparative analysis of clinical data, pathomorphological and ultrastructural changes of the colonic musculature in the surgical material from 68 patients undergoing left-sided hemicolectomy was carried out.

RESULTS: The operative material of 37 patients with complicated course of DD, 19 with uncomplicated course of DD and 12 without diverticula was analyzed. In men, this disease occurs at a younger age than in women (Median age of men 49 (39.5; 61) years, women 66.5 (58; 81) years; U=178, p<0.001). It was shown that the area occupied by connective tissue fibres in the colonic musculature in patients with a complicated DD was 5 times greater (15%) than in observations with an uncomplicated DD (3%) and 50 times greater than in cases without colonic diverticula (0.3%; p<0.001).

CONCLUSION: The present study demonstrates age- and sex-specific features of DD, as well as significant differences in the prevalence of fibrosis of the colonic musculature, which can be considered as a potential predictor of a complicated course of DD.},
}

Humans
Male
Female
Middle Aged
Aged
Adult
*Colon/pathology/surgery
Muscle, Smooth/pathology
Aged, 80 and over
Sex Factors

@article {pmid39073239,
year = {2024},
author = {Boechler, M and Fu, YP and Raja, N and Ruiz-Escobar, E and Nimmagadda, L and Osgood, S and Levin, MD and Hadigan, C and Kozel, BA},
title = {Gastrointestinal manifestations in Williams syndrome: A prospective analysis of an adult and pediatric cohort.},
journal = {American journal of medical genetics. Part A},
volume = {},
number = {},
pages = {e63827},
doi = {10.1002/ajmg.a.63827},
pmid = {39073239},
issn = {1552-4833},
support = {//Division of Intramural Research for the National Heart, Lung, and Blood Institute/ ; //National Institute of Allergy and Infectious Disease/ ; //Clinical Center of the National Institutes of Health/ ; },
abstract = {Williams syndrome (WS) is a multi-system condition caused by the deletion of 25-27 coding genes on human chromosome 7. Irritability, gastrointestinal (GI) reflux and slow growth are commonly reported in infants with WS, but less data exist regarding GI concerns in older children and adults with the condition. This study evaluates 62 individuals with WS (31 children aged 3-17, and 31 adults aged 18-62) as well as 36 pediatric and adult controls to assess current and historical rates of common GI symptoms. Data were evaluated using a regression model including age, sex, self-reported race, and diagnosis. Symptoms including food intolerance, reflux, dysphagia, choking/gagging, vomiting, constipation, bloating, diarrhea, hematochezia, rectal prolapse, abdominal pain, and weight loss are more common in those with WS relative to controls. In addition, people with WS utilize more GI medications, specialty care, procedures, and supplemental feeds. Among those with WS, symptoms were present at similar rates in children and adults, except for diverticular disease, which was not noted until adulthood. GI symptoms are frequent in people with WS and serve as a significant source of morbidity.},
}

@article {pmid39051586,
year = {2024},
author = {Tursi, A and Mocci, G and Usai Satta, P and Elisei, W},
title = {Impact of a Symbiotic Mixture on Moderate-to-severe Diverticular Disease of the Colon.},
journal = {Reviews on recent clinical trials},
volume = {},
number = {},
pages = {},
doi = {10.2174/0115748871308652240712101604},
pmid = {39051586},
issn = {1876-1038},
abstract = {BACKGROUND: Microbial imbalance is thought to play a role in the pathogenesis of Diverticular Disease (DD).

OBJECTIVE: We aimed to assess the efficacy of a symbiotic mixture (Prolactis GG Plus®) in the treatment of moderate to severe DD, scored according to the Diverticular Inflammation and Complication Assessment (DICA) classification.

METHODS: A retrospective study was conducted enrolling the following patients: at the first diagnosis of DD; in whom DD was diagnosed with colonoscopy and scored according to DICA classification; treated with Prolactis GG Plus® two times/daily for 2 consecutive months; in whom the severity of the abdominal pain was scored with a 10-points visual-analogue scale (VAS) at baseline and the end of follow-up; in whom fecal calprotectin (FC) was assessed at baseline and the end of follow-up as μg/g.

RESULTS: Twenty-four patients were identified (10 males, 14 females; 16 as DICA 2, and 8 as DICA 3). Prolactis GG Plus® decreased the severity of abdominal pain both in DICA 2 (p =0.02) and DICA 3 patients (p =0.01), while FC decreased significantly in DICA 2 (p <0.02) but not in DICA 3 (p =0.123) patients. Acute diverticulitis occurred during the follow-up in two DICA 3 patients but none DICA 2 patients. Add-on therapy was required by eight DICA 2 (50%) and six DICA 3 patients (75%).

CONCLUSION: In newly diagnosed patients with DD, the symbiotic mixture Prolactis GG Plus® can be a potential treatment for moderate (DICA 2) DD as a single treatment.},
}

@article {pmid39039300,
year = {2024},
author = {Simonetti, S and Lanciotti, S and Carlomagno, D and De Cristofaro, F and Galardo, G and Cirillo, B and Fiore, F and Bonito, G and Severi, C and Ricci, P and , },
title = {Acute diverticulitis: beyond the diagnosis: predictive role of CT in assessing risk of recurrence and clinical implications in non-operative management of acute diverticulitis.},
journal = {La Radiologia medica},
volume = {},
number = {},
pages = {},
pmid = {39039300},
issn = {1826-6983},
abstract = {PURPOSE: The aim of the study is to identify CT findings that are predictive of recurrence of acute uncomplicated colonic diverticulitis, to better risk-stratify these patients for whom guidelines recommend a conservative outpatient treatment and to determine the appropriate management with an improvement of health costs.

MATERIALS AND METHODS: Over the past year, 33 patients enrolled in an outpatient integrated care pathway (PDTA) for uncomplicated acute diverticulitis with 1-year follow-up period, without recurrence, and 33 patients referred to Emergency Department for a recurrent acute diverticulitis were included. Images of admission CT were reviewed by two radiologists and the imaging features were analyzed and compared with Chi-square and Student t tests. Univariate and multivariate Cox regression models were employed to identify parameters that significantly predicted recurrence in 1-year follow-up period and establish cutoff and recurrence-free rates. The maximally selected rank statistics (MSRS) were used to identify the optimal wall thickening cutoff for the prediction of recurrence.

RESULTS: Patients with recurrence showed a greater mean parietal thickness compared to the group without recurrence (16 mm vs. 11.5 mm; HR 1.25, p < 0.001) and more evidence of grade 4 of peridiverticular inflammation (40% vs. 12%, p = 0.009, HR 3.44). 12-month recurrence-free rates progressively decrease with increasing thickness and inflammation. In multivariate analysis, only parietal thickness maintained its predictive power with an optimal cutpoint > 15 mm that causes a sixfold increased risk of recurrence (HR 6.22; 95% CI, 3.05-12.67; p < 0.001). Beyond thickness and peridiverticular inflammation, predictive value of early recurrence within 90 days from the 1st episode resulted also an Hinchey Ib on admission CT.

CONCLUSIONS: The maximum wall thickening and the grade of peridiverticular inflammation can be considered as predictive factors of recurrence and may be helpful in selecting patients for a tailored treatment to prevent the risk of recurrence.},
}

@article {pmid39004551,
year = {2024},
author = {Carabotti, M and Sgamato, C and Amato, A and Beltrame, B and Binda, GA and Germanà, B and Leandro, G and Pasquale, L and Peralta, S and Viggiani, MT and Severi, C and Annibale, B and Cuomo, R},
title = {Italian guidelines for the diagnosis and management of colonic diverticulosis and diverticular disease.},
journal = {Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver},
volume = {},
number = {},
pages = {},
doi = {10.1016/j.dld.2024.06.031},
pmid = {39004551},
issn = {1878-3562},
abstract = {Colonic diverticulosis and diverticular disease are among the most common gastrointestinal disorders encountered in clinical practice. These Italian guidelines focus on the diagnosis and management of diverticulosis and diverticular disease in the adult population, providing practical and evidence-based recommendations for clinicians. Experts from five Italian scientific societies, constituting a multidisciplinary panel, conducted a comprehensive review of meta-analyses, systematic reviews, randomised controlled trials, and observational studies to formulate 14 PICO questions. The assessment of the quality of the evidence and the formulation of the recommendations were carried out using an adaptation of the GRADE methodology. The guidelines covered the following topics: i) Management of diverticulosis; ii) Symptomatic uncomplicated diverticular disease: diagnosis and treatment; iii) Acute diverticulitis: diagnosis and treatment; iv) Management of diverticular disease complications; v) Prevention of recurrent acute diverticulitis; vi) Interventional management of diverticular disease.},
}

@article {pmid38988424,
year = {2024},
author = {Irowa, OO and Agbonrofo, PI and Odigie, VI},
title = {Colonoscopy findings in patients with haematochezia in Benin (South-South Nigeria): A 9-year prospective study.},
journal = {Journal of the West African College of Surgeons},
volume = {14},
number = {3},
pages = {275-279},
pmid = {38988424},
issn = {2992-5827},
abstract = {BACKGROUND: Colonoscopy is an important armamentarium in the investigation of haematochezia. Patients with haematochezia are very anxious about the presence of blood in their faeces. They are usually referred for diagnostic colonoscopy based on the presence of blood in stool or anaemia.

AIMS/OBJECTIVES: To highlight the causes of haematochezia in patients over a 9-year prospective period in the Premier tertiary health centre in the South-South zone of Nigeria.

MATERIALS AND METHODS: All Consecutive patients seen in our surgical services (June 1, 2009, to May 30, 2018) requiring colonoscopy for haematochezia were entered into a proforma. The demographics, findings at colonoscopy, and outcome of colonoscopy were analysed.

RESULTS: Three hundred and sixty-five colonoscopies were done during the study period; of these, 44% (160 patients) had a colonoscopy for haematochezia. Mean age of patients was 54.7 years. Age range was 16-86 years. Cluster age group was fifth to seventh decade (62.5%). The male-to-female ratio was 2:1. Causes of haematochezia were Haemorrhoids 32.5%, large bowel cancer 23.8%, diverticular disease 10%, inflammatory disease of the bowel 6.3%, polyps 3.8%. About 15% of the patients had more than one colonic site of bleeding. The most common subsites for colon cancer were rectum and sigmoid colon (79.6%), in 11 patients (6.8%) was the tumour within reach of the examining finger. Repeat colonoscopy occurred in 3 patients (0.8%). The most common complication of colonoscopy was bleeding (0.8%). Two patients (0.5%) had colonic perforation.

CONCLUSION: Forty-four percent (44%) of colonoscopy in Benin, South-South Nigeria has haematochezia as its indication. The cluster age group is the fifth to seventh decade. One in four patients had colon cancer and in 6.8% the tumour was within reach of the examining finger. It is the authors' opinion that colonoscopy should be routinely done in patients with haematochezia in South-South Nigeria.},
}

@article {pmid38978934,
year = {2024},
author = {Yang, S and Flynn, R and Tessema, TT},
title = {Acute Primary Small Bowel Volvulus in a Male With Loeys-Dietz Syndrome.},
journal = {Cureus},
volume = {16},
number = {6},
pages = {e61956},
pmid = {38978934},
issn = {2168-8184},
abstract = {Loeys-Dietz syndrome (LDS) is a connective tissue disorder with features including, but not limited to, aortic dissections, skeletal abnormalities, and craniofacial defects. However, considering its relatively recent discovery, there are still many unknowns about LDS. The extent of a connective tissue disorder like LDS is yet to be defined throughout the various organ systems, including the gastrointestinal system. Connective tissue disorders have been found to have higher associations with certain conditions, like constipation. In a similar manner, LDS may increase the propensity for developing uncommon gastrointestinal manifestations, like primary small bowel volvulus. A volvulus is defined as an abnormal rotation of the small bowel segment along the axis of its mesentery. Primary small bowel volvulus is differentiated from secondary small bowel volvulus by its nature of origin: primary small bowel volvulus occurs as an independent spontaneous occurrence, whereas secondary small bowel volvulus is secondary to the presence of adhesions, diverticular disease, or abdominal masses. In this case report, we highlight a potential gastrointestinal manifestation of LDS with the occurrence of a primary small bowel volvulus in a young adult male diagnosed with LDS. The patient experienced acute primary small bowel volvulus 14 days into his stay, which may have been influenced by this newfound connective tissue disorder.},
}

@article {pmid38976060,
year = {2024},
author = {Brière, R and Simard, AJ and Rouleau-Fournier, F and Letarte, F and Bouchard, P and Drolet, S},
title = {Retrospective study on the feasibility and safety of laparoscopic surgery for complicated fistulizing diverticular disease in a high-volume colorectal center.},
journal = {Langenbeck's archives of surgery},
volume = {409},
number = {1},
pages = {208},
pmid = {38976060},
issn = {1435-2451},
mesh = {Humans ; *Laparoscopy ; Male ; Retrospective Studies ; Female ; *Feasibility Studies ; Middle Aged ; Aged ; *Intestinal Fistula/surgery/etiology/mortality ; *Postoperative Complications/etiology/epidemiology ; Hospitals, High-Volume ; Adult ; Colectomy/methods/adverse effects ; Conversion to Open Surgery ; Diverticulitis, Colonic/surgery/complications/mortality ; Treatment Outcome ; Aged, 80 and over ; },
abstract = {BACKGROUND: We assessed feasibility and safety of laparoscopic sigmoidectomy for complicated fistulizing diverticular disease in a tertiary care colorectal center.

METHODS: A single-center retrospective study of patients undergoing sigmoidectomy for fistulizing diverticular disease between 2011 and 2021 was realized. Primary outcomes were rates of conversion to open surgery and severe postoperative morbidity at 30 days. Secondary outcomes included rates of postoperative bladder leaks on cystogram.

RESULTS: Among the 104 patients, 32.7% had previous laparotomy. Laparoscopy was the initial approach in 103 (99.0%), with 6 (5.8%) conversions to laparotomy. Clavien-Dindo grade ≥ III complication rate at 30 days was 10.6%, including two (1.9%) anastomotic leaks. The median postoperative length of stay was 4.0 days. Seven (6.7%) patients underwent reoperation, six (5.8%) were readmitted, and one (0.9%) died within 30 days. Twelve (11.5%) ileostomies were created initially, and two (1.9%) were created following anastomotic leaks. At last follow-up, 101 (97.1%) patients were stoma-free. Urgent surgeries had a higher rate of severe postoperative complications. Among colovesical fistula patients (n = 73), postoperative cystograms were performed in 56.2%, identifying two out of the three bladder leaks detected on closed suction drains. No differences in postoperative outcomes occurred between groups with and without postoperative cystograms, including Foley catheter removal within seven days (73.2% vs. 90.6%, p = 0.08).

CONCLUSIONS: Laparoscopic surgery for complicated fistulizing diverticulitis showed low rates of severe complications, conversions to open surgery and permanent stomas in high-volume colorectal center.},
}

Humans
*Laparoscopy
Male
Retrospective Studies
Female
*Feasibility Studies
Middle Aged
Aged
*Intestinal Fistula/surgery/etiology/mortality
*Postoperative Complications/etiology/epidemiology
Hospitals, High-Volume
Adult
Colectomy/methods/adverse effects
Conversion to Open Surgery
Diverticulitis, Colonic/surgery/complications/mortality
Treatment Outcome
Aged, 80 and over

@article {pmid38952045,
year = {2024},
author = {Forbes, N and Yi, Q and Moayyedi, P and Bosch, J and Bhatt, DL and Fox, KAA and Eikelboom, JW},
title = {Incidence and predictors of major gastrointestinal bleeding in patients on aspirin, low-dose rivaroxaban, or the combination: Secondary analysis of the COMPASS randomised controlled trial.},
journal = {Alimentary pharmacology & therapeutics},
volume = {},
number = {},
pages = {},
doi = {10.1111/apt.18139},
pmid = {38952045},
issn = {1365-2036},
abstract = {BACKGROUND: The incidence of major gastrointestinal bleeding (GIB) in patients on low-dose direct-acting oral anticoagulants (DOACs) is relatively unknown. Estimates from randomised controlled trials (RCTs) are lacking.

AIMS: To assess GIB incidence and predictors from RCT data of patients on aspirin, low-dose rivaroxaban, or both.

METHODS: This was a secondary analysis of RCT data wherein patients received aspirin 100 mg daily and rivaroxaban 2.5 mg b.d., aspirin alone, or rivaroxaban 5 mg b.d. Patients were followed from 2013 to 2016 at 602 centres. Outcomes included overall, upper, and lower GIB. We employed multivariable logistic regression to yield odds ratios (ORs) and 95% confidence intervals for potential exposures.

RESULTS: Among 27,395 patients, the annual incidence of GIB on rivaroxaban 2.5 mg b.d. with aspirin was 801.7 per 100,000 compared with 372.3 in 100,000 for aspirin. Age (OR 4.16, 2.53-6.82 for ≥75 vs. 55-64), peptic ulcer disease (PUD, OR 1.57, 1.01-2.44), liver disease (OR 2.09, 1.01-4.33), hypertension (OR 1.42, 1.04-1.94), and smoking (OR 1.85, 1.26-2.73) were associated with overall GIB. Kidney disease (OR 1.68, 1.12-2.51) was significantly associated with upper GIB, whereas diverticular disease (OR 3.75, 1.88-7.49) was associated with lower GIB. Addition of rivaroxaban to aspirin was associated more with lower GIB (OR 2.82, 1.64-4.84) than upper GIB (OR 1.86, 1.18-2.92).

CONCLUSIONS: We established incidences and identified risk factors for GIB in users of low-dose DOACs. Novel risk factors included current or former smoking and diverticulosis. Future studies should aim to validate these risk factors.},
}

@article {pmid38935194,
year = {2024},
author = {Presl, J and Ehgartner, M and Schabl, L and Singhartinger, F and Gantschnigg, A and Wallner, E and Jäger, T and Emmanuel, K and Kessler, H and Koch, OO},
title = {Robotic surgery versus conventional laparoscopy in sigmoid colectomy for diverticular disease-a comparison of operative trauma and cost-effectiveness: retrospective, single-center analysis.},
journal = {Langenbeck's archives of surgery},
volume = {409},
number = {1},
pages = {200},
pmid = {38935194},
issn = {1435-2451},
mesh = {Humans ; Male ; Female ; *Robotic Surgical Procedures/economics ; *Laparoscopy/economics/methods ; *Colectomy/economics/methods ; Retrospective Studies ; Middle Aged ; *Cost-Benefit Analysis ; Aged ; Adult ; Sigmoid Diseases/surgery/economics ; Colon, Sigmoid/surgery ; Diverticulitis, Colonic/surgery/economics ; },
abstract = {PURPOSE: Robotic assisted surgery is an alternative, fast evolving technique for performing colorectal surgery. The primary aim of this single center analysis is to compare elective laparoscopic and robotic sigmoid colectomies for diverticular disease on the extent of operative trauma and the costs.

METHODS: Retrospective analysis from our prospective clinical database to identify all consecutive patients aged ≥ 18 years who underwent elective minimally invasive left sided colectomy for diverticular disease from January 2016 until December 2020 at our tertiary referral institution.

RESULTS: In total, 83 patients (31 female and 52 male) with sigmoid diverticulitis underwent elective minimally invasive sigmoid colectomy, of which 42 underwent conventional laparoscopic surgery (LS) and 41 robotic assisted surgery (RS). The mean C-reactive protein difference between the preoperative and postoperative value was significantly lower in the robotic assisted group (4,03 mg/dL) than in the laparoscopic group (7.32 mg/dL) (p = 0.030). Similarly, the robotic´s hemoglobin difference was significantly lower (p = 0.039). The first postoperative bowel movement in the LS group occurred after a mean of 2.19 days, later than after a mean of 1.63 days in the RS group (p = 0.011). An overview of overall charge revealed significantly lower total costs per operation and postoperative hospital stay for the robotic approach, 6058 € vs. 6142 € (p = 0,014) not including the acquisition and maintenance costs for both systems.

CONCLUSION: Robotic colon resection for diverticular disease is cost-effective and delivers reduced intraoperative trauma with significantly lower postoperative C-reactive protein and hemoglobin drift compared to conventional laparoscopy.},
}

Humans
Male
Female
*Robotic Surgical Procedures/economics
*Laparoscopy/economics/methods
*Colectomy/economics/methods
Retrospective Studies
Middle Aged
*Cost-Benefit Analysis
Aged
Adult
Sigmoid Diseases/surgery/economics
Colon, Sigmoid/surgery
Diverticulitis, Colonic/surgery/economics

@article {pmid38924329,
year = {2024},
author = {Pallotta, L and Pisano, A and Vona, R and Cappelletti, M and Pignataro, MG and Tattoli, I and Maselli, MA and Tarallo, M and Casella, G and Caronna, R and Tancredi, A and Scotti, GB and Scalese, G and Matarrese, P and Giordano, C and Severi, C},
title = {From diverticulosis to complicated diverticular disease: Progression of myogenic alterations and oxidative imbalance.},
journal = {Neurogastroenterology and motility},
volume = {},
number = {},
pages = {e14850},
doi = {10.1111/nmo.14850},
pmid = {38924329},
issn = {1365-2982},
support = {000106_22_RS__SEVER PROGETTI ATENEO MEDI 2021//Sapienza University of Rome/ ; RM122181620497CF PROGETTI ATENEO MEDI 2022//Sapienza University of Rome/ ; },
abstract = {BACKGROUND: The natural history and pathophysiology of diverticular disease (DD) are still uncertain. An ex-vivo human complicated DD (cDD) model has recently shown a predominant transmural oxidative imbalance. The present study aims to evaluate whether the previously described alterations may precede the symptomatic form of the disease.

METHODS: Colonic surgical samples obtained from patients with asymptomatic diverticulosis (DIV), complicated DD, and controls were systematically and detailed morphologically and molecularly analyzed. Therefore, histologic, histomorphometric, immunohistochemical evaluation, and gene and protein expression analysis were performed to characterize colonic muscle changes and evaluate chronic inflammation, oxidative imbalance, and hypoxia. Functional muscle activity was tested on strips and isolated cells in response to contractile and relaxant agents.

KEY RESULTS: Compared with controls, DD showed a marketed increase in muscle layer thickness, smooth muscle cell syncytium disarray, and increased interstitial fibrosis; moreover, the observed features were more evident in the cDD group. These changes mainly affected longitudinal muscle and were associated with altered contraction-relaxation dynamics and fibrogenic switch of smooth muscle cells. Chronic lymphoplasmacytic inflammation was primarily evident in the mucosa and spared the muscle. A transmural increase in carbonylated and nitrated proteins, with loss of antioxidant molecules, characterized both stages of DD, suggesting early oxidative stress probably triggered by recurrent ischemic events, more pronounced in cDD, where HIF-1 was detected in both muscle and mucosa.

CONCLUSION & INFERENCES: The different DD clinical scenarios are part of a progressive process, with oxidative imbalance representing a new target in the management of DD.},
}

@article {pmid38911441,
year = {2024},
author = {Kent, KG},
title = {The relationship between post-traumatic stress disorder and gastrointestinal disease in United States Military Veterans.},
journal = {SAGE open medicine},
volume = {12},
number = {},
pages = {20503121241260000},
pmid = {38911441},
issn = {2050-3121},
abstract = {BACKGROUND: This study examined the relationship between gastrointestinal disease and post-traumatic stress disorder in U.S. military Veterans. Based on literature and clinical practice data sources from the U.S. Veterans Administration, gastrointestinal disease and post-traumatic stress disorder were hypothesized to be positively correlated in Veterans.

OBJECTIVES: This study aimed to determine the frequency with which gastrointestinal disease and post-traumatic stress disorder are diagnosed comorbidities, a diagnosis of gastrointestinal disease accompanies a diagnosis of post-traumatic stress disorder, and a diagnosis of post-traumatic stress disorder accompanies a diagnosis of a gastrointestinal disease.

METHODS: The methodology was a retrospective, correlational design using data collected from the U.S. Department of Veterans Affairs patient database.

RESULTS: The results were that post-traumatic stress disorder is bi-directionally correlated with the gastrointestinal diseases of gastroesophageal reflux disease, peptic ulcer disease, functional dyspepsia, Crohn's disease, diverticular disease, irritable bowel syndrome, and the symptoms of constipation and nausea/vomiting within Veterans who served during wartime periods. The study also found that post-traumatic stress disorder is not correlated with ulcerative colitis in Veterans.

CONCLUSIONS: The conclusions are that clinicians who see a presentation of post-traumatic stress disorder should be screening for gastrointestinal disease, while primary care and gastroenterology providers treating gastrointestinal disease should be screening for a history of trauma, as improved diagnosis rates may lead to improved treatment.},
}

@article {pmid38898867,
year = {2024},
author = {Bachelani, AM},
title = {Natural history and surgical treatment of a giant colonic diverticulum: A case report.},
journal = {World journal of clinical cases},
volume = {12},
number = {17},
pages = {3151-3155},
pmid = {38898867},
issn = {2307-8960},
abstract = {BACKGROUND: While diverticular disease is prevalent in the West, the formation of giant colonic diverticula is rare. To date, approximately 200 cases have been reported, with only a handful treated surgically using a minimally invasive approach. Furthermore, the natural history of giant colonic diverticula is not well documented.

CASE SUMMARY: This report describes the case of a 66-year-old man who developed a giant colonic diverticulum with primary symptoms including dull and chronic pain in the right lower quadrant at presentation. The patient had undergone several computed tomography scans of the abdomen and pelvis over the previous two years, through which the natural history of this rare entity could be retrospectively observed. The patient was successfully treated with a robot-assisted sigmoid colectomy and had an uneventful recovery with resolution of symptoms during the follow-up.

CONCLUSION: This rare case demonstrates the natural history of giant colonic diverticulum formation and supports the feasibility of robot-assisted surgery.},
}

@article {pmid38874611,
year = {2024},
author = {McKechnie, T and Jessani, G and Bakir, N and Lee, Y and Sne, N and Doumouras, A and Hong, D and Eskicioglu, C},
title = {Evaluating frailty using the modified frailty index for colonic diverticular disease surgery: analysis of the national inpatient sample 2015-2019.},
journal = {Surgical endoscopy},
volume = {},
number = {},
pages = {},
pmid = {38874611},
issn = {1432-2218},
abstract = {BACKGROUND: Frailty has been associated with increased postoperative mortality and morbidity; however, the use of the modified frailty index (mFI-11) to assess patients undergoing surgery for diverticular disease has not been widely assessed. This paper aims to examine frailty, evaluated by mFI-11, to assess postoperative morbidity and mortality among patients undergoing operative intervention for colonic diverticular disease.

METHODS: We used data from the Healthcare Cost and Utilization Project National Inpatient Sample (October 1, 2015-December 31, 2019). ICD-10-CM codes were utilized to identify a cohort of adult patients with a primary admission diagnosis of diverticulitis. mFI-11 items were adapted to correspond with ICD-10-CM codes. Patients were stratified into robust (mFI < 0.27) and frail (mFI ≥ 0.27) groups. Primary outcomes were in-hospital postoperative morbidity and mortality. Secondary outcomes included system-specific postoperative complications, length of stay (LOS), total admission cost, and discharge disposition. Multivariable regression models were fit.

RESULTS: Of the 26,826 patients, there were 24,194 patients with mFI-11 < 0.27 (i.e., robust) and 2,632 patients with mFI-11 ≥ 0.27 (i.e., frail). Adjusted analysis showed significant increases in postoperative mortality (aOR 2.16, 95% CI 1.38-3.38, p = 0.001) and overall postoperative morbidity (aOR 1.84, 95% CI 1.65-2.06, p < 0.001). LOS was higher in the frail group (MD 1.78 days, 95% CI 1.46-2.11, p < 0.001) as well as total cost (MD $25,495.19, 95% CI $19,851.63-$31,138.75, p < 0.001).

CONCLUSION: In the elective setting, a high mFI-11 (i.e., presence of the variables comprising the index) could alert clinicians to the possibility of implementing preoperative optimization strategies. In the emergent setting, a high mFI-11 may help guide prognostication for these vulnerable patients.},
}

@article {pmid38873987,
year = {2024},
author = {Hokama, A and Iraha, A and Yamamoto, K},
title = {Reply to the comments on "Coffee bean sign, steel pan sign and whirl sign in sigmoid volvulus".},
journal = {Revista espanola de enfermedades digestivas},
volume = {},
number = {},
pages = {},
doi = {10.17235/reed.2024.10571/2024},
pmid = {38873987},
issn = {1130-0108},
abstract = {We thank Prof. Atamanalp and colleagues for their interest and valuable comments on our article. The authors have highlighted important considerations in the diagnosis of sigmoid volvulus (SV). We would like to respond to their comments. Firstly, although we agree with their opinion that CT, MRI, and endoscopy are more reliable diagnostic tools than plain radiography, we still emphasize that diagnostic imaging for SV is initially based on plain radiography, as recommended by the WSES consensus guidelines. Since SV is the third most common cause of colonic obstruction worldwide, the accessibility of plain radiography is crucial. Among the many plain radiographic signs of SV, Levsky et al. reported that the most sensitive signs were absence of rectal gas, followed by inverted-U appearance and coffee bean sign. Understanding these signs may lead to early detection of SV and further CT evaluation for ischemia or perforation. Despite the high value of plain radiography, there is a global tend to use CT instead from the outset. Secondly, we agree with their opinion that endoscopy is not only a therapeutic, but also a diagnostic procedure to assess mucosal viability. In addition, we believe that endoscopy is also useful in ruling out other obstructive lesions, including colorectal neoplasia and complicated sigmoid diverticular disease. In the clinical setting, endoscopy is performed after the diagnosis of SV by plain radiography or CT and serves as the first line of decompression of SV when ischemia or perforation is not suspected. Finally, we congratulate Prof. Atamanalp and colleagues for their dedicated contribution to the large-scale SV studies in Eastern Anatolia, Turkey, where SV is endemic.},
}

@article {pmid38864053,
year = {2024},
author = {Taha, M and Fakieh, AT and Alhazmi, AM and Khiami, AJ and Alasmari, EA and Alharbi, SS and Almajnoni, MH},
title = {The Assessment of Knowledge, Awareness and Practice Regarding Diverticulitis and Its Risk Factors Among the Population of Saudi Arabia.},
journal = {Cureus},
volume = {16},
number = {5},
pages = {e60124},
pmid = {38864053},
issn = {2168-8184},
abstract = {Background The term "diverticula" refers to the existence of diverticula in the gastrointestinal tract but is mainly located in the sigmoid colon and is used to describe colonic diverticulosis. Diverticula, which are sac-like protrusions in the wall of the large bowel, are becoming more prevalent globally, in both developed and developing nations. This increase in occurrence is primarily attributed to changes in dietary and lifestyle patterns. Raising public awareness can potentially contribute to a decrease in the incidence of the disease and its associated complications. Aim This study aims to assess knowledge and awareness levels among the Saudi Arabian population regarding diverticulitis and its risk factors. Methods A descriptive cross-sectional study was conducted in Saudi Arabia between 1st January 2024 to 1st April 2024 using an online questionnaire for data collection. The target population consists of individuals who are between 18 years and 45, in Saudi Arabia without a history of diverticulitis. The study questionnaire covered participants' demographic (Western, Central, Southern, Eastern, Northern) regions, knowledge, awareness and practice of diverticulitis. Results A total of 548 eligible participants completed the study questionnaire, most of them (80.3%; 395) were from the Western region including Mecca, Medina and Jeddah. Participants' ages ranged from 18 to more than 40 years with a mean age of 30.5 ± 11.9 years old. A greater percentage (72.3%) of the participants were males compared to the percentage of females, which was 27.7%. The vast majority of the study participants had an inadequate knowledge level about diverticulitis (85.9%; 471) while only 31 (5.7%) had adequate knowledge and awareness about the disease. The most reported sources of information included study courses (6.4%), media (5.3%), and physicians (4.7%) while most respondents (83.6%) had no source. Conclusion In conclusion, aside from preventive strategies, the current study found that the public knew very little about diverticulitis, including its risk factors, clinical presentation, and diagnostic process. The two significant predictors of public awareness level were age and doctors as information sources.},
}

@article {pmid38850356,
year = {2024},
author = {Gatta, L and Bellini, M and Scarpignato, C and Marrocco, W and Chiriatti, A and Grosso, A and Lambiase, C and Usai-Satta, P and Vassallo, R and Bartoletti, P and Monica, F and Manta, R and Scotti, S and Soncini, M and , },
title = {Rifaximin in diverticulosis and diverticular disease: a national survey among Italian gastroenterologists and general practitioners.},
journal = {Internal and emergency medicine},
volume = {},
number = {},
pages = {},
pmid = {38850356},
issn = {1970-9366},
abstract = {The management of patients with diverticular disease remains challenging. The aim of this national survey was to assess how gastroenterologists and general practitioners use rifaximin to manage diverticulosis and diverticular disease. Members of the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) and the Italian Federation of General Practitioners (FIMMG) were invited to complete a 39-item online survey concerning the use of rifaximin in five clinical settings: (1) diverticulosis; (2) reducing symptoms in symptomatic uncomplicated diverticular disease; (3) reducing the occurrence of diverticulitis in patients with symptomatic uncomplicated diverticular disease (primary prevention); (4) reducing the recurrence of diverticulitis in patients with previous attacks of diverticulitis (secondary prevention); (5) treatment of uncomplicated acute diverticulitis. A total of 1094 physicians completed the survey. Overall, 25.1%, 83.5%, 68%, 74.2%, and 63% of physicians prescribed rifaximin for the clinical settings 1, 2, 3, 4, and 5, respectively. In each clinical setting, the dosage of rifaximin most frequently used was 800 mg/day, the most common duration of therapy was 7 days, and the cyclic administration of treatment (expressed in months) most frequently used was > 24 months. These results highlight that a reappraisal of the use of rifaximin in patients with diverticulosis and diverticular disease is required to reduce the gap between the evidence available and the daily clinical practice, optimizing also the use of healthcare resources.},
}

@article {pmid38844410,
year = {2024},
author = {Morini, A and Zizzo, M and Tumiati, D and Mereu, F and Bernini, D and Fabozzi, M},
title = {Nonoperative management of acute complicated diverticulitis with pericolic and/or distant extraluminal air: A systematic review.},
journal = {World journal of surgery},
volume = {},
number = {},
pages = {},
doi = {10.1002/wjs.12244},
pmid = {38844410},
issn = {1432-2323},
abstract = {INTRODUCTION: Colonic Diverticular Disease (CDD) is a multifactorial inflammatory disease. Acute diverticulitis (AD), with extraluminal free air (both pericolic and distant), represents about 15% of radiological scenarios and remains a therapeutic challenge for surgeons. Currently, the WSES guidelines suggest trying a conservative strategy both in the presence of pericolic and distant free extraluminal air, even if both have respectively weak recommendation based on low/very low-quality evidence.

METHODS: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Embase databases were used to identify articles of interest.

RESULTS: A total of 2380 patients with AD and extraluminal free air (both pericolic and distant) who underwent nonoperative management (NOM) were analyzed. Of the 2380 patients, 2095(88%) were successfully treated with NOM, while 285 (12%) patients failed. A total of 1574 (93.1%) patients with pericolic extraluminal free air had a successful NOM with 6.9% (117) failure rates, while 135 (71.1%) patients with distant extraluminal free air had a successful NOM with 28.9% (55) failure rates. Regarding distant recurrence, we recorded a rate of 18.3% (261/1430), while a rate of 11.3% (167/1472) was recorded for patients undergoing elective surgery.

CONCLUSION: NOM for patients with AD and extraluminal free air (both pericolic and distant) seems to be feasible and safe despite a higher failure rate in the distant subgroup, which remains the most challenging clinical scenario to deal with through conservative treatment.},
}

@article {pmid38831715,
year = {2024},
author = {Humphrey, HN and Sibley, P and Walker, ET and Keller, DS and Pata, F and Vimalachandran, D and Daniels, IR and McDermott, FD},
title = {Genetic, epigenetic and environmental factors in diverticular disease: systematic review.},
journal = {BJS open},
volume = {8},
number = {3},
pages = {},
doi = {10.1093/bjsopen/zrae032},
pmid = {38831715},
issn = {2474-9842},
mesh = {Humans ; Risk Factors ; *Epigenesis, Genetic ; *Genetic Predisposition to Disease ; Diverticular Diseases/genetics ; Gene-Environment Interaction ; Obesity/genetics/complications ; },
abstract = {BACKGROUND: Diverticulosis is a normal anatomical variant of the colon present in more than 70% of the westernized population over the age of 80. Approximately 3% will develop diverticulitis in their lifetime. Many patients present emergently, suffer high morbidity rates and require substantial healthcare resources. Diverticulosis is the most common finding at colonoscopy and has the potential for causing a significant morbidity rate and burden on healthcare. There is a need to better understand the aetiology and pathogenesis of diverticular disease. Research suggests a genetic susceptibility of 40-50% in the formation of diverticular disease. The aim of this review is to present the hypothesized functional effects of the identified gene loci and environmental factors.

METHODS: A systematic literature review was performed using PubMed, MEDLINE and Embase. Medical subject headings terms used were: 'diverticular disease, diverticulosis, diverticulitis, genomics, genetics and epigenetics'. A review of grey literature identified environmental factors.

RESULTS: Of 995 articles identified, 59 articles met the inclusion criteria. Age, obesity and smoking are strongly associated environmental risk factors. Intrinsic factors of the colonic wall are associated with the presence of diverticula. Genetic pathways of interest and environmental risk factors were identified. The COLQ, FAM155A, PHGR1, ARHGAP15, S100A10, and TNFSF15 genes are the strongest candidates for further research.

CONCLUSION: There is increasing evidence to support the role of genomics in the spectrum of diverticular disease. Genomic, epigenetic and omic research with demographic context will help improve the understanding and management of this complex disease.},
}

Humans
Risk Factors
*Epigenesis, Genetic
*Genetic Predisposition to Disease
Diverticular Diseases/genetics
Gene-Environment Interaction
Obesity/genetics/complications

@article {pmid38816902,
year = {2024},
author = {Kostev, K and Smith, L and Veronese, N and Soysal, P and Krieg, S},
title = {Association between diverticular disease and subsequent dementia.},
journal = {Journal of gastroenterology and hepatology},
volume = {},
number = {},
pages = {},
doi = {10.1111/jgh.16644},
pmid = {38816902},
issn = {1440-1746},
}

@article {pmid38812706,
year = {2024},
author = {Carabotti, M and Cuomo, R and Marasco, G and Barbara, G and Radaelli, F and Annibale, B},
title = {Unmet needs in treatment of symptomatic uncomplicated diverticular disease and prevention of recurrent acute diverticulitis: a scoping review.},
journal = {Therapeutic advances in gastroenterology},
volume = {17},
number = {},
pages = {17562848241255297},
pmid = {38812706},
issn = {1756-283X},
abstract = {BACKGROUND: Diverticular disease (DD) represents a common gastrointestinal condition that poses a heavy burden on healthcare systems worldwide. A high degree of uncertainty surrounds the therapeutic approaches for the control of symptoms in patients with symptomatic uncomplicated diverticular disease (SUDD) and primary and secondary prevention of diverticulitis and its consequences.

OBJECTIVES: To review the current knowledge and discuss the unmet needs regarding the management of SUDD and the prevention of acute diverticulitis.

ELIGIBILITY CRITERIA: Randomized trials, observational studies, and systematic reviews on lifestyle/dietary interventions and medical treatment (rifaximin, mesalazine, and probiotics) of SUDD or prevention of acute diverticulitis.

SOURCES OF EVIDENCE: The literature search was performed from inception to April 2023, without language restriction, following the modified Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) reporting guidelines. References of the papers selected were checked to identify additional papers of potential interest. The final list of references was evaluated by a panel of experts, who were asked to check for any lack of relevant studies.

CHARTING METHODS: Information on patient population, study design, intervention, control group, duration of the observation, and outcomes assessed was collected by two authors independently.

RESULTS: The review shows a high degree of uncertainty about therapeutic interventions, both dietary/lifestyle and pharmacological, in patients with SUDD, because of the scarcity and weakness of existing evidence. Available studies are generally of low quality, heterogeneous, and outdated, precluding the possibility to draw robust conclusions. Similarly, acute diverticulitis prevention has been seldom investigated, and there is a substantial lack of evidence supporting the role of dietary/lifestyle or pharmacological approaches to reduce the risk of diverticulitis.

CONCLUSION: The lack of robust evidence regarding therapeutic options for gastrointestinal symptoms in SUDD patients and for primary and secondary prevention of acute diverticulitis remains an important unmet need in the management of DD.},
}

@article {pmid38802514,
year = {2024},
author = {Adewuyi, EO and Porter, T and O'Brien, EK and Olaniru, O and Verdile, G and Laws, SM},
title = {Genome-wide cross-disease analyses highlight causality and shared biological pathways of type 2 diabetes with gastrointestinal disorders.},
journal = {Communications biology},
volume = {7},
number = {1},
pages = {643},
pmid = {38802514},
issn = {2399-3642},
support = {APP1161706//Department of Health | National Health and Medical Research Council (NHMRC)/ ; APP1191535//Department of Health | National Health and Medical Research Council (NHMRC)/ ; },
mesh = {*Diabetes Mellitus, Type 2/genetics ; Humans ; *Genome-Wide Association Study ; *Gastrointestinal Diseases/genetics ; Genetic Predisposition to Disease ; Mendelian Randomization Analysis ; },
abstract = {Studies suggest links between diabetes and gastrointestinal (GI) traits; however, their underlying biological mechanisms remain unclear. Here, we comprehensively assess the genetic relationship between type 2 diabetes (T2D) and GI disorders. Our study demonstrates a significant positive global genetic correlation of T2D with peptic ulcer disease (PUD), irritable bowel syndrome (IBS), gastritis-duodenitis, gastroesophageal reflux disease (GERD), and diverticular disease, but not inflammatory bowel disease (IBD). We identify several positive local genetic correlations (negative for T2D - IBD) contributing to T2D's relationship with GI disorders. Univariable and multivariable Mendelian randomisation analyses suggest causal effects of T2D on PUD and gastritis-duodenitis and bidirectionally with GERD. Gene-based analyses reveal a gene-level genetic overlap between T2D and GI disorders and identify several shared genes reaching genome-wide significance. Pathway-based study implicates leptin (T2D - IBD), thyroid, interferon, and notch signalling (T2D - IBS), abnormal circulating calcium (T2D - PUD), cardiovascular, viral, proinflammatory and (auto)immune-mediated mechanisms in T2D and GI disorders. These findings support a risk-increasing genetic overlap between T2D and GI disorders (except IBD), implicate shared biological pathways with putative causality for certain T2D - GI pairs, and identify targets for further investigation.},
}

*Diabetes Mellitus, Type 2/genetics
Humans
*Genome-Wide Association Study
*Gastrointestinal Diseases/genetics
Genetic Predisposition to Disease
Mendelian Randomization Analysis

@article {pmid38770354,
year = {2024},
author = {Quigley, EMM},
title = {Can diet change the natural history of gastrointestinal diseases?.},
journal = {JGH open : an open access journal of gastroenterology and hepatology},
volume = {8},
number = {5},
pages = {e13063},
pmid = {38770354},
issn = {2397-9070},
abstract = {Belatedly, gastroenterologists have begun to pay attention to the role of diet in the exacerbation of gastrointestinal symptoms in many digestive disorders-a recognition that has spurred both high-quality clinical trials and translational research into this area. It has become clear that multiple mechanisms acting either in isolation or together can induce gut symptoms and that appropriate interventions can lead to significant relief. What this review will explore is not the role of diet in the production of certain symptoms or symptom clusters, but rather whether a dietary intervention can beneficially alter the natural history of a gastrointestinal disease-a much more demanding expectation. Yet there are examples of where a diet, if sustained, can have a long-term impact on at least some of those affected by conditions such as eosinophilic esophagitis, celiac disease, food allergy, and constipation.},
}

@article {pmid38754448,
year = {2024},
author = {Waldmann, E},
title = {Beyond the scope: diverticular disease and post-colonoscopy colorectal cancer.},
journal = {Endoscopy},
volume = {},
number = {},
pages = {},
doi = {10.1055/a-2309-5998},
pmid = {38754448},
issn = {1438-8812},
}

@article {pmid38742534,
year = {2024},
author = {Saha, B and Jang, S and Friesen, JN and Kalinoski-DuBose, V and Verma, A and Mundell, W},
title = {Concomitant Sigmoid Diverticulitis and Periampullary Duodenal Diverticulitis Complicated by Lemmel Syndrome: A Case Report.},
journal = {Journal of investigative medicine high impact case reports},
volume = {12},
number = {},
pages = {23247096241253342},
doi = {10.1177/23247096241253342},
pmid = {38742534},
issn = {2324-7096},
mesh = {Humans ; *Duodenal Diseases/complications ; Tomography, X-Ray Computed ; Male ; Aged ; Intestinal Fistula/complications/etiology ; Diverticulitis, Colonic/complications ; Female ; Sigmoid Diseases/complications/etiology ; Diverticulitis/complications ; },
abstract = {Diverticular disease is a major cause of hospitalizations, especially in the elderly. Although diverticulosis and its complications predominately affect the colon, the formation of diverticula in the small intestine, most commonly in the duodenum, is well characterized in the literature. Although small bowel diverticula are typically asymptomatic, and diagnosed incidentally, a complication of periampullary duodenal diverticulum is Lemmel syndrome. Lemmel syndrome is an extremely rare condition whereby periampullary duodenal diverticula, most commonly without diverticulitis, leads to obstruction of the common bile duct due to mass effect and associated complications including acute cholangitis and pancreatitis. Here, we present the first case, to our knowledge, of periampullary duodenal diverticulitis complicated by Lemmel syndrome with concomitant colonic diverticulitis with colovesical fistula. Our case and literature review emphasizes that Lemmel syndrome can present with or without suggestions of obstructive jaundice and can most often be managed conservatively if caught early, except in the setting of emergent complications.},
}

Humans
*Duodenal Diseases/complications
Tomography, X-Ray Computed
Male
Aged
Intestinal Fistula/complications/etiology
Diverticulitis, Colonic/complications
Female
Sigmoid Diseases/complications/etiology
Diverticulitis/complications

@article {pmid38731032,
year = {2024},
author = {Mortensen, LQ and Andresen, K and Thygesen, L and Pommergaard, HC and Rosenberg, J},
title = {Diverticulitis Is Associated with Increased Risk of Colon Cancer-A Nationwide Register-Based Cohort Study.},
journal = {Journal of clinical medicine},
volume = {13},
number = {9},
pages = {},
doi = {10.3390/jcm13092503},
pmid = {38731032},
issn = {2077-0383},
support = {62786-2020//Knud og Edith Eriksens Mindefond/ ; 20-L-0200//A.P. Møllers Fond/ ; 20-2B-7108//Aage og Johanne Louis-Hansens Fond/ ; },
abstract = {Background: An association between diverticulitis and colon cancer has been proposed. The evidence is conflicting, and the guidelines differ regarding recommended follow-up with colonoscopy after an episode of diverticulitis. To guide regimes for follow-up, this study aimed to investigate if patients with diverticulitis have an increased risk of colon cancer. Methods: This study is reported according to the RECORD statement. We performed a cohort study with linked data from nationwide Danish registers. The inclusion period was 1997-2009, and the complete study period was 1995-2013. The primary outcome was the risk of developing colon cancer estimated using a Cox regression analysis with time-varying covariates. We performed a sensitivity analysis on a cohort of people with prior colonoscopies, comparing the risk of colon cancer between the diverticulitis group and the control group. Results: We included 29,173 adult males and females with diverticulitis and 145,865 controls matched for sex and age. The incidence proportion of colon cancer was 2.1% (95% confidence interval (CI) 1.9-2.3) in the diverticulitis group and 1.5% (95% CI 1.4-1.5) in the matched control group (hazard ratio 1.6; 95% CI 1.5-1.8). The risk of having a colon cancer diagnosis was significantly increased in the first six months after inclusion (hazard ratio 1.7; 95% CI 1.5-1.8), and hereafter there was a lower risk in the diverticulitis group compared with controls (hazard ratio 0.8; 95% CI 0.7-0.9). This protective effect lasted eight years. The increased risk of colon cancer during the first six months after diverticulitis was also found in the cohort with prior colonoscopies. Conclusions: The risk of a colon cancer diagnosis was significantly increased for patients with diverticulitis 0-6 months after the diagnosis of diverticulitis. Hereafter, we found a protective effect of diverticulitis until eight years later, possibly due to a screening effect. We recommend a follow-up colonoscopy after the first diagnosis of diverticulitis.},
}

@article {pmid38721481,
year = {2024},
author = {AlLehibi, AH and Alsubaie, FF and Alzahrani, RH and Ekhuraidah, HA and Koshan, MA and Alotaibi, NF and Alotaibi, FM and Alghamdi, HS and Aljumah, AA},
title = {Clinical Presentations and Risk Factors of Gastrointestinal Bleeding in the Emergency Department: A Multicenter Retrospective Study.},
journal = {Cureus},
volume = {16},
number = {5},
pages = {e59912},
pmid = {38721481},
issn = {2168-8184},
abstract = {BACKGROUND AND AIMS: Gastrointestinal bleeding is a major healthcare burden and is associated with significant morbidity and mortality. This study aimed to assess the prevalence, clinical presentation, and risk factors of patients presenting with gastrointestinal bleeding in the emergency department.

MATERIALS AND METHODS: This retrospective study was conducted in two tertiary care hospitals in Riyadh, Saudi Arabia. The medical records of patients who presented to the emergency department with gastrointestinal bleeding between January 2010 and January 2020 were reviewed. Patients aged 18 years or older, with gastrointestinal bleeding (upper or lower) regardless of underlying cause, lifestyle, location of bleeding, health status, or medication use, were included. Demographic characteristics, initial vital signs, medical history, physical examination findings, comorbidities, medications, laboratory and radiological investigations, cause and stage of liver disease, management, and complications were recorded. Endoscopic findings and management of the bleeding site were collected according to the presenting symptoms.

RESULTS: A total of 760 patients were included. The mean age was 62.7 ± 17.8 years, and 61.4% were males. The most common comorbidities at presentation were hypertension (54.1%), diabetes mellitus (51.2%), and ischemic heart disease (18.2%). The origins of the bleeding were lower gastrointestinal in 52% and upper gastrointestinal in 48% of patients.

CONCLUSIONS: Lower gastrointestinal bleeding was found to be more common than upper gastrointestinal bleeding. Hemorrhoids, polyps, diverticular disease, and colonic ulcers were the major risk factors for lower gastrointestinal bleeding. In contrast, upper gastrointestinal bleeding was predominantly caused by esophageal varices, gastritis, and peptic ulcers.},
}

@article {pmid38713610,
year = {2024},
author = {Christos, K and Filip, S and Wilhelm, G},
title = {Evaluation of laparoscopic peritoneal lavage for perforated diverticulitis: a national registry-based study.},
journal = {The British journal of surgery},
volume = {111},
number = {5},
pages = {},
doi = {10.1093/bjs/znae109},
pmid = {38713610},
issn = {1365-2168},
mesh = {Humans ; Male ; Female ; *Laparoscopy ; Aged ; Sweden/epidemiology ; *Peritoneal Lavage/methods ; Middle Aged ; *Registries ; *Intestinal Perforation/surgery ; *Diverticulitis, Colonic/surgery/complications/therapy ; Length of Stay ; Treatment Outcome ; Aged, 80 and over ; },
abstract = {BACKGROUND: Laparoscopic lavage (LPL) has been suggested for treatment of non-feculent perforated diverticulitis. In this observational study, the surgical treatment of diverticular disease in Sweden outside prospective trials was investigated.

METHODS: This population-based study used the National Patient Register to identify all patients in Sweden with emergency admissions for diverticular disease, as defined by ICD codes from July 2014 to December 2020. Demographics, surgical procedures and outcomes were assessed. In addition, register data since 1997 were retrieved to assess co-morbidities, previous abdominal surgeries, and previous admissions for diverticular disease.

RESULTS: Among 47 294 patients with emergency hospital admission, 2035 underwent LPL (427 patients) or sigmoid resection (SR, 1608 patients) for diverticular disease. The mean follow-up was 30.8 months. Patients selected for LPL were younger, healthier and with less previous abdominal surgery for diverticular disease than those in the SR group (P < 0.01). LPL was associated with shorter postoperative hospital stay (mean 9.4 versus 14.9 days, P < 0.001) and lower 30-day mortality (3.5% versus 8.7%, P < 0.001). Diverticular disease-associated subsequent surgery was more common in the SR group than the LPL group except during the first year (P < 0.001). LPL had a lower mortality rate during the study period (stratified HR 0.70, 95% c.i. 0.53-0.92, P = 0.023).

CONCLUSION: Laparoscopic lavage constitutes a safe alternative to sigmoid resection for selected patients judged clinically to require surgery.},
}

Humans
Male
Female
*Laparoscopy
Aged
Sweden/epidemiology
*Peritoneal Lavage/methods
Middle Aged
*Registries
*Intestinal Perforation/surgery
*Diverticulitis, Colonic/surgery/complications/therapy
Length of Stay
Treatment Outcome
Aged, 80 and over

@article {pmid38671294,
year = {2024},
author = {Carabotti, M and Marasco, G and Sbarigia, C and Cuomo, R and Barbara, G and Pace, F and Sarnelli, G and Annibale, B and , },
title = {Site and duration of abdominal pain discriminate symptomatic uncomplicated diverticular disease from previous diverticulitis patients.},
journal = {Internal and emergency medicine},
volume = {},
number = {},
pages = {},
pmid = {38671294},
issn = {1970-9366},
abstract = {Abdominal pain in patients with diverticular disease (DD) can be challenging in clinical practice. Patients with symptomatic uncomplicated diverticular disease (SUDD) and patients with a previous acute diverticulitis (PD) may share a similar clinical pattern, difficult to differentiate from irritable bowel syndrome (IBS). We used standardized questionnaires for DD (short and long lasting abdominal pain) and IBS (following Rome III Criteria) to assess clinical features of abdominal pain, in terms of presence, severity and length, in SUDD and PD patients. One hundred and forty-eight SUDD and 118 PD patients completed all questionnaires. Short-lasting pain was more frequent in SUDD than PD patients (p = 0.007). Number of long-lasting pain episodes was higher in SUDD (6.6 ± 11.9) compared to PD patients (3.4 ± 6.9) (p < 0.001). PD patients reported long-lasting pain more frequently in the lower left abdomen (p < 0.001), while in SUDD it was more frequently diffuse (p = 0.002) or localized in the lower right quadrant (p = 0.009). Features associated with long-lasting pain (fever, confinement to bed, consultations, antibiotic therapy, hospitalization) were more often reported in PD patients. IBS criteria were reported in 28.2% of patients and were more frequent in SUDD than PD patients (37.2% vs 17.1%, p < 0.001). SUDD and PD patients presented different pattern of abdominal pain (length, number of long lasting episodes, site and associated features), with a third reporting overlap with IBS. Further observational studies are needed to better characterize abdominal symptoms in DD patients, especially in those not fulfilling IBS criteria.Trial registration: The REMAD Registry is registered as an observational study in ClinicalTrial.gov (ID: NCT03325829).},
}

@article {pmid38653494,
year = {2024},
author = {Yilmaz, S and Gunter, RL and Kanters, AE and Rosen, DR and Lipman, J and Holubar, SD and Hull, TL and Steele, SR},
title = {Segmental Colectomy in Ulcerative Colitis.},
journal = {Diseases of the colon and rectum},
volume = {},
number = {},
pages = {},
doi = {10.1097/DCR.0000000000003311},
pmid = {38653494},
issn = {1530-0358},
abstract = {BACKGROUND: Segmental colectomy in ulcerative colitis is performed in select patients who may be at increased risk for postoperative morbidity.

OBJECTIVE: To identify ulcerative colitis patients who underwent segmental colectomy and assess their postoperative and long-term outcomes.

DESIGN: Retrospective case series.

SETTING: A tertiary-care inflammatory bowel disease center.

PATIENTS: Ulcerative colitis patients who underwent surgery between 1995 and 2022.

INTERVENTION: Segmental colectomy.

MAIN OUTCOME MEASURES: Postoperative complications, early and late colitis, metachronous cancer development, completion proctocolectomy-free survival rates and stoma at follow-up.

RESULTS: Fifty-five patients were included [20 (36.4%) female; 67.8 (57.4-77.1) years of age at surgery; body mass index 27.7 (24.2-31.1) kg/m2; median follow-up 37.3 months]. ASA score was III in 32 (58.2%) patients, 48 (87.3%) had at least one comorbidity, 48 (87.3%) had Mayo endoscopic subscore of 0-1. Patients underwent right hemicolectomy (28, 50.9%), sigmoidectomy (17, 30.9%), left hemicolectomy (6, 10.9%), low anterior resection (2, 3.6%), or a non-anatomic resection (2, 3.6%) for; endoscopically unresectable polyps (21, 38.2%), colorectal cancer (15, 27.3%), symptomatic diverticular disease (13, 23.6%), and stricture (6, 10.9%). Postoperative complications occurred in 16 (29.1%) patients [7 (12.7%) Clavien-Dindo Class III-V]. Early and late postoperative colitis rates were 9.1% and 14.5%, respectively. Metachronous cancer developed in 1 patient. 4 (7.3%) patients underwent subsequent completion proctocolectomy with ileostomy. Six (10.9%) patients had stoma at the follow-up. Two and 5-year completion proctocolectomy-free survival rates were 91% and 88%, respectively.

LIMITATIONS: Retrospective study, small sample size.

CONCLUSIONS: Segmental colectomy in ulcerative colitis is associated with low postoperative complication rates, symptomatic early colitis and late colitis rates, metachronous cancer development and the need for subsequent completion proctocolectomy. Therefore, it can be safe to consider select patients, such as the elderly with quiescent colitis and other indications for colectomy. See Video Abstract.},
}

@article {pmid38646562,
year = {2024},
author = {Santacroce, G and Lenti, MV and Abruzzese, GM and Alunno, G and Di Terlizzi, F and Frenna, C and Gentile, A and Latorre, MA and Petrucci, C and Ruggeri, D and Soriano, S and Aronico, N and De Silvestri, A and Corazza, GR and Iacucci, M and Di Sabatino, A},
title = {Clinical outcomes of diverticular disease in young adults: results from a tertiary referral center.},
journal = {Frontiers in medicine},
volume = {11},
number = {},
pages = {1363548},
pmid = {38646562},
issn = {2296-858X},
abstract = {INTRODUCTION: Diverticular disease (DD), commonly associated with the elderly, is becoming more prevalent among younger individuals. This retrospective study aimed to evaluate the differences in the natural history and outcomes between young and old patients with DD.

METHODS: Adult patients with DD diagnosed between 2010 and 2022 at an Italian tertiary referral center were enrolled, and their demographic and clinical data were retrieved. The patients were categorized as young or old based on the 25th percentile of the population's age at diagnosis. Univariate and multivariate analyses were performed to assess the association between the collected variables and the age of disease presentation. Additionally, survival analyses were conducted to evaluate the association between the age of diagnosis and clinical outcomes at follow-up, including disease recurrence, hospital access, surgery, and death.

RESULTS: A total of 220 DD patients (with a median age of 66 years, IQR 55-74, and a female-to-male ratio of 1.4:1) were included in the study, comprising 54 patients receiving a diagnosis before the age of 49 years (young DD patients) and 166 patients diagnosed after the age of 49 years (old DD patients). Male sex (57 vs. 36%, p < 0.01), smoking (38 vs. 14%, p < 0.01), and alcohol consumption (54 vs. 38%) were highly prevalent in young patients. The complications at the time of diagnosis, particularly abscesses and free perforations, occurred more frequently in younger patients (p = 0.04). Moreover, young DD patients experienced a higher rate of hospitalization and surgical intervention (p = 0.01 and p = 0.04, respectively) over a median follow-up period of 5 years.

CONCLUSION: Preventive strategies and prompt diagnosis are crucial in young patients with DD for achieving better disease outcomes and preventing complications.},
}

@article {pmid38646313,
year = {2024},
author = {Narváez González, HF and De Alba Cruz, I and Carbajal Cabrera, PR and Morales Tercero, YA and Luna León, LG and Vargas Ávila, AL},
title = {Neutrophil- and Platelet-Lymphocyte Ratio as Biomarkers of Severity in Complicated Diverticular Disease.},
journal = {Cureus},
volume = {16},
number = {3},
pages = {e56656},
pmid = {38646313},
issn = {2168-8184},
abstract = {INTRODUCTION: Diverticulitis is a prevalent gastrointestinal disease that may require surgical intervention. The aim of the study was to investigate the involvement of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as biomarkers of severity in complicated diverticular disease (CDD) in Mexican patients and their correlation with the need for surgical intervention, the length of hospital stay, and mortality.

MATERIAL AND METHODS: An observational, longitudinal, and retrospective study performed from 2017 to 2021 was considered in patients over 18 years of age, with a diagnosis of CDD by using computed tomography and with a hemogram taken in the first 24 hours upon admission to the emergency department to describe the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) of NLR and PLR in the CDD.  Results: A total of 102 Mexican patients suffering from CDD, 54% women and 46% men with a mean of 59 years, were analyzed. According to Hinchey's classification, 79 (77.5%) patients showed type I, 12 (12.8%) type II, 5 (4.9%) type III, and 6 (5.9%) type IV. The mean hospital stay was 8.8 days, with a mortality rate of 3.9%. The cut-off value was established at 5.1 for NLR according to the results of the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.633, a sensitivity of 90%, a specificity of 43%, PPV of 21.8%, and NPV of 96% for the prediction of CDD. A cut-off value for PLR at 72 was established according to the results of the ROC curve with an AUC of 0.482, a sensitivity of 78%, a specificity of 40%, PPV of 96%, and NPV of 9% for the prediction of CDD.

CONCLUSION: The NLR and PLR are easily calculable and accessible biomarkers that can be part of the decision-making for the diagnosis and treatment of CDD in Mexican people as has been observed in other populations. However, more prospective, multicenter comparative studies are needed to assess the efficacy and safety of these biomarkers in relation to those already described.},
}

@article {pmid38645837,
year = {2024},
author = {Pham, PC and Van, HAT and Hoang, VT and Hoang, TH and Nguyen, DD and Hoang, DT},
title = {Appendiceal Diverticulitis Mimics Cecal Diverticulitis Diagnosed Preoperatively.},
journal = {Clinical pathology (Thousand Oaks, Ventura County, Calif.)},
volume = {17},
number = {},
pages = {2632010X241248909},
pmid = {38645837},
issn = {2632-010X},
abstract = {Appendiceal diverticulitis is an uncommon condition that clinically resembles acute appendicitis. However, it is an incidental finding in histopathological studies and is rarely diagnosed preoperatively by imaging studies. In this article, we present the clinical and imaging findings of a male patient presenting with right upper quadrant pain with a preoperative imaging diagnosis of appendiceal diverticulitis. He underwent laparoscopic appendectomy and confirmed the diagnosis of appendiceal diverticulitis. This is a rare preoperative diagnosis. The management is often like typical appendicitis which is appendectomy. It is important to differentiate it from diverticulitis of the small intestine or colon because these diseases usually require only conservative treatment.},
}

@article {pmid38642312,
year = {2024},
author = {Bassotti, G},
title = {Treating colonic diverticula with rifaximin: a call to action.},
journal = {Internal and emergency medicine},
volume = {},
number = {},
pages = {},
pmid = {38642312},
issn = {1970-9366},
}

@article {pmid38638782,
year = {2024},
author = {Malone, JC and Patel, SR and Walker, JP and Shabot, M},
title = {Giant Colonic Diverticulum: A Rare Type of Diverticular Disease.},
journal = {Cureus},
volume = {16},
number = {3},
pages = {e56463},
pmid = {38638782},
issn = {2168-8184},
abstract = {Giant colonic diverticulum (GCD) is a well-recognized but infrequently encountered disease in clinical practice. GCD is its own unique entity and differs from commonly seen diverticular disease in both size and management. Initial clinical presentation is typically associated with diverticulitis and symptoms such as abdominal pain, fever, nausea, vomiting, rectal bleeding, or even a palpable abdominal mass. Surgery is the recommended treatment option largely due to the risk of associated complications including colonic perforation. We describe the case of a 56-year-old female diagnosed with a sigmoid GCD that was successfully stabilized medically and definitively treated surgically.},
}

@article {pmid38632117,
year = {2024},
author = {Podda, M and Ceresoli, M and Di Martino, M and Ortenzi, M and Pellino, G and Pata, F and Ielpo, B and Murzi, V and Balla, A and Lepiane, P and Tamini, N and De Carlo, G and Davolio, A and Di Saverio, S and Cardinali, L and Botteri, E and Vettoretto, N and Gelera, PP and De Simone, B and Grasso, A and Clementi, M and Meloni, D and Poillucci, G and Favi, F and Rizzo, R and Montori, G and Procida, G and Recchia, I and Agresta, F and Virdis, F and Cioffi, SPB and Pellegrini, M and Sartelli, M and Coccolini, F and Catena, F and Pisanu, A},
title = {Towards a tailored approach for patients with acute diverticulitis and abscess formation. The DivAbsc2023 multicentre case-control study.},
journal = {Surgical endoscopy},
volume = {},
number = {},
pages = {},
pmid = {38632117},
issn = {1432-2218},
abstract = {BACKGROUND: This multicentre case-control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses.

METHODS: This study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed.

RESULTS: Failure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI - 0.66;3.70, P = 0.23).

CONCLUSIONS: Non-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.},
}

@article {pmid38615466,
year = {2024},
author = {Dourado, J and Jassir, FF and Pavlovsky, A and Blumofe, K},
title = {Perforated jejunal diverticulitis in the setting of biologic therapy presenting as transverse Colon diverticulitis: A case report.},
journal = {International journal of surgery case reports},
volume = {118},
number = {},
pages = {109615},
doi = {10.1016/j.ijscr.2024.109615},
pmid = {38615466},
issn = {2210-2612},
abstract = {INTRODUCTION: Small bowel diverticula are a rare entity and are mostly found in the duodenum on diagnosis. Some common complications of this pathology include bleeding, obstruction, diverticulitis, and perforation. Furthermore, there is growing evidence supporting an association between biologic therapies and spontaneous intestinal perforation.

PRESENTATION OF CASE: We present a case of a 79-year-old female on prednisone, hydroxychloroquine, and tofacitinib for rheumatoid arthritis who was misdiagnosed with transverse colonic diverticulitis and eventually found to have perforated jejunal diverticulitis on laparotomy.

DISCUSSION: While tofacitinib has been associated with spontaneous intestinal perforation, it has not been documented as an aggravating factor in small bowel diverticular disease.

CONCLUSION: It is imperative to maintain a high index of suspicion for this pathology in immunosuppressed patients with an atypical presentation of diverticular disease.},
}

@article {pmid38598172,
year = {2024},
author = {Krieg, S and Kolbe, EW and Loosen, SH and Roderburg, C and Krieg, A and Kostev, K},
title = {Is there a link between appendicitis and the risk of diverticular disease?: a large German cohort study.},
journal = {International journal of colorectal disease},
volume = {39},
number = {1},
pages = {50},
pmid = {38598172},
issn = {1432-1262},
abstract = {PURPOSE: Appendicitis, characterized by inflammation of the vermiform appendix, is a common abdominal emergency necessitating appendectomy. Recent evidence suggests a potential link between appendicitis and subsequent diverticular disease, yet population-based studies investigating this association are limited.

METHODS: Utilizing the Disease Analyzer database encompassing data from over 1000 primary care practices in Germany, we conducted a retrospective cohort study. We included 25,379 adults diagnosed with appendicitis and an equal number of matched controls without appendicitis. The incidence of diverticular disease over a 10-year follow-up period was compared between the two cohorts. Cox regression analysis was performed to assess the association between appendicitis and diverticular disease, adjusting for potential confounders.

RESULTS: Our findings revealed a significant association between appendicitis and subsequent diverticular disease (HR: 1.76; 95% CI: 1.57-1.97), with an increased risk observed across all age groups. Notably, this association was stronger in men (HR: 2.00; 95% CI: 1.68-2.37) than in women (HR: 1.58; 95% CI: 1.36-1.84). The cumulative 10-year incidence of diverticular disease was higher in patients with appendicitis (6.5%) compared to those without (3.6%). Additionally, we observed a clear age-dependent increase in the incidence of diverticular disease.

CONCLUSION: This large-scale population-based study provides valuable insights into the interaction between appendicitis and diverticular disease. The study underscores the need for further research elucidating the underlying mechanisms linking appendicitis to diverticular disease. Probiotics emerge as a potential therapeutic avenue warranting exploration in the management of both conditions. These findings have important implications for clinical practice, highlighting the importance of considering appendicitis as a potential risk factor for diverticular disease, particularly in men. Further investigation is warranted to validate these findings and explore potential therapeutic interventions targeting the shared pathophysiological pathways underlying both conditions.},
}

@article {pmid38585039,
year = {2024},
author = {Bachelani, AM and Holton, LA},
title = {Factors affecting minimally invasive surgery utilization during elective colectomies for diverticular disease in the United States.},
journal = {Surgery open science},
volume = {19},
number = {},
pages = {14-19},
pmid = {38585039},
issn = {2589-8450},
abstract = {BACKGROUND: Compared with open surgery, minimally invasive surgery (MIS) has been shown to have improved outcomes when treating diverticular disease. This study aimed to analyze recent trends in MIS utilization for elective colectomy for diverticular disease and to identify individual variables and hospital characteristics associated with MIS utilization.

METHODS: This population-based study examined individuals from the National Inpatient Sample who underwent elective colectomy for diverticular disease from 2016 to 2019.

RESULTS: Hospitals in the Midwest used MIS less than those in other geographic regions. Rural hospitals used MIS less than urban hospitals. Hospital bed size and teaching status were not associated with differences in MIS utilization. Patients with private insurance were more likely to have an MIS operation. There was also a racial disparity in MIS utilization, even after adjusting for insurance status.

CONCLUSIONS: While there is no longer any variance in MIS utilization based on hospital bed size or teaching status, disparities concerning patient race remain, even after adjusting for insurance status. Further investigation is needed to determine the roots of these disparities.},
}

@article {pmid38583262,
year = {2024},
author = {Chen, J and Ruan, X and Fu, T and Lu, S and Gill, D and He, Z and Burgess, S and Giovannucci, EL and Larsson, SC and Deng, M and Yuan, S and Li, X},
title = {Sedentary lifestyle, physical activity, and gastrointestinal diseases: evidence from mendelian randomization analysis.},
journal = {EBioMedicine},
volume = {103},
number = {},
pages = {105110},
doi = {10.1016/j.ebiom.2024.105110},
pmid = {38583262},
issn = {2352-3964},
abstract = {BACKGROUND: The causal associations of physical activity and sedentary behavior with the risk of gastrointestinal disease are unclear. We performed a Mendelian randomization analysis to examine these associations.

METHODS: Genetic instruments associated with leisure screen time (LST, an indicator of a sedentary lifestyle) and moderate-to-vigorous intensity physical activity (MVPA) at the genome-wide significance (P < 5 × 10[-8]) level were selected from a genome-wide association study. Summary statistics for gastrointestinal diseases were obtained from the UK Biobank study, the FinnGen study, and large consortia. Multivariable MR analyses were conducted for genetically determined LST with adjustment for MVPA and vice versa. We also performed multivariable MR with adjustment for genetically proxied smoking, body mass index (BMI), waist-to-hip ratio, type 2 diabetes, and fasting insulin for both exposures.

FINDINGS: Genetically proxied longer LST was associated with an increased risk of gastrointestinal reflux, gastric ulcer, duodenal ulcer, chronic gastritis, irritable bowel syndrome, diverticular disease, Crohn's disease, ulcerative colitis, non-alcoholic fatty liver disease, alcoholic liver disease, cholangitis, cholecystitis, cholelithiasis, acute pancreatitis, chronic pancreatitis, and acute appendicitis. Most associations remained after adjustment for genetic liability to MVPA. Genetic liability to MVPA was associated with decreased risk of gastroesophageal reflux, gastric ulcer, chronic gastritis, irritable bowel syndrome, cholecystitis, cholelithiasis, acute and chronic pancreatitis. The associations attenuated albeit directionally remained after adjusting for genetically predicted LST. Multivariable MR analysis found that BMI and type 2 diabetes mediated the associations of LST and MVPA with several gastrointestinal diseases.

INTERPRETATION: The study suggests that a sedentary lifestyle may play a causal role in the development of many gastrointestinal diseases.

FUNDING: Natural Science Fund for Distinguished Young Scholars of Zhejiang Province (LR22H260001), Natural Science Foundation of Hunan Province (2021JJ30999), Swedish Heart-Lung Foundation (Hjärt-Lungfonden, 20210351), Swedish Research Council (Vetenskapsrådet, 2019-00977), Swedish Cancer Society (Cancerfonden), the Wellcome Trust (225790/7/22/Z), United Kingdom Research and Innovation Medical Research Council (MC_UU_00002/7) and National Institute for Health Research Cambridge Biomedical Research Centre (NHIR203312).},
}

@article {pmid38572374,
year = {2024},
author = {Obata, K and Uchiyama, K and Murai, R},
title = {Endoscopic and clinicopathological features of segmental colitis associated with diverticulosis.},
journal = {DEN open},
volume = {4},
number = {1},
pages = {e356},
pmid = {38572374},
issn = {2692-4609},
abstract = {OBJECTIVES: Segmental colitis associated with diverticulosis (SCAD) has close endoscopic and pathological similarities to ulcerative colitis (UC) and Crohn's disease. Clinical data on SCAD are limited in Japan. We examined the endoscopic and clinicopathological features of patients with SCAD.

METHODS: This single-center retrospective study included 13 patients with SCAD between 2012 and 2022. Endoscopic findings were categorized as follows: type A (swollen red patches 5-10 mm at the top of mucosal folds), mild and moderate type B (mild-to-moderate UC-like findings), type C (aphthous ulcers resembling Crohn's disease), and type D (severe UC-like findings).

RESULTS: Overall, six, five, and two patients were diagnosed with type A, mild type B, and moderate type B disease, respectively. Among the type A cases, two spontaneously progressed to moderate type B and one escalated to type D, necessitating an emergency sigmoidectomy owing to perforation peritonitis, despite repeated antibiotic treatments. Histopathologically, diffuse neutrophil and lymphocyte infiltration with cryptitis were noted in all type A cases, whereas UC-like alterations were observed in type B and D cases. Seven type B cases were treated with oral 5-aminosalicylic acid and/or salazosulfapyridine. Clinical remission was achieved in three mild type B cases and one moderate type B case, while clinical relapse and remission were noted in three moderate type B cases. No anti-inflammatory treatment was required in three type A and two mild type B cases.

CONCLUSIONS: Aggressive anti-inflammatory treatment should be considered for SCAD with UC-like findings due to the potential risk of severe ulceration, stenosis, and/or perforation.},
}

@article {pmid38563552,
year = {2024},
author = {Wang, Y and Zhu, J and Tang, Y and Huang, C},
title = {Association of periodontitis with gastrointestinal tract disorders: A bidirectional Mendelian randomization study.},
journal = {Journal of periodontology},
volume = {},
number = {},
pages = {},
doi = {10.1002/JPER.23-0560},
pmid = {38563552},
issn = {1943-3670},
abstract = {BACKGROUND: The bidirectional link of periodontitis (PD) and gastrointestinal tract (GIT) disorders has been investigated in previous epidemiological studies; however, the conclusions still remain controversial. The aim of this study was to comprehensively explore the bidirectional causal effect between PD and various GIT diseases.

METHODS: Based on summary-level data of genome-wide association studies (GWASs), a two-sample bidirectional Mendelian randomization (MR) study was undertaken. Single-nucleotide polymorphisms (SNPs) associated with PD or GIT disorders (chronic gastritis [CG], gastric ulcer [GU], duodenal ulcer [DU], gastroesophageal reflux disease [GERD], irritable bowel syndrome [IBS], and diverticular disease of the intestine [DI]) in GWASs were applied as exposure. The primary method employed was the inverse-variance weighted (IVW) method, and several sensitivity analyses were performed to investigate potential pleiotropy.

RESULTS: With regard to the investigation of the causality between PD and GIT disorders, the IVW method revealed that there is a causal impact of PD on GU (odds ratio [OR] 1.088; 95% confidence interval [CI], 1.036-1.141; adjusted p = 0.004) and DI (OR 0.938; 95% CI, 0.911-0.965; adjusted p = 0.000). However, no significant genetic liability was observed for the causal effect of PD on CG, DU, GERD, and IBS. Furthermore, the primary analysis did not demonstrate a causal effect of GIT disorders on PD.

CONCLUSION: This MR study suggests that PD may be associated with an increased risk of GU and a reduced risk of DI, with possibly limited clinical relevance. Further studies are needed to support the conclusions of this MR study.},
}

@article {pmid38562396,
year = {2024},
author = {Taah-Amoako, P and Bediako-Bowan, AAA and Dakubo, JCB},
title = {The Prevalence and Management Outcomes of Diverticular Disease in a Tertiary Facility in Ghana.},
journal = {Journal of the West African College of Surgeons},
volume = {14},
number = {2},
pages = {141-145},
pmid = {38562396},
issn = {2992-5827},
abstract = {BACKGROUND: Diverticular disease of the colon, previously believed to be rare among Africans, is now an emerging disease entity in many African countries. The increasing morbidity and varied presentations are associated with this.

OBJECTIVES: To determine the prevalence of diverticular disease among patients who underwent lower gastrointestinal endoscopies over a 5-year period and evaluate the common presentations, interventions, and treatment outcomes at the Korle-Bu Teaching Hospital (KBTH), Ghana.

MATERIALS AND METHODS: This was a retrospective cross-sectional study of patients who underwent either a colonoscopy or proctosigmoidoscopy between January 2017 and December 2021, at the KBTH. The records of patients admitted for complications of diverticular disease over the same period were also reviewed.

RESULTS: A total of 4266 patients underwent lower gastrointestinal endoscopy over the study period. Out of this, 380 were diagnosed with diverticular disease giving a prevalence of 8.91%. This comprised 58.95% male and 41.05% female. Their mean age was 67.02 (standard deviation ± 11.45). The age ranged from 26 to 95 years with a median of 67. Sixty-seven patients with 88 episodes of admission were managed for complications. The average age was 69.26 (SD ± 13.28) and ranged from 40 to 98 years with an interquartile range of 20 years. Complications were predominantly bleeding diverticular disease (94.32%), whereas 5.6% presented with diverticulitis. Ninety percent were managed conservatively, and 10% had surgical intervention.

CONCLUSION: This study concludes that the prevalence of diverticular disease among Ghanaians undergoing lower gastrointestinal endoscopy is still low and bleeding is the commonest indication for admission which is mostly managed conservatively.},
}

@article {pmid38540970,
year = {2024},
author = {Gallo, A and Covino, M and Baroni, S and Camilli, S and Ibba, F and Andaloro, S and Agnitelli, MC and Rognoni, FM and Landi, F and Montalto, M},
title = {Diagnostic Accuracy of Fecal Calprotectin in Discriminating Organic-Inflammatory Gastrointestinal Diseases and Functional Gastrointestinal Disorders in Older Patients.},
journal = {Journal of personalized medicine},
volume = {14},
number = {3},
pages = {},
doi = {10.3390/jpm14030227},
pmid = {38540970},
issn = {2075-4426},
abstract = {Fecal calprotectin (FC) has been largely recognized as a surrogate marker of intestinal neutrophilic inflammation, very reliable in distinguishing between inflammatory bowel diseases and functional gastrointestinal (GI) disorders. Aging has been suggested to influence FC results and their diagnostic accuracy; however, no studies are specifically targeted on this focus. In a retrospective study, we evaluated the eventual age-differences of the diagnostic accuracy of FC in discriminating between organic-inflammatory GI diseases and functional GI disorders. In 573 younger and 172 older (≥65 years) subjects undergoing an FC assay, we found that the latter showed higher median FC values, 72 (25-260) µg/g vs. 47 (25-165) µg/g (p < 0.01). Younger patients were more commonly affected by IBDs, while colorectal cancer and high-risk polyps, infective colitis, and diverticular disease represented the most common findings in the older subgroup. However, the estimated optimum FC threshold in discriminating between organic-inflammatory GI diseases and functional GI disorders was quite similar between the two groups (109 μg/g for the younger subgroup and 98 μg/g for the older subgroup), maintaining a very high specificity. In conclusion, we show that FC also represents a very specific test for intestinal inflammation in older patients, at similar threshold levels to younger subjects.},
}

@article {pmid38505449,
year = {2024},
author = {Sahay, SC and Mangla, V and Kesarwani, P and Goel, A},
title = {Robotic-Assisted Colovesical Fistula Repair: A Case Report.},
journal = {Cureus},
volume = {16},
number = {2},
pages = {e54404},
pmid = {38505449},
issn = {2168-8184},
abstract = {Colovesical fistulas present a diagnostic and therapeutic challenge, commonly arising from complications of diverticular disease. In our case, a 71-year-old male with colovesical fistula symptoms underwent robotic-assisted surgery for complicated sigmoid diverticulitis. Intraoperatively, meticulous adhesiolysis and fistula repair were performed. Histopathology confirmed diverticular disease. Postoperatively, the patient recovered well. Colovesical fistulas may indicate underlying malignancy in diverticulitis. With a lack of standardized protocols, our case suggests that robotic-assisted surgery offers improved outcomes, better vision, and ergonomics. To conclude, robotic-assisted colovesical fistula repair and sigmoidectomy demonstrated excellent outcomes, suggesting a promising approach for enhanced postoperative recovery.},
}

@article {pmid38496209,
year = {2024},
author = {Rizzuto, A and Andreuccetti, J and Bracale, U and Silvestri, V and Pontecorvi, E and Reggio, S and Sagnelli, C and Peltrini, R and Amaddeo, A and Bozzarello, C and Pignata, G and Cuccurullo, D and Corcione, F},
title = {Shifting paradigms: a pivotal study on laparoscopic resection for colovesical fistulas in diverticular disease.},
journal = {Frontiers in surgery},
volume = {11},
number = {},
pages = {1370370},
pmid = {38496209},
issn = {2296-875X},
abstract = {BACKGROUND: Colovesical fistulas (CVFs) pose a challenge in diverticulitis, affecting 4% to 20% of sigmoid colon cases. Complicated diverticular disease contributes significantly, accounting for 60%-70% of all CVFs. Existing studies on laparoscopic CVF management lack clarity on its effectiveness in diverticular cases compared to open surgery. This study redefines paradigms by assessing the potentiality, adequacy, and utility of laparoscopy in treating CVFs due to complicated diverticular disease, marking a paradigm shift in surgical approaches.

METHODS: Conducting a retrospective analysis at Ospedale Monaldi A.O.R.N dei Colli and University Federico II, Naples, Italy, patients undergoing surgery for CVF secondary to diverticular disease between 2010 and 2020 were examined. Comprehensive data, including demographics, clinical parameters, preoperative diagnoses, operative and postoperative details, and histopathological examination, were meticulously recorded. Patients were classified into open surgery (Group A) and laparoscopy (Group B). Statistical analysis used IBM SPSS Statistic 19.0.

RESULTS: From January 2010 to December 2020, 76 patients underwent surgery for colovesical fistula secondary to diverticular disease. Laparoscopic surgery (Group B, n = 40) and open surgery (Group A, n = 36) showed no statistically significant differences in operative time, bladder suture, or associated procedures. Laparoscopy demonstrated advantages, including lower intraoperative blood loss, reduced postoperative primary ileus, and a significantly shorter length of stay. Postoperative morbidity differed significantly between groups. Mortality occurred in Group A but was unrelated to surgical complications. No reoperations were observed. Two-year follow-up revealed no fistula recurrence.

CONCLUSION: This pivotal study marks a paradigm shift by emphasizing laparoscopic resection and primary anastomosis as a safe and feasible option for managing CVF secondary to diverticular disease. Comparable conversion, morbidity, and mortality rates to the open approach underscore the transformative potential of these findings. The study's emphasis on patient selection and surgeon experience challenges existing paradigms, offering a progressive shift toward minimally invasive solutions.},
}

@article {pmid38490316,
year = {2024},
author = {Troelsen, FS and Farkas, DK and Erichsen, R and Strate, LL and Baron, JA and Sørensen, HT},
title = {Risk of Cancer in Patients with Diverticular Disease: A Population-based Cohort Study.},
journal = {Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association},
volume = {},
number = {},
pages = {},
doi = {10.1016/j.cgh.2024.02.024},
pmid = {38490316},
issn = {1542-7714},
abstract = {BACKGROUND AND AIMS: Several studies have investigated the association between diverticular disease (DD) and colorectal cancer. However, whether there is an association between DD and malignancies other than those in the colorectum remains uncertain.

METHODS: For the 1978-2019 period, we conducted a nationwide, population-based cohort study using national Danish healthcare data. We followed DD patients for up to 20 years, beginning one year after the date of DD diagnosis until the first occurrence of incident cancer, emigration, death, 20 years of follow-up, or December 31[st], 2019. We calculated cumulative incidence proportions of cancer and standardized incidence ratios (SIRs) comparing cancer incidence among DD patients with that in the general population.

RESULTS: We identified 200,639 patients with DD, of whom 20,498 were diagnosed with cancer during the 1-20 years after their DD diagnosis. The SIRs were increased for most cancer sites except for those in the colorectum (SIR: 0.75 [95% CI: 0.72-0.78]). The highest SIRs were observed for cancers of the lung, bronchi, and trachea (SIR, 1.20; 95% CI: 1.15-1.24) and kidney (SIR, 1.27; 95% CI: 1.16-1.39).

CONCLUSIONS: Our findings show an increased long-term relative risk of cancer following a diagnosis of DD. These findings are likely due to prevalence of numerous risk factors in DD patients that confer an increased risk of cancer. The decreased relative risk of colorectal cancer might be explained by an increased likelihood of DD patients undergoing colonoscopy with polypectomy.},
}

@article {pmid38487561,
year = {2024},
author = {Williams, S and Bjarnason, I and Hayee, B and Haji, A},
title = {Diverticular disease: update on pathophysiology, classification and management.},
journal = {Frontline gastroenterology},
volume = {15},
number = {1},
pages = {50-58},
doi = {10.1136/flgastro-2022-102361},
pmid = {38487561},
issn = {2041-4137},
abstract = {Colonic diverticulosis is prevalent, affecting approximately 70% of the western population by 80 years of age. Incidence is rapidly increasing in younger age groups. Between 10% and 25% of those with diverticular disease (DD) will experience acute diverticulitis. A further 15% will develop complications including abscess, bleeding and perforation. Such complications are associated with significant morbidity and mortality and constitute a worldwide health burden. Furthermore, chronic symptoms associated with DD are difficult to manage and present a further significant healthcare burden. The pathophysiology of DD is complex due to multifactorial contributing factors. These include diet, colonic wall structure, intestinal motility and genetic predispositions. Thus, targeted preventative measures have proved difficult to establish. Recently, commonly held conceptions on DD have been challenged. This review explores the latest understanding on pathophysiology, risk factors, classification and treatment options.},
}

@article {pmid38479421,
year = {2024},
author = {Frieling, T},
title = {[Non-distinctive abdominal pain: is it diverticular disease or not?].},
journal = {Deutsche medizinische Wochenschrift (1946)},
volume = {149},
number = {7},
pages = {369-373},
doi = {10.1055/a-2063-0967},
pmid = {38479421},
issn = {1439-4413},
abstract = {Acute abdominal pain may relate to specific organ systems and needs an interdisciplinary approach with close collaboration between internal and surgical disciplines. Main objective is to shorten the diagnostic work-up between the beginning of the symptoms and their therapy. After clarifying of the five w-questions: when, how, how long, why, and where, abdominal ultrasound, ECG, laboratory diagnostics and early application of computed tomography should be performed.For the most part, chronic abdominal pain is caused by disorders of the gut-brain-axis such as the irritable bowel syndrome. Because of the synaptic plasticity, the processing of pain is dynamic and cannot be related to a single organ system. This problem is obvious in patients with irritable bowel syndrome and colonic diverticula, which may be interpreted as symptomatic uncomplicated diverticular disease (SUDD, type 3a). However, a reliable clinical differentiation between both groups is not possible. The establishment of SUDD (type 3a) considerable widened the application area of mesalazine.},
}

@article {pmid38471466,
year = {2024},
author = {Völkerer, A and Wernly, S and Semmler, G and Flamm, M and Radzikowski, K and Datz, L and Aigner, E and Datz, C and Wernly, B},
title = {The Impact of Educational Status on the Occurrence of Colonic Diverticula: Insights from an Austrian Cohort Study.},
journal = {Medical principles and practice : international journal of the Kuwait University, Health Science Centre},
volume = {},
number = {},
pages = {},
doi = {10.1159/000538308},
pmid = {38471466},
issn = {1423-0151},
abstract = {OBJECTIVE: Education often reflects socioeconomic status. Research indicates that lower socioeconomic status may increase the risk of diverticulosis, and ccording to data from the USA, diverticular disease is a significant and costly health problem. Our study explores the link between educational level and colonic diverticula occurrence.

SUBJECT AND METHODS: We conducted a cohort study on 5,532 asymptomatic Austrian patients who underwent colonoscopy, categorizing them by education level using the updated Generalized International Standard Classification of Education (GISCED). Logistic regression models, adjusting for age, gender, metabolic syndrome, diet, and activity, were used to determine the association between education and diverticulosis.

RESULTS: Overall, 39% of the patients had low educational status, while 53% had medium, and 8% had high educational status. Colon diverticula were less frequent in patients with medium (OR 0.73) and high (aOR 0.62) educational status. Medium educational level remained associated with lower rates of diverticulosis after adjustment for age and sex (aOR 0.85) and further metabolic syndrome, dietary habits, and physical activity (aOR 0.84). In higher education status this phenomenon was only seen by trend.

CONCLUSION: Low education correlated with higher colon diverticula risk, while medium education showed lower rates even after adjustments. This trend persisted at higher education levels, highlighting the potential for strategies for cost-reduction tailored to socioeconomic conditions.},
}

@article {pmid38459424,
year = {2024},
author = {Nantais, J and Baxter, NN and Saskin, R and Calzavara, A and Gomez, D},
title = {Short- and long-term outcomes of acute diverticulitis in patients with transplanted kidneys.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {},
number = {},
pages = {},
doi = {10.1111/codi.16941},
pmid = {38459424},
issn = {1463-1318},
support = {/CAPMC/CIHR/Canada ; },
abstract = {AIM: The safety of nonoperative treatment for patients with transplanted kidneys who develop acute diverticulitis is unclear. Our primary aim was to examine the long-term sequelae of nonoperative management in this group.

METHOD: We performed a population-based retrospective cohort study using linked administrative databases housed at ICES in Ontario, Canada. We included adult (≥18 years) patients admitted with acute diverticulitis between April 2002 and December 2019. Patients with a functioning kidney transplant were compared with those without a transplant. The primary outcome was failure of conservative management (operation, drainage procedure or death due to acute diverticulitis) beyond 30 days. The cumulative incidence function and a Fine-Grey subdistribution hazard model were used to evaluate this outcome accounting for competing risks.

RESULTS: We examined 165 patients with transplanted kidneys and 74 095 without. Patients with transplanted kidneys were managed conservatively 81% of the time at the index event versus 86% in nontransplant patients. Short-term outcomes were comparable, but cumulative failure of conservative management at 5 years occurred in 5.6% (95% CI 2.3%-11.1%) of patients with transplanted kidneys versus 2.1% (95% CI 2.0%-2.3%) in those without. Readmission for acute diverticulitis was also higher in transplanted patients at 5 years at 16.7% (95% CI 10.1%-24.7%) versus 11.6% (95% CI 11.3%-11.9%). Adjusted analyses showed increased failure of conservative management [subdistribution hazard ratio (sHR) 3.24, 95% CI 1.69-6.22] and readmissions (sHR 1.55, 95% CI 1.02-2.36) for patients with transplanted kidneys.

CONCLUSION: Most patients with transplanted kidneys are managed conservatively for acute diverticulitis. Although long-term readmission and failure of conservative management is higher for this group than the nontransplant population, serious outcomes are infrequent, substantiating the safety of this approach.},
}

@article {pmid38453141,
year = {2024},
author = {Chen, K and Wang, YC and Yang, KT and Huang, TH and Hung, YM and Chang, R},
title = {Association of diverticulitis and potential risk of ischemic stroke: population-based matched cohort study in Taiwan.},
journal = {Postgraduate medical journal},
volume = {},
number = {},
pages = {},
doi = {10.1093/postmj/qgae010},
pmid = {38453141},
issn = {1469-0756},
abstract = {BACKGROUND: Previous studies have suggested relationship between diverticular disease and cardiovascular disease. Since cardiovascular disease and cerebrovascular accident share a lot of pathogenesis, diverticulitis could also be a risk factor for stroke. This study tried to establish epidemiological evidence of the relationship between colon diverticulitis and ischemic stroke.

METHODS: In this retrospective cohort study, patients with newly diagnosed colon diverticulitis (N = 6238) and patients without colon diverticulitis (control group; N = 24 952) were recruited between January 1, 2000, and December 31, 2017. Both groups were matched by propensity score at a 1:4 ratio by age, sex, comorbidities and medications. Cox proportional hazard regression was applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) of ischemic stroke. We also conducted 4 different regression models and 2 sensitivity analyses to test the robustness of our findings.

RESULTS: The diverticulitis group had a higher risk of IS than the control group (adjusted HR, 1.25; 95% CI, 1.12-1.39; P < 0.001). Serial sensitivity analyses yielded consistent positive link between diverticulitis and IS. Further subgroup analysis showed that in the study group, the risk of IS was 2.54-fold higher than the matched controls in 30-39 years.

CONCLUSIONS: Our study found that colon diverticulitis was associated with a higher risk of developing subsequent ischemic stroke, especially for patients aged 30-39 years, among Asian population. This result provides us a chance to undertake preventive measures for ischemic stroke in high-risk patients.},
}

@article {pmid38443061,
year = {2024},
author = {Seo, J and Liu, H and Young, K and Zhang, X and Keku, TO and Jones, CD and North, KE and Sandler, RS and Peery, AF},
title = {Genetic and transcriptomic landscape of colonic diverticulosis.},
journal = {Gut},
volume = {},
number = {},
pages = {},
doi = {10.1136/gutjnl-2023-331267},
pmid = {38443061},
issn = {1468-3288},
abstract = {OBJECTIVE: Colonic diverticulosis is a prevalent condition among older adults, marked by the presence of thin-walled pockets in the colon wall that can become inflamed, infected, haemorrhage or rupture. We present a case-control genetic and transcriptomic study aimed at identifying the genetic and cellular determinants underlying this condition and the relationship with other gastrointestinal disorders.

DESIGN: We conducted DNA and RNA sequencing on colonic tissue from 404 patients with (N=172) and without (N=232) diverticulosis. We investigated variation in the transcriptome associated with diverticulosis and further integrated this variation with single-cell RNA-seq data from the human intestine. We also integrated our expression quantitative trait loci with genome-wide association study using Mendelian randomisation (MR). Furthermore, a Polygenic Risk Score analysis gauged associations between diverticulosis severity and other gastrointestinal disorders.

RESULTS: We discerned 38 genes with differential expression and 17 with varied transcript usage linked to diverticulosis, indicating tissue remodelling as a primary diverticula formation mechanism. Diverticula formation was primarily linked to stromal and epithelial cells in the colon including endothelial cells, myofibroblasts, fibroblasts, goblet, tuft, enterocytes, neurons and glia. MR highlighted five genes including CCN3, CRISPLD2, ENTPD7, PHGR1 and TNFSF13, with potential causal effects on diverticulosis. Notably, ENTPD7 upregulation was confirmed in diverticulosis cases. Additionally, diverticulosis severity was positively correlated with genetic predisposition to diverticulitis.

CONCLUSION: Our results suggest that tissue remodelling is a primary mechanism for diverticula formation. Individuals with an increased genetic proclivity to diverticulitis exhibit a larger numbers of diverticula on colonoscopy.},
}

@article {pmid38419785,
year = {2024},
author = {Aierken, A and Atabieke, F and Aierken, M and Li, J and Xia, Y and Aizezi, Y and Li, SX},
title = {No bidirectional relationship between inflammatory bowel disease and diverticular disease: a genetic correlation and Mendelian randomization study.},
journal = {Frontiers in genetics},
volume = {15},
number = {},
pages = {1334473},
pmid = {38419785},
issn = {1664-8021},
abstract = {Background: Although previous studies found that inflammatory bowel disease (IBD) and diverticular disease (DD) usually co-exist clinically, studies examining the relationship are spare. Aim: Our study aspires to investigate the causal correlation between the IBD [including ulcerative colitis (UC) and Crohn's disease (CD)] and DD using the Mendelian randomization (MR) analysis. Methods: We conducted a two-sample bidirectional MR analysis using publicly available genome-wide association studies (GWAS) summary data. The single nucleotide polymorphism (SNP) data associated with DD and IBD were obtained from the Finnish Biobank and UK Biobank, respectively. Through secondary data analysis of all GWAS summary data, we systematically screened genetic instrumental variables. To address the impact of horizontal pleiotropy, several methods were employed, including the inverse variance-weighted method (IVW), maximum likelihood method, Egger regression method, weighted median method, and simple median method. These approaches aimed to detect and correct for the potential bias caused by horizontal pleiotropy. Results: Genetically predicted DD did not have a causal effect on IBD (OR 1.06, 95% CI 0.98-1.17, p = 0.15), and had no causal effect on UC (OR 1.10, 95% CI 0.94-1.20, p = 0.36) and CD (OR 1.03, 95% CI 0.92-1.16, p = 0.62) either. Furthermore, in the reverse MR analysis, we did not observe any significant causal effect of IBD on DD. Results of complementary methods showed consistent results with those of the IVW method. Conclusion: This study's findings do not provide evidence for a causal relationship between IBD and DD, which contradicts the majority of observational studies.},
}

@article {pmid38391336,
year = {2023},
author = {Shanmugasundaram, S and Gurusamy, U and Venkataswamy, C and Prabhakaran, VK},
title = {A rare association of non-IBD-related giant filiform polyposis and diverticular disease.},
journal = {Indian journal of pathology & microbiology},
volume = {},
number = {},
pages = {},
doi = {10.4103/ijpm.ijpm_344_22},
pmid = {38391336},
issn = {0974-5130},
}

@article {pmid38369674,
year = {2024},
author = {Sabbagh, C and Beyer-Berjot, L and Ouaissi, M and Zerbib, P and Bridoux, V and Manceau, G and Karoui, M and Panis, Y and Buscail, E and Venara, A and Khaoudy, I and Gaillard, M and Ortega-Deballon, P and Viennet, M and Thobie, A and Menahem, B and Eveno, C and Bonnel, C and Mabrut, JY and Badic, B and Godet, C and Eid, Y and Duchalais, E and Lakkis, Z and Cotte, E and Laforest, A and Defourneaux, V and Maggiorri, L and Rebibo, L and Christou, N and Talal, A and Mege, D and Bonnamy, C and Germain, A and Mauvais, F and Tresallet, C and Ahmed, O and Regimbeau, JM and Roudie, J and Laurent, A and Trilling, B and Bertrand, M and Massalou, D and Romain, B and Tranchart, H and Giger, U and Dejardin, O and Pellegrin, A and Alves, A and , },
title = {Risk factors for severe morbidity and definitive stoma after elective surgery for sigmoid diverticulitis: a multicenter national cohort study.},
journal = {Techniques in coloproctology},
volume = {28},
number = {1},
pages = {34},
pmid = {38369674},
issn = {1128-045X},
abstract = {BACKGROUND: In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level.

METHODS: All consecutive patients who had elective surgery for SDD (2010-2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD.

RESULTS: In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m[2], and 2310 (50%) were men. The indications for surgery were complicated diverticulitis in 50% and smoldering diverticulitis in 47.4%. The procedures were performed laparoscopically for 88% and with an anastomosis for 83.8%. The severe complication rate on postoperative day 90 was 11.7%, with a risk of anastomotic leakage of 4.7%. The independent risk factors in multivariate analysis were an American Society of Anesthesiologists (ASA) score ≥ 3, an open approach, and perioperative blood transfusion. Age, perioperative blood transfusion, and Hartmann's procedure were the three independent risk factors for a permanent stoma.

CONCLUSIONS: This series provides a real-life picture of elective sigmoidectomy for SDD at a national level.

TRIAL REGISTRATION: Comité National Information et Liberté (CNIL) (n°920361).},
}

@article {pmid38344628,
year = {2024},
author = {Vigilante, N and Constantinescu, CS},
title = {Two Cases of Acute Diverticulitis Following Ocrelizumab Infusion in Patients With Multiple Sclerosis.},
journal = {Cureus},
volume = {16},
number = {1},
pages = {e52032},
pmid = {38344628},
issn = {2168-8184},
abstract = {Ocrelizumab is an anti-CD20 monoclonal antibody used to treat primary progressive and relapsing-remitting multiple sclerosis. Several prior case reports have demonstrated colitis in association with ocrelizumab infusion, and one case report has shown ocrelizumab-associated diverticulitis. We report on two cases in which ocrelizumab treatment of multiple sclerosis was complicated by acute diverticulitis. A 50-year-old woman and a 41-year-old man, both with relapsing-remitting multiple sclerosis, presented with acute abdominal pain. One patient had no known gastrointestinal history while the other had a history of laparoscopic sleeve gastrectomy. Both patients had received an ocrelizumab infusion one month prior to presentation. The woman underwent exploratory laparotomy, which revealed perforated sigmoid diverticulitis. The man was initially suspected of appendicitis and was treated with appendectomy, but a pathology review demonstrated diverticular disease in the appendix. In patients with multiple sclerosis on ocrelizumab, presentation with diverticulitis should include ocrelizumab-induced diverticulitis in the differential diagnosis.},
}

@article {pmid38331045,
year = {2024},
author = {Troelsen, FS and Sørensen, HT and Erichsen, R},
title = {Risk of a post-colonoscopy colorectal cancer in patients with diverticular disease: A population-based cohort study.},
journal = {Endoscopy},
volume = {},
number = {},
pages = {},
doi = {10.1055/a-2264-8199},
pmid = {38331045},
issn = {1438-8812},
abstract = {BACKGROUND AND STUDY AIMS: Post-colonoscopy colorectal cancers (PCCRCs) may account for up to 30% of all colorectal cancers (CRCs) diagnosed in patients with diverticular disease (DD); however, the absolute and relative risks of PCCRC among DD patients undergoing colonoscopy remain unknown.

PATIENTS AND METHODS: We performed a cohort study (1995-2015) including DD and non-DD patients undergoing colonoscopy. We calculated 7-36-month cumulative incidence proportions (CIPs) of PCCRC. We used Cox proportional hazards regression models to compute hazard ratios (HRs) of PCCRC comparing DD with non-DD patients undergoing colonoscopy, as a measure of relative risk. Finally, we calculated 3-year PCCRC rates, as recommended by the World Endoscopy Organization, to estimate the proportion of DD and non-DD patients with CRC who experience a PCCRC. We stratified all analyses by site of PCCRC.

RESULTS: We observed 373 PCCRC cases among 56,642 DD patients and 1,536 PCCRC cases among 306,800 non-DD patients. The CIP of PCCRC after a first-time colonoscopy was 0.45% (95% confidence interval [CI] 0.40%-0.51%) for DD patients and 0.36% (95% CI [0.34%-0.38%]) for non-DD patients. Comparing DD with non-DD patients, the adjusted HR of PCCRC after a first-time colonoscopy was 0.84 (95% CI [ 0.73-0.97]) while the corresponding HR of proximal PCCRCs was 1.23 (95% [CI: 1.01-1.50]). The 3-year PCCRC rate was 19.0% for DD patients (22% for proximal PCCRC location) and 6.5% for non-DD patients.

CONCLUSIONS: Although the absolute risk was low, the relative risk of proximal PCCRCs may be elevated in patients with DD undergoing colonoscopy compared with non-DD patients.},
}

@article {pmid38322683,
year = {2024},
author = {Sun, YM and Xin, W and Liu, YF and Guan, ZM and Du, HW and Sun, NN and Liu, YD},
title = {Appendicitis combined with Meckel's diverticulum obstruction, perforation, and inflammation in children: Three case reports.},
journal = {World journal of clinical cases},
volume = {12},
number = {4},
pages = {865-871},
doi = {10.12998/wjcc.v12.i4.865},
pmid = {38322683},
issn = {2307-8960},
abstract = {BACKGROUND: Meckel's diverticulum is a common congenital malformation of the small intestine, with the three most common complications being obstruction, perforation, and inflammation. To date, only a few cases have been reported worldwide. In children, the clinical symptoms are similar to appendicitis. As most of the imaging features are nonspecific, the preoperative diagnosis is not precise. In addition, the clinical characteristics are highly similar to pediatric acute appendicitis, thus special attention is necessary to distinguish Meckel's diverticulum from pediatric appendicitis. Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications, including intestinal necrosis, intestinal perforation and gastrointestinal bleeding.

CASE SUMMARY: This report presents three cases of appendicitis in children combined with intestinal obstruction, which was caused by fibrous bands (ligaments) arising from the top part of Meckel's diverticulum, diverticular perforation, and diverticular inflammation. All three patients, aged 11-12 years, had acute appendicitis as their initial clinical presentation. All were treated by laparoscopic surgery with a favorable outcome. A complete dataset including clinical presentation, diagnostic imaging, surgical information, and histopathologic findings was also provided.

CONCLUSION: Preoperative diagnosis of Meckel's diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children. Laparoscopy combined with laparotomy is useful for diagnosis and treatment.},
}

@article {pmid38283500,
year = {2023},
author = {Tan, YR and Lee, JCS and A Sivarajah, SS and Chong, CXZ and Chua, HL and Bhutia, K},
title = {Colovaginal Fistula: An Uncommon Complication After Vaginal Hysterectomy and Pelvic Floor Repair With Mesh Surgery.},
journal = {Cureus},
volume = {15},
number = {12},
pages = {e51221},
doi = {10.7759/cureus.51221},
pmid = {38283500},
issn = {2168-8184},
abstract = {A colovaginal fistula (CVF) is an abnormal epithelialized connection between the colon and the vagina. It is a rare complication following gynaecology surgery and can significantly affect patients' quality of life. CVFs are commonly associated with diverticular disease and are usually seen in patients with a previous hysterectomy. We report an uncommon case of postsurgical CVF following vaginal hysterectomy with mesh-augmented pelvic floor repair, which was unrelated to diverticulitis. The patient was successfully managed by a multidisciplinary team with staged surgery.},
}