@article {pmid39845636,
year = {2024},
author = {Fahrner, R and Dohner, E and Kierdorf, FJ and Canal, C and Neuhaus, V},
title = {Retrospective registry-based nationwide analysis of the COVID-19 lockdown effect on the volume of general and visceral non-malignant surgical procedures.},
journal = {Surgery in practice and science},
volume = {17},
number = {},
pages = {100241},
pmid = {39845636},
issn = {2666-2620},
abstract = {INTRODUCTION: Coronavirus disease 2019 (COVID-19) is an acute virus infection, which was declared a pandemic by the World Health Organization. The Swiss government decreed a public lockdown to reduce and restrict further infections. The aim of this investigation was to analyze the impact of the first COVID-19 lockdown on the performance of general and visceral surgery procedures.

MATERIALS AND METHODS: A retrospective study was performed on the basis of the surgical registry of the working group for quality assurance in surgery ("Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie" or AQC). All patients with specific surgical diagnoses (complicated gastric or duodenal ulcer, acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus, cutaneous and perianal abscess) were analyzed during 2019 and the corresponding lockdown period of March 14 through April 26, 2020. Data regarding patients' characteristics, diagnoses, and treatments were analyzed.

RESULTS: In total, 3,330 patients were analyzed, with 2,203 patients treated in 2019 and 1,127 patients treated in 2020. There was a reduction in the number of all investigated diagnoses during the pandemic period, with statistically significant differences in acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus (all p < 0.001), and cutaneous abscess (p = 0.01). The proportion of complicated appendicitis (p = 0.02), complicated hernia (p < 0.001), and complicated gallstone disease (choledocholithiasis p = 0.01; inflammation, p = 0.001) was significantly higher during the lockdown period. The surgical urgency rate in all patients was higher during the lockdown period compared to the control period (p < 0.001).

CONCLUSIONS: The socioeconomic lockdown significantly impacted the number of general and visceral surgery procedures in Switzerland. The reasons for the reduction are multifactorial.},
}

@article {pmid39828300,
year = {2025},
author = {Ong Ming San, E and Ali, M and Sprakes, MB and Burr, NE},
title = {Giant sigmoid diverticulum.},
journal = {BMJ case reports},
volume = {18},
number = {1},
pages = {},
doi = {10.1136/bcr-2023-258689},
pmid = {39828300},
issn = {1757-790X},
mesh = {Humans ; Male ; *Diverticulum, Colon/surgery/diagnostic imaging/complications ; Tomography, X-Ray Computed ; Colon, Sigmoid/pathology/surgery/diagnostic imaging ; Sigmoid Diseases/surgery/diagnostic imaging/diagnosis ; Aged ; },
abstract = {Giant colonic diverticulum is an uncommon presentation of colonic diverticular disease. It is characterised by the presence of a diverticulum exceeding 4 cm in size, with approximately 90% of the cases involving the sigmoid colon. Typically, diagnosis relies on CT of the abdomen and pelvis (CTAP). The preferred treatment approach is sigmoid resection with a primary colonic anastomosis. However, in complicated or emergency cases, proctosigmoidectomy with end colostomy (Hartmann's procedure) is often considered the safest surgical option.We present an atypical case of a symptomatic patient with a giant sigmoid diverticulum that had increased in size and symptoms over several years. Initial diagnosis by CTAP revealed an incidental 6 cm sigmoid diverticulum. Over approximately 6 years, the diverticulum enlarged substantially, reaching 20 cm in size. This caused compression of the stomach and splinting of the left hemidiaphragm, resulting in nutritional failure. He was admitted with a plan to optimise for curative surgery; however complications such as nutritional failure and frailty developed, leading to a decision for palliative care.},
}

Humans
Male
*Diverticulum, Colon/surgery/diagnostic imaging/complications
Tomography, X-Ray Computed
Colon, Sigmoid/pathology/surgery/diagnostic imaging
Sigmoid Diseases/surgery/diagnostic imaging/diagnosis
Aged

@article {pmid39824785,
year = {2025},
author = {Winter, J and Clark, G and Steele, R and Thornton, M},
title = {Post-colonoscopy cancer rates in Scotland from 2012 to 2018: A population-based cohort study.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {27},
number = {1},
pages = {e17298},
doi = {10.1111/codi.17298},
pmid = {39824785},
issn = {1463-1318},
mesh = {Humans ; Scotland/epidemiology ; Female ; *Colonoscopy/statistics & numerical data ; Male ; Middle Aged ; *Colorectal Neoplasms/diagnosis/epidemiology ; Aged ; *Early Detection of Cancer/statistics & numerical data/methods ; Cohort Studies ; Incidence ; Referral and Consultation/statistics & numerical data ; State Medicine/statistics & numerical data ; },
abstract = {AIM: The aim of this work was to quantify post-colonoscopy colorectal cancer (PCCRC) rates in National Health Service (NHS) Scotland using World Endoscopy Association guidelines, compare incidence between health boards and referral streams and explore comparisons in results with published data from other healthcare systems.

METHOD: This is a population-based cohort study using NHS Scotland data between 2012 and 2018. All people undergoing colonoscopy between 2012 and 2018 and subsequently diagnosed as having bowel cancer up to 3 years after their investigation were included. The main outcome measures are national trends in the PCCRC rate at 3 years (PCCRC-3yr). with comparison between bowel screening and non-screening referral routes, board of referral and analysis of factors associated with occurrence.

RESULTS: The overall unadjusted PCCRC-3yr was 7.9% (7.4%-8.3%). There was no change in the annual rate over the 7-year study period. The PCCRC rate was lower for the Scottish Bowel Cancer Screening Programme (6.7% vs. 8.3%), but compared unfavourably with rates reported by the NHS England Bowel Cancer Screening Programme from an earlier time period. There was wide variation in rates between health boards of similar population size. Rates were higher in women, with increasing age and in patients with a history of inflammatory bowel disease or diverticular disease.

CONCLUSION: Despite advances in technology, there has been no improvement in the PCCRC rate in Scotland between 2012 and 2018. Rates in bowel screening colonoscopy are better than in nonscreening colonoscopy but compare unfavourably with NHS England, possibly as a result of less robust endoscopist selection and training. Quality improvement is required in colonoscopy in order to improve patient outcomes nationally, and to allow equitable access to higher-quality colonoscopy in different regions of the country.},
}

Humans
Scotland/epidemiology
Female
*Colonoscopy/statistics & numerical data
Male
Middle Aged
*Colorectal Neoplasms/diagnosis/epidemiology
Aged
*Early Detection of Cancer/statistics & numerical data/methods
Cohort Studies
Incidence
Referral and Consultation/statistics & numerical data
State Medicine/statistics & numerical data

@article {pmid39822402,
year = {2024},
author = {Baker, JT and Cury, R and Hernandez-Suarez, DF},
title = {Myocarditis as a Possible Underlying Cause for Mid-Ventricular Takotsubo Cardiomyopathy: A Case Report.},
journal = {Cureus},
volume = {16},
number = {12},
pages = {e75813},
doi = {10.7759/cureus.75813},
pmid = {39822402},
issn = {2168-8184},
abstract = {Our case report characterizes a rare presentation of mid-ventricular Takotsubo cardiomyopathy (TTC) in a patient with suspected myocarditis as an underlying cause. Mid-ventricular TTC is a rare variant of TTC presenting with overlapping symptoms and physical exam findings of acute coronary syndrome, which often leads to misdiagnosis as myocardial infarction. Our case is of a 77-year-old female patient with a history of hyperlipidemia, right breast ductal carcinoma in situ, and diverticular disease who presented to the emergency department for evaluation of chest pain radiating to the jaw with associated nausea and vomiting. She had a similar event eight months earlier and was diagnosed with ischemia with non-obstructive coronary arteries (INOCA) based on cardiac catheterization findings. Family history was notable for myocardial infarction in the patient's father and paternal grandfather. At presentation, the patient had elevated blood pressure, elevated troponins (initially 1058 ng/L with a repeat level of 11,421 ng/L), and electrocardiogram (ECG) findings of sinus bradycardia without ischemic changes. Cardiac MRI (CMR) revealed sub-epicardial delayed enhancement suggestive of possible myocarditis and diffuse hypokinesis involving the inferolateral left ventricular wall, sparing the basal and apical segments. Left ventricular function was mildly decreased (ejection fraction of 49%) and improved prior to discharge with ejection fraction (55-60%). There were no wall motion abnormalities or significant valve disease. This case presentation exemplifies a rare manifestation of mid-ventricular TTC that occurred in the setting of underlying myocarditis. Given the patient's history, elevated troponins, and CMR results suggestive of myocarditis, we hypothesize that underlying myocarditis may have incited the development of mid-ventricular TTC. The absence of identifiable triggers in conjunction with the inferolateral ventricular wall hypokinesis and late gadolinium enhancement on CMR supports our hypothesis. The variability in clinical presentations between the present case and other reported cases of mid-ventricular TTC emphasizes the need for a deeper understanding of this condition, its triggers, and the associated clinical features to reduce the risk of future misdiagnoses. This case report highlights the significance of thorough imaging assessments for patients presenting with INOCA. Further investigations are warranted to determine underlying causes for hemodynamic instability and unique aspects of the mid-ventricular manifestation of TTC, with an emphasis on the potential association of myocarditis as an inciting factor.},
}

@article {pmid39821452,
year = {2025},
author = {Kolbe, EW and Buciunas, M and Krieg, S and Loosen, SH and Roderburg, C and Krieg, A and Kostev, K},
title = {Minimally invasive versus open surgery for colonic diverticular disease: a nationwide analysis of German hospital data.},
journal = {Techniques in coloproctology},
volume = {29},
number = {1},
pages = {46},
pmid = {39821452},
issn = {1128-045X},
mesh = {Humans ; Male ; Female ; Germany/epidemiology ; Middle Aged ; Aged ; *Length of Stay/statistics & numerical data ; *Hospital Mortality ; *Postoperative Complications/epidemiology/etiology ; Laparoscopy/statistics & numerical data/methods/adverse effects ; Adult ; Robotic Surgical Procedures/statistics & numerical data/methods/adverse effects ; Treatment Outcome ; Diverticulitis, Colonic/surgery ; Diverticulum, Colon/surgery ; Aged, 80 and over ; Intestinal Perforation/surgery/etiology ; Minimally Invasive Surgical Procedures/methods/statistics & numerical data/adverse effects ; Retrospective Studies ; Colectomy/methods/adverse effects/statistics & numerical data ; },
abstract = {BACKGROUND: This study aims to evaluate the current rates and outcomes of minimally invasive versus open surgery for colonic diverticular disease in Germany, using a nationwide dataset.

METHODS: We analyzed data from 36 hospitals, encompassing approximately 1.25 million hospitalizations from 1 January 2019 to 31 December 2023. Patients aged 18 years and older with colonic diverticular disease (International Classification of Diseases, Tenth Revision (ICD-10): K57.2 and K57.3) who underwent surgical treatment were included. Surgeries were classified as open or minimally invasive (laparoscopic or robotic). Outcomes such as in-hospital mortality, complications, and length of stay were assessed using multivariable logistic and linear regression models.

RESULTS: Out of 1670 patients who underwent surgery for colonic diverticular disease, 63.2% had perforation and abscess. The rate of minimally invasive surgery increased from 34.6% in 2019 to 52.9% in 2023 for complicated cases and from 67.8% to 86.2% for uncomplicated cases. Open surgery was associated with higher in-hospital mortality (odds ratio (OR): 7.41; 95% CI: 2.86-19.21) and complications compared with minimally invasive surgery. The length of hospital stay was significantly longer for open surgery patients, with an increase of 4.6 days for those with perforation and abscess and 5.0 days for those without.

CONCLUSIONS: Minimally invasive surgery for colonic diverticular disease is increasingly preferred in Germany, especially for uncomplicated cases. However, open surgery remains common for complicated cases, but is associated with higher mortality, more complications, and longer hospital stays.},
}

Humans
Male
Female
Germany/epidemiology
Middle Aged
Aged
*Length of Stay/statistics & numerical data
*Hospital Mortality
*Postoperative Complications/epidemiology/etiology
Laparoscopy/statistics & numerical data/methods/adverse effects
Adult
Robotic Surgical Procedures/statistics & numerical data/methods/adverse effects
Treatment Outcome
Diverticulitis, Colonic/surgery
Diverticulum, Colon/surgery
Aged, 80 and over
Intestinal Perforation/surgery/etiology
Minimally Invasive Surgical Procedures/methods/statistics & numerical data/adverse effects
Retrospective Studies
Colectomy/methods/adverse effects/statistics & numerical data

@article {pmid39814952,
year = {2025},
author = {Mari, FS and Chiarini, L and Trampetti, L and Savina, C and Cosmi, F and Cicolani, A and Gasparrini, M and Brescia, A},
title = {Preservation of inferior mesenteric artery reduces short- and long-term defecatory dysfunction after laparoscopic colorectal resection for diverticular disease: An RCT.},
journal = {Surgical endoscopy},
volume = {},
number = {},
pages = {},
pmid = {39814952},
issn = {1432-2218},
abstract = {BACKGROUND: The quality of life after surgery for diverticular disease is mainly linked to the presence and severity of postoperative defecatory disorders. These symptoms are frequently related to the sigmoid and rectal denervation following the arterial ligation. The preservation of Inferior Mesenteric Artery performing colorectal resections seems to reduce denervation, which led to a better defecatory function. This study aimed to assessing the efficacy of inferior mesenteric artery preservation following colonic resections for diverticular disease in terms of reduced defecatory disorders and improved quality of life.

METHODS: This is a prospective randomized controlled trial entirely conducted at St. Maria Goretti and St. Andrea Hospitals. Between January 2012 and January 2018 each patient scheduled for sigmoidectomy, left colonic or rectal resection for diverticular disease were included in the study and randomly divided in two groups. Colorectal resections were performed either preserving the inferior mesenteric artery or not. The incurrence of defecatory disorders and their impact on QoL of defecatory disorders were assessed with 6 questionnaires, administered at 6 and12 months and after 6 years from surgery and with an anorectal manometry performed after 6 months and 5 years.

RESULTS: 219 patients were evaluated during the study showing a statistically lower incidence and severity of defecatory disorders in the group of patients whose inferior mesenteric artery was preserved. These defecatory disorders remained stable over the time. The study showed a statistically better quality of life in patients who experienced less defecatory disorders.

CONCLUSION: Inferior Mesenteric Artery preserving in colonic resection for diverticular disease allows to improve defecatory function by reducing the denervated colonic tract. This led to better quality of life and less impairment of daily activities also after 6 years from surgery. The study was registered in ClinicalTrials.gov with number NCT06506552.},
}

@article {pmid39803010,
year = {2024},
author = {Ahmed, YA and Manna, R and Thomas, P and Mohamedahmed, AY and Eccersley, J},
title = {A Rare Case of Isolated Diverticular Disease of the Appendix Combined With Uncomplicated Appendicitis.},
journal = {Cureus},
volume = {16},
number = {12},
pages = {e75575},
pmid = {39803010},
issn = {2168-8184},
abstract = {The differential diagnoses for patients presenting with right iliac fossa pain are broad, with appendicitis almost always on the top of the list. Although rare, diverticulosis of the appendix, complicated by inflammation, should be considered in these patients. We report a case of a middle-aged female with right iliac fossa pain with a high inflammatory marker. CT of the abdomen and pelvis showed uncomplicated appendicitis. The patient underwent a diagnostic laparoscopy, which confirmed an inflamed appendix and three small nodules in the body of the appendix. An appendectomy was performed, and histopathology showed diverticulosis of the appendix with appendicitis. She recovered uneventfully, and the follow-up colonoscopy was normal. This report illustrates the complexities associated with diverticular disease of the appendix and its potential to mimic appendicitis and highlights the importance of histopathology examination in these cases.},
}

@article {pmid39787400,
year = {2024},
author = {Sobrado, LF and Schabl, L and Foley, NM and Prien, C and Nahas, SC and Liska, D and Kessler, H and Valente, MA and Steele, SR and Hull, TL},
title = {Deloyers Technique for Restoration of Bowel Continuity Following Extended Left Hemicolectomy: A Comprehensive Analysis of 97 Cases and Literature Review.},
journal = {Diseases of the colon and rectum},
volume = {},
number = {},
pages = {},
doi = {10.1097/DCR.0000000000003597},
pmid = {39787400},
issn = {1530-0358},
abstract = {BACKGROUND: Deloyers technique addresses challenges in restoring bowel continuity following extended left hemicolectomies. Despite being first described in 1958, the technique remains underutilized, with limited data on long-term outcomes.

OBJECTIVE: To evaluate the indications, surgical and functional outcomes of Deloyers technique and review existing literature.

DESIGN: Using a prospectively maintained database, patient demographics and perioperative data were collected. A telephone interview was conducted to assess bowel function and statistical analysis identified factors affecting bowel function.

SETTINGS: Single tertiary care center.

PATIENTS: Patients that underwent Deloyers technique from January 1995 to February 2023.

RESULTS: A total of 97 patients were included. Most common indications were colorectal cancer (50.5%) and diverticular disease (21.6%). In 53.6% of cases DT was performed at re-operations and in 70.1% a diverting loop ileostomy was created. Early surgical complications occurred in 7.2% of patients, including five anastomotic leaks, one colonic conduit ischemia and one small bowel obstruction. Late complications occurred in 8.2%, including 6 anastomotic strictures and 2 chronic leaks. There was no perioperative mortality. A total of 40 patients were interviewed and reported an average of 3.5 bowel movements per day and 0.5 at night, 17.5% used bowel stoppers and 52.5% of patients reported that their bowel function did not impact their quality of life. Previous radiotherapy and anastomosis less than eight cm from the anal verge were associated with having four or more bowel movements per day (p < 0.01).

MAIN OUTCOMES MEASURES: Postoperative morbidity and bowel function.

LIMITATIONS: Retrospective analysis of a heterogeneous group of patients with different pathologies and indications for surgery.

CONCLUSION: Deloyers technique is a safe and effective alternative for restoring bowel continuity after extended left hemicolectomy. Postoperative functional results are generally satisfactory, with more favorable outcomes noted in patients with higher anastomoses and those who have not undergone prior pelvic radiotherapy.},
}

@article {pmid39764487,
year = {2025},
author = {Tursi, A and Procaccianti, G and D'Amico, F and DE Bastiani, R and Turroni, S},
title = {Can gut microbiota explain acute diverticulitis occurrence in patients with symptomatic uncomplicated diverticular disease?.},
journal = {Bioscience of microbiota, food and health},
volume = {44},
number = {1},
pages = {1-3},
pmid = {39764487},
issn = {2186-6953},
abstract = {Why patients with symptomatic uncomplicated diverticular disease (SUDD) may develop acute diverticulitis (AD) is still unknown. We analyzed the gut microbiota (GM) in two SUDD patients, one who did experience SUDD recurrence but not AD occurrence (case 1) and one who did experience AD occurrence during follow-up (case 2). The GM of these patients showed differences in terms of phyla (Firmicutes and Bacteroidota in case 1; Actinobacteriota and Proteobacteria in case 2) and subgenera (Prevotella and Phascolarctobacterium in case 1 and Alloprevotella, Prevotella, Holdemanella, Turicibacter, Eubacterium eligens group, and Dialister in case 2). This novel insight may advance our ecological understanding of this complex disease.},
}

@article {pmid39764150,
year = {2025},
author = {Strigenz, RZ and Dairi, OF and Curley, MA},
title = {Hypercontractile Esophagus Causing Midesophageal Diverticulum.},
journal = {ACG case reports journal},
volume = {12},
number = {1},
pages = {e01586},
pmid = {39764150},
issn = {2326-3253},
abstract = {Esophageal diverticulum (ED) is a rare condition with a clinical presentation that can be variable. Esophageal diverticulum has been associated with motility disorders; however, the association with mid-ED is less clear. Hypercontractile esophagus, also known as jackhammer esophagus, is a rare motility disorder of peristalsis diagnosed by esophageal high-resolution manometry after exclusion of mechanical obstruction. We describe the second reported case of mid-ED secondary to hypercontractile esophagus successfully treated through robotic diverticulectomy with long myotomy. KEYWORDS: esophagus; esophageal manometry; motility; diverticular disease.},
}

@article {pmid39752564,
year = {2025},
author = {Wang, Y and Zhao, Z and Wang, R and Hu, X},
title = {Genetic Links Between Gastrointestinal Disorders and Kidney Stone Disease: Insights from Genome-Wide Cross-Trait Analysis.},
journal = {Kidney360},
volume = {},
number = {},
pages = {},
doi = {10.34067/KID.0000000689},
pmid = {39752564},
issn = {2641-7650},
abstract = {BACKGROUND: Epidemiological associations between kidney stone disease (KSD) and gastrointestinal disorders have been reported, and intestinal homeostasis plays a critical role in stone formation. However, the underlying intrinsic link is not adequately understood. This study aims to investigate the genetic associations between these two types of diseases.

METHODS: We obtained summary statistics from large-scale genome-wide association studies of KSD and gastrointestinal diseases, including gastroesophageal reflux disease (GERD), peptic ulcer disease, inflammatory bowel disease and its subtypes, irritable bowel syndrome (IBS) and diverticular disease (N = 311,254 to 720,199). Their overall genetic correlations were first estimated. We then detected the shared genetic architecture, including pleiotropic single nucleotide polymorphisms (SNPs), loci, genes and biological processes, through cross-trait analyses. In addition, bidirectional Mendelian randomization (MR) analysis was performed to look for their causal relationships.

RESULTS: We found significantly positive genetic correlations between KSD and all five gastrointestinal diseases. The cross-trait analysis identified 3184 potential pleiotropic SNPs, and 33 of which were pleiotropic loci shared by the two disorders. Gene-level analyses revealed 8 pleiotropic causal genes, primarily enriched in biological pathways involving ion homeostasis and response to vitamin D. In the MR analysis, we detected causal effects from GERD, IBS and Crohn's disease to KSD, while no reverse causality was observed.

CONCLUSIONS: Our study demonstrated the positive genetic links between KSD and gastrointestinal diseases and reported pleiotropic variants, loci, and genes, implicating potential biological mechanisms in the pathogenesis of stone disease. These findings further support the role of the gut-kidney axis and provide a genetic basis for the prevention, coregulation and treatment of these diseases.},
}

@article {pmid39751887,
year = {2025},
author = {Anderesen, CK and Al-Najami, I and Liu, W and Orwoll, E and Folkestad, L},
title = {Risk of Gastrointestinal Diseases in Osteogenesis Imperfecta: A Nationwide, Register-Based Cohort Study.},
journal = {Calcified tissue international},
volume = {116},
number = {1},
pages = {15},
pmid = {39751887},
issn = {1432-0827},
mesh = {Humans ; *Osteogenesis Imperfecta/epidemiology/complications ; Female ; Male ; *Gastrointestinal Diseases/epidemiology ; *Registries/statistics & numerical data ; Denmark/epidemiology ; Cohort Studies ; Adult ; Middle Aged ; Risk Factors ; Adolescent ; Young Adult ; Aged ; Child ; Child, Preschool ; Infant ; },
abstract = {Osteogenesis imperfecta (OI) is a group of rare genetic disorders most commonly caused by reduced amount of biologically normal collagen type I, a structural component of the gastrointestinal tract and abdominal wall. The risk of gastrointestinal (GI) disease in individuals with OI is not well understood, despite GI complaints being frequently reported by the OI population. To investigate the risk of GI diseases in individuals with OI. A Danish nationwide register-based cohort study utilizing data from the Danish National Patient Register and the Danish National Prescription Register. All individuals registered with an OI diagnosis in Denmark from 1995 through 2018, along with a reference population matched 1:5 based on sex, birth year, and month. Sub-hazard ratios (SHR) for peptic ulcer disease, diverticular disease, gastrointestinal cancers, intestinal obstruction with ileus, constipation, abdominal wall hernia, and other reasons for abdominal discomfort. The study included 864 individuals with OI (472 women) and 4,276 in the reference population (2,332 women). The SHR was significantly increased for ulcer (3.28 [95% CI 2.21-4.28]), constipation (2.67 [1.91-3.74]), and hernia (among women: 1.85 [1.22-2.80]). Higher SHRs were also observed for inflammatory bowel disease, biliary and pancreatic diseases, appendicitis, and unspecified abdominal pain. SHRs were not statistically significantly increased for diverticular disease, gastrointestinal cancers, intestinal obstruction with ileus, kidney stones or hemorrhoid disease. Individuals with OI have a higher risk of peptic ulcer disease, constipation, hernia among women, inflammatory bowel diseases, biliary and pancreatic diseases, appendicitis, and unspecified abdominal pain, compared with the general population.},
}

Humans
*Osteogenesis Imperfecta/epidemiology/complications
Female
Male
*Gastrointestinal Diseases/epidemiology
*Registries/statistics & numerical data
Denmark/epidemiology
Cohort Studies
Adult
Middle Aged
Risk Factors
Adolescent
Young Adult
Aged
Child
Child, Preschool
Infant

@article {pmid39745398,
year = {2025},
author = {Pietrzak, AM and Chreptowicz, A and Wieszczy-Szczepanik, P and Mróz, A},
title = {Diverticular inflammation and complication assessment does not predict diverticulitis in asymptomatic individuals.},
journal = {Polish archives of internal medicine},
volume = {},
number = {},
pages = {},
doi = {10.20452/pamw.16915},
pmid = {39745398},
issn = {1897-9483},
abstract = {INTRODUCTION: Recently, a three-step endoscopic scale, known as the Diverticular Inflammation and Complication Assessment (DICA), was introduced to predict the course of diverticular disease (DD), yielding some promising outcomes. However, analyses were performed only for symptomatic individuals.

OBJECTIVES: The aim of our study was to prospectively evaluate the predictive value of DICA in asymptomatic individuals with no previous diagnosis of DD who underwent colorectal cancer screening colonoscopy.

PATIENTS AND METHODS: We performed a prospective cohort study. All consecutive individuals, aged 55-65, undergoing screening colonoscopy in a single center during a 6-month period were assessed for eligibility. Those with diverticulosis were followed-up for 12 months. Information on the course of the disease, symptoms, treatment, diverticulitis episodes confirmed by healthcare professionals, complications, and hospital admissions was obtained via telephone interviews conducted by doctors. Detailed data and medical conditions were evaluated.

RESULTS: Out of 3,879 participants, 958 (24.7%) had diverticula. Of these, 872 (49.8% females, mean age 61 years) completed the study. About 83.5%, 12.85%, and 3.67%  of patients were classified as DICA1, DICA2, and DICA3, respectively. Diverticulitis occurred in 12 (1.37%) patients. Hospital admission was needed in five patients. No surgical interventions were necessary. There were no statistically significant relationship between DICA score and diverticulitis or hospital admission. Previous abdominal surgery and appendectomy, the presence and severity of pain, bloating, and previous DD treatment were the only factors predisposing to diverticulitis.

CONCLUSIONS: In our cohort, DICA scale had no predictive value for the occurrence of diverticulitis. Hence, has a limited predictive value for occurrence of diverticulitis and more studies on bigger cohorts are necessary to test its usefulness.},
}

@article {pmid39742189,
year = {2024},
author = {Siddiqui, A and Zafar, N and Hakiminezhad, M and Jamal, Z and Alam, I and Khawaja, Z},
title = {Beyond the Usual Suspects: Appendiceal Bleeding as the Surprising Cause of Lower Gastrointestinal (GI) Bleeding.},
journal = {Cureus},
volume = {16},
number = {12},
pages = {e76663},
doi = {10.7759/cureus.76663},
pmid = {39742189},
issn = {2168-8184},
abstract = {Lower gastrointestinal bleeding (LGIB) is a common clinical condition typically associated with diseases like diverticular disease, inflammatory bowel disease, and cancer. However, rarer etiologies such as appendiceal hemorrhage can present similarly, complicating diagnosis and management. This case report discusses a 42-year-old male who presented with severe rectal bleeding. Despite a comprehensive diagnostic workup, including colonoscopy and CT angiography, the underlying cause was identified as an obscure appendiceal hemorrhage. This atypical presentation underscores the importance of considering a broad differential diagnosis, even in cases with seemingly straightforward clinical features. While laparoscopic appendectomy is the standard surgical approach for managing appendiceal hemorrhage, a conservative management strategy was successfully employed in this particular case, highlighting the importance of individualized patient care and judicious clinical decision-making. This case report emphasizes the necessity of a multidisciplinary approach, involving careful clinical assessment, advanced imaging, and endoscopic evaluation, to accurately diagnose and manage complex cases of gastrointestinal bleeding. By recognizing and addressing uncommon etiologies, clinicians can improve patient outcomes and minimize unnecessary interventions.},
}

@article {pmid39736798,
year = {2024},
author = {Tursi, A and Papa, A},
title = {The role of gut microbiota in the pathogenesis of diverticular disease: where are we now?.},
journal = {Genome medicine},
volume = {16},
number = {1},
pages = {153},
pmid = {39736798},
issn = {1756-994X},
mesh = {Humans ; *Gastrointestinal Microbiome ; *Diverticular Diseases/microbiology ; },
abstract = {Diverticular disease (DD) is widespread worldwide. The role of gut microbiota (GM) in DD is not entirely understood. Here we discuss the significance of the current knowledge on GM in the different stages of DD and how crucial these acquisitions are for designing diagnostic and therapeutic trials in this field.},
}

Humans
*Gastrointestinal Microbiome
*Diverticular Diseases/microbiology

@article {pmid39734997,
year = {2024},
author = {Reed, TJ and Zimmer, SK and Nelson, NT and Bush, AM},
title = {Pernicious Pouch of Problems: A Challenging Case of Massive Hemorrhage Secondary to Jejunal Diverticular Bleeding.},
journal = {Cureus},
volume = {16},
number = {11},
pages = {e74590},
pmid = {39734997},
issn = {2168-8184},
abstract = {Small bowel (SB) diverticulosis is an uncommon diagnosis and a rare cause of gastrointestinal (GI) bleeding. A particularly rare form of SB diverticular disease, jejunal diverticulosis, is usually discovered due to complications, such as hemorrhage, obstruction, or perforation. Owing in part to its rarity, jejunal diverticular bleeding can be difficult to identify and treat, resulting in increased morbidity and mortality. Here, we present the case of a 57-year-old female with recurrent massive GI hemorrhage from a jejunal diverticular vessel that was ultimately diagnosed and successfully managed endoscopically.},
}

@article {pmid39726573,
year = {2025},
author = {Correa, N},
title = {Colo-cutaneous fistula in the setting of complicated sigmoid diverticulitis previously managed with percutaneous drainage: a case report.},
journal = {Journal of surgical case reports},
volume = {2025},
number = {1},
pages = {rjae674},
pmid = {39726573},
issn = {2042-8812},
abstract = {Colo-cutaneous fistulas are a rare complication of diverticular disease. Percutaneous drainage offers a promising alternative to surgical intervention in the management of complicated diverticular disease with abscess formation. Recent case studies and literature reviews support its efficacy in achieving abscess resolution and reducing the need for surgery. However, careful patient selection, technical proficiency, and multidisciplinary management are critical to optimizing outcomes. As the body of evidence grows, percutaneous drainage is likely to play an increasingly important role in the therapeutic arsenal against complicated diverticular disease; however, the risk of complications, particularly fistula formation, must be carefully considered. Our case presents a rare incident of a colo-cutaneous fistula occurring after CT-guided percutaneous drainage of a pericolic abscess secondary to perforated sigmoid diverticulitis that failed medical management. The patient ultimately underwent Hartmann's procedure where the diseased sigmoid colon, adhered small bowel, and fistula tract were excised with an end colostomy creation.},
}

@article {pmid39723190,
year = {2024},
author = {Zheng, B and Chen, D and Zeng, H and Lin, S},
title = {Deciphering the gut microbiota's role in diverticular disease: insights from a Mendelian randomization study.},
journal = {Frontiers in cellular and infection microbiology},
volume = {14},
number = {},
pages = {1460504},
pmid = {39723190},
issn = {2235-2988},
mesh = {*Gastrointestinal Microbiome/genetics ; Humans ; *Mendelian Randomization Analysis ; *Genome-Wide Association Study ; *Diverticular Diseases/genetics/microbiology ; Bacteria/classification/genetics/isolation & purification ; },
abstract = {BACKGROUND: Previous studies have indicated a potential association between gut microbiota and diverticular disease. However, the precise nature of this relationship remains unclear. In light of this, we decided to use a bidirectional two-sample Mendelian randomization (MR) study to investigate the causal relationship between gut microbiota and intestinal diverticular disease in greater depth.

METHODS: To investigate the potential causal relationship between gut microbiota and intestinal diverticular disease, we conducted a two-sample MR study in a European ancestry. Genetic instrumental variables for gut microbiota were obtained from a genome-wide association study (GWAS) involving 5,959 participants. Summary statistics for intestinal diverticular disease were sourced from the IEU Open GWAS project, which included data from 5,193 cases and 457,740 controls. The analysis was primarily conducted using the inverse variance weighted method, with additional sensitivity analyses to assess the robustness of the findings.

RESULTS: With regard to the findings, 11 microbial taxa were identified as having a potential causal relationship with intestinal diverticular disease. Specifically, the microbial taxa Caryophanales, Paenibacillaceae, Herbinix, Turicibacter, Turicibacteraceae, and Staphylococcus fleurettii were found to be positively associated with the risk of developing intestinal diverticular disease, while Chromatiales, Arcobacter, Herbidospora, Ligilactobacillus ruminis, and Megamonas funiformis were found to be negatively associated with the risk. Further reverse MR analysis did not reveal a reverse causal effect between these microbial taxa and intestinal diverticular disease.

CONCLUSION: Our MR analyses revealed a potential causal relationship between certain gut microbiota and intestinal diverticular disease, which may provide new directions for future intestinal diverticular disease prevention and treatment strategies.},
}

*Gastrointestinal Microbiome/genetics
Humans
*Mendelian Randomization Analysis
*Genome-Wide Association Study
*Diverticular Diseases/genetics/microbiology
Bacteria/classification/genetics/isolation & purification

@article {pmid39723082,
year = {2024},
author = {Tian, W and Yang, W and Wang, X and Yang, Y},
title = {Exploring the Impact of Dietary Factors on Intestinal Diverticular Disease: A Mendelian Randomization Approach.},
journal = {Food science & nutrition},
volume = {12},
number = {12},
pages = {10859-10866},
pmid = {39723082},
issn = {2048-7177},
abstract = {Dietary habits significantly influence the development of intestinal diverticular disease (IDD), a common gastrointestinal condition primarily affecting the colon. We performed a Mendelian randomization (MR) analysis on 20 diet-related factors using data from the UK Biobank. IDD cases (n = 33,618) and controls (n = 329,381) were obtained from the FinnGen Biobank. Three key MR methods were applied: the inverse-variance-weighted (IVW) method as the primary approach to estimate causal relationships, along with the weighted median (WM) and MR-Egger methods. Significant associations were found for pork intake (β = 1.06, p = 0.00244), nonoily fish intake (β = 0.709, p = 0.0449), oily fish intake (β = 0.246, p = 0.0222), and dried fruit intake (β = -0.953, p < 0.0001). After false discovery rate (FDR) adjustment, pork intake (q = 0.0244) and dried fruit intake (q < 0.0001) remained significant. Our results indicate that while pork and certain types of fish intake may elevate the risk of IDD, dried fruit intake may offer a protective effect. These findings highlight the potential of dietary changes in IDD prevention and management, though further research across diverse populations is needed.},
}

@article {pmid39716092,
year = {2024},
author = {Chapman, JA and Wroot, E and Brown, T and Beck, LC and Embleton, ND and Berrington, JE and Stewart, CJ},
title = {Characterising the metabolic functionality of the preterm neonatal gut microbiome prior to the onset of necrotising enterocolitis: a pilot study.},
journal = {BMC microbiology},
volume = {24},
number = {1},
pages = {533},
pmid = {39716092},
issn = {1471-2180},
abstract = {BACKGROUND: Necrotising enterocolitis (NEC) is a devastating bowel disease that primarily occurs in infants born prematurely and is associated with abnormal gut microbiome development. While gut microbiome compositions associated with NEC have been well studied, there is a lack of experimental work investigating microbiota functions and their associations with disease onset. The aim of this pilot study was to characterise the metabolic functionality of the preterm gut microbiome prior to the onset of NEC compared with healthy controls.

RESULTS: Eight NEC infants were selected of median gestation 26.5 weeks and median day of life (DOL) of NEC onset 20, with one sample used per infant, collected within one to eight days (median four) before NEC onset. Each NEC case was matched to a control infant based on gestation and sample DOL, the main driver of microbiome composition in this population, giving a total cohort of 16 infants for this study. Dietary exposures were well matched. The microbiota of NEC and control infants showed similar wide-ranging metabolic functionalities. All 94 carbon sources were utilised to varying extents but NEC and control samples clustered separately by supervised ordination based on carbon source utilisation profiles. For a subset of eight samples (four NEC, four control) for which pre-existing metagenome data was available, microbiome composition was found to correlate significantly with metabolic activity measured on Biolog plates (p = 0.035). Comparisons across all 16 samples showed the NEC microbiota to have greater utilisation of carbon sources that are the products of proteolytic fermentation, specifically amino acids. In pairwise comparisons, L-methionine was highly utilised in NEC samples, but poorly utilised in controls (p = 0.043). Carbon sources identified as discriminatory for NEC also showed a greater enrichment for established markers of inflammatory disease, such as inflammatory bowel disease, irritable bowel syndrome and diverticular disease.

CONCLUSIONS: Before NEC onset, the preterm gut microbiota showed greater metabolic utilisation of amino acids, potentially indicating a shift from predominantly saccharolytic to proteolytic fermentation. Products of amino acid breakdown could therefore act as biomarkers for NEC development. A larger study is warranted, ideally with infants from multiple sites.},
}

@article {pmid39712703,
year = {2024},
author = {Orgovan, JM and Dodson, BD},
title = {Colouterine Fistula: A Rare Presentation of Severe Diverticular Disease.},
journal = {Cureus},
volume = {16},
number = {11},
pages = {e74162},
pmid = {39712703},
issn = {2168-8184},
abstract = {Colouterine fistula as a sequela of diverticulitis is an extremely rare complication due to the extraordinarily thick layer of myometrium of the uterus. Because of this, an aggressive clinical evaluation is required to rule out other potential causes of fistula formation such as malignancy. However, imaging and laboratory techniques may be inconclusive, and surgery with pathologic analysis may be required for a definitive diagnosis. The case presented here illustrates the atypical presentation of a 63-year-old woman with acutely symptomatic, severely extensive diverticular disease with resultant colouterine fistula. The patient underwent exploratory laparotomy, sigmoidectomy with end colostomy, appendectomy, and total abdominal hysterectomy with bilateral salpingo-oophorectomy. Eventually, she was discharged with an excellent prognosis and had an uneventful recovery. This case is being presented because of the rarity of the disease course as well as the complexity of the decision-making and surgical approach that resulted in patient recovery.},
}

@article {pmid39697924,
year = {2024},
author = {Xicohtencatl, S and Durango, D and Damacio, RE and Cabrera, D},
title = {Management of Lumbar Abscess Secondary to Colocutaneous Fistula From Complicated Diverticular Disease Using Negative Pressure Therapy.},
journal = {Cureus},
volume = {16},
number = {11},
pages = {e73871},
pmid = {39697924},
issn = {2168-8184},
abstract = {Diverticular disease is a common gastrointestinal condition with rising prevalence. Complications, such as fistulas, are rare but significant, often requiring innovative treatment strategies. This case report examines the use of negative pressure wound therapy (NPWT) with instillation (VERAFLO®, KCI, an Acelity Company, San Antonio, Texas) and antiseptic solution (VASHE®, Urgo Medical North America LLC, Fort Worth, Texas) in treating a colocutaneous fistula secondary to complicated diverticular disease. A 43-year-old male presented with lumbar pain and erythema. Computed tomography (CT) scans revealed a left-sided collection with gas, suggesting a colocutaneous fistula. Initial management included drainage, antibiotics, and NPWT. Follow-up involved transrectal contrast CT to assess the fistula tract and subsequent colonoscopy to confirm resolution. NPWT with VERAFLO® was applied for 20 days, followed by wound closure. Two-month follow-up showed no evidence of fistula on colonoscopy, confirming successful treatment. NPWT can be an effective alternative for treating colocutaneous fistulas in diverticular disease, promoting wound healing and reducing infection. Further research is warranted to explore its broader applications in gastrointestinal fistulas.},
}

@article {pmid39692883,
year = {2024},
author = {Hamid, M and Zaman, S and Mostafa, OES and Deutsch, A and Bird, J and Kawesha, A and Reay, M and Banga, I and Williams, A and Waterland, P and Akingboye, A},
title = {Low vs. conventional intra-abdominal pressure in laparoscopic colorectal surgery: a prospective cohort study.},
journal = {Langenbeck's archives of surgery},
volume = {410},
number = {1},
pages = {12},
pmid = {39692883},
issn = {1435-2451},
mesh = {Humans ; Male ; Female ; *Laparoscopy/methods/adverse effects ; Aged ; Middle Aged ; Prospective Studies ; *Pressure ; Length of Stay ; Postoperative Complications/etiology ; Cohort Studies ; Pain, Postoperative ; },
abstract = {PURPOSE: Low intraabdominal pressure (IAP) during laparoscopy is associated with improved post-operative outcomes across a variety of surgical specialties. A prospective cohort study was undertaken to assess post-operative outcomes in patients undergoing laparoscopic colorectal surgery (LCRS) with low (8mmHg) versus conventional (15mmHg) IAP.

METHODS: A prospective real-world observational study of patients undergoing LCRS in a single-centre, between June 2020 and June 2023 was performed. Operative procedures for diverse colonic pathology such as diverticular disease, inflammatory bowel disease (IBD), and colorectal cancers (CRC) were included. The evaluated primary outcomes were post-operative pain, return of gastrointestinal motility, and length of hospital stay. Secondary outcomes were the overall safety profile including intra- and post-operative complications and morbidity. Outcomes of interest were investigated using multivariate analysis.

RESULTS: A total of 120 patients were included of which 69 (57.5%) were male. Median age and BMI of the cohort was 67 years (51-75 years) and 27 kg/m[2] (24-32 kg/m[2]), respectively. 61 (50.8%) patients were categorised as an ASA grade 3. Two (1.7%) patients had diverticular disease; 31 (25.9%) had IBD, and 87 (72.4%) were operated on for colonic malignancy. Low IAP (8mmHg) was used in 53 (44.2%) cases, whilst the remainder (55.8%) had IAP set at 15mmHg (conventional). Low-pressure surgery was associated with improved intraoperative lung compliance (p < 0.001) and peak inspiratory pressures up to 6 h (p < 0.001); reduced analgesic requirement (p ≤ 0.028), and decreased postoperative pain both at rest (p = 0.001) and on exertion (p < 0.001). Moreover, low IAP was associated with an earlier time to pass flatus postoperatively (p = 0.047) with no significant difference in length of hospital stay (p = 0.574). Additionally, no significant difference was observed between the groups for outcomes including median operating time (p = 0.089), conversion to open surgery (p = 0.056), overall complication rate (p = 0.102), and 90-day mortality (p = 0.381).

CONCLUSION: Low IAP use during LCRS is feasible with a comparable safety profile to conventional laparoscopy. Intra-operative respiratory physiology is improved with reduced postoperative pain and analgesic requirement, and earlier time to pass flatus. Future rationally designed; well-powered, randomised trials are needed to understand the benefits of low intra-peritoneal pressure during laparoscopic colorectal resections.},
}

Humans
Male
Female
*Laparoscopy/methods/adverse effects
Aged
Middle Aged
Prospective Studies
*Pressure
Length of Stay
Postoperative Complications/etiology
Cohort Studies
Pain, Postoperative

@article {pmid39677849,
year = {2024},
author = {Chasman, DI and Guo, Y and Chan, AT and Rist, PM and Staller, K},
title = {Shared Genetics of Migraine and Gastrointestinal Disorders Implicates Underlying Neurologic Mechanisms Yet Heterogeneous Etiologies.},
journal = {Neurology. Genetics},
volume = {10},
number = {6},
pages = {e200201},
pmid = {39677849},
issn = {2376-7839},
abstract = {BACKGROUND AND OBJECTIVES: Migraine is strongly comorbid with irritable bowel syndrome (IBS), one of several gastrointestinal (GI) conditions that are distinguished by symptomatic profiles that are partly overlapping. Potential shared mechanisms of migraine and the GI conditions were investigated by assessing shared genetics on a genome-wide basis.

METHODS: Analyses leveraged genome-wide summary statistics from large-scale genetic studies for migraine, including by aura status, IBS, peptic ulcer disease (PUD), gastrointestinal reflux (GERD), functional dyspepsia (FD), diverticular disease (DD), and the immune-related inflammatory bowel disease (IBD) or its constituents, ulcerative colitis (UC) and Crohn disease (CD). Genetic correlation was evaluated on a genome-wide basis and at independent local regions, including those related to therapeutic targeting of serotonin and the calcitonin gene-related peptide. Genetic correlation was assessed for enrichment at genes according to tissue specificity of gene expression. Potential causality between migraine and the GI conditions was assessed by Mendelian randomization.

RESULTS: Genetic correlation with migraine was strongly significant among the nonimmune GI disorders, maximally for IBS (rg [SE] = 0.37[0.04], p = 10[-21]) and minimally for DD (0.18 (0.04), 7.5 × 10[-7]), but null for IBD. There were distinct patterns of local genetic sharing with migraine across the GI conditions at 22 significant segments of the genome, 7 of which were novel for either migraine or GI or both. Enrichment analysis suggested involvement of the CNS in genetic overlap of GERD, IBS, and PUD with migraine. There was local genetic sharing with migraine at CALCA/CALCB (encoding calcitonin gene-related peptide [CGRP]) in an inverse sense for GERD and PUD, but with concordance and greater significance for DD, IBD, and UC. Mendelian randomization supported causal effects of PUD, GERD and particularly DD (OR[SE] = 1.90 (1.35-2.68, p = 2.2 × 10[-4]) on migraine, but not of migraine on any GI condition.

DISCUSSION: Genetic sharing of migraine and non-immune-related GI disorders was extensive yet distinct across GI disorders that have overlapping symptoms, with enrichment signals that imply neurologic mechanisms. Causal effects of some GI conditions on migraine were supported. A concordant local correlation at CALCA/CALCB of migraine with both DD and the immune-related disorders suggests potential benefit to these conditions from repurposed migraine therapeutics targeting CGRP.},
}

@article {pmid39665227,
year = {2024},
author = {Ferrara, F and Grassi, N and Graceffa, G and Macaione, I and Pantuso, G},
title = {Routine histopathological examination in patients undergoing sigmoidectomy for diverticular disease: Are we ready to avoid it?.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {},
number = {},
pages = {},
doi = {10.1111/codi.17264},
pmid = {39665227},
issn = {1463-1318},
}

@article {pmid39648791,
year = {2024},
author = {de Silva, AP and Nuwanshika, N and Dassanayake, U and Niriella, MA and de Silva, J and Ranasinghe, P},
title = {Colonic diverticular disease revisited.},
journal = {Expert review of gastroenterology & hepatology},
volume = {},
number = {},
pages = {},
doi = {10.1080/17474124.2024.2438708},
pmid = {39648791},
issn = {1747-4132},
abstract = {INTRODUCTION: Diverticular disease, including diverticulosis and diverticulitis, presents a significant health concern globally, with increasing prevalence in Western societies and emerging trends in Asia. The incidence of diverticulitis, is on the rise, leading to significant morbidity and healthcare costs.

AREAS COVERED: A literature search was conducted using the PubMed database and studies published between 1995 to 2024 were selected based on their relevance to the overall understanding of disease. This review investigates the clinical spectrum, classification, and management strategies of diverticular disease, focusing particularly on evolving trends in diagnosis and treatment. Discussions regarding the prevalence of diverticulosis, the identification of risk factors associated with disease progression, recent advancements in research, and the utilization of biomarkers in disease monitoring and treatment decision-making are considered in detail.

EXPERT OPINION: The discourse on diverticular disease underscores the pressing need for tailored management strategies and innovative treatments. Understanding the intricacies of the disease's pathophysiology is paramount for effective intervention. Recent advances in diagnostic imaging and biomarker identification are promising, yet more research is imperative to further refine patient care. Advances in these areas hold the potential for significantly improving outcomes in disease management.},
}

@article {pmid39647416,
year = {2024},
author = {Saidi, A and Khefacha, F and Touati, MD and Othmane, MRB and Belhadj, A and Chebbi, F},
title = {Appendiceal diverticulitis: A rare case report highlighting diagnostic challenges and complication risks.},
journal = {International journal of surgery case reports},
volume = {126},
number = {},
pages = {110697},
doi = {10.1016/j.ijscr.2024.110697},
pmid = {39647416},
issn = {2210-2612},
abstract = {INTRODUCTION AND IMPORTANCE: Diverticular disease of the appendix is a rare condition often mistaken for acute appendicitis, with most cases diagnosed incidentally during histopathology, underscoring the importance of comprehensive pathological evaluation for accurate diagnosis.

CASE PRESENTATION: A 34-year-old male presented with one day of periumbilical pain migrating to the right iliac fossa, without vomiting or bowel changes. Clinical examination revealed tenderness in the RIF. Laboratory tests indicated a syndrome inflammatoire biologique. Ultrasound and CT scans suggested appendicular diverticulitis. Laparoscopic appendectomy confirmed an inflamed diverticulum. The patient had an uncomplicated recovery and was discharged on day 1, with no anomalies noted at one-year follow-up.

CLINICAL DISCUSSION: There are two types of appendiceal diverticula: congenital and acquired. Congenital diverticula result from outpouching of all appendiceal layers, while acquired diverticula arise from increased pressure due to factors like fecaliths or tumors. Risk factors for diverticular disease of the appendix (DDA) include male gender and age over 30. Diagnosing appendiceal diverticulitis preoperatively is challenging, often relying on ultrasound and CT findings. Appendicectomy is the preferred treatment, with pathological evaluation necessary for diagnosis. Prophylactic appendicectomy is advised for incidentally detected diverticular disease due to associated risks of perforation and malignancy.

CONCLUSION: The differential diagnosis of appendiceal diverticulitis is a rare but significant condition with increased risks of complications and malignancy. Early diagnosis and surgical intervention are crucial for effective management, highlighting the importance of thorough pathological evaluation in confirming the diagnosis.},
}

@article {pmid39606539,
year = {2024},
author = {Dang, N and Kay, S},
title = {Acute Large Bowel Obstruction Post Umbilical Hernia Repair Surgery: A Case Report.},
journal = {Cureus},
volume = {16},
number = {10},
pages = {e72566},
pmid = {39606539},
issn = {2168-8184},
abstract = {While large bowel obstruction (LBO) is a less common cause of bowel obstruction, it has a broad range of differentials. Its most common etiology in the United States is colorectal adenocarcinoma. Patients usually present with diffuse abdominal pain, constipation, abdominal distension, and nausea. Abdominal X-rays can quickly assess bowel dilation, but a CT scan is the gold standard to determine the location and severity of the blockage. The treatment can range from IV fluid to emergent colectomy. A 41-year-old male with a history of bronchitis and hypertension presented for a surgical consult six days post-incarcerated umbilical hernia repair. The patient complained of nausea, diffuse abdominal distension and tenderness, and inability to pass gas. Physical examination revealed a severely distended abdomen with rebound and guarding at the lower right quadrant. CT scan showed severely dilated ascending colon and cecum along with pneumatosis. There was also an obstructing mass at the sigmoid colon. A diagnosis of severe LBO with impending perforation was made, and the patient underwent emergent exploratory laparotomy. Subtotal colectomy was done with anastomosis between the ileum and sigmoid colon. The pathology report showed an 8.0 cm dilated cecum, necrosis of the ascending colon, and diverticulitis with scar fibrosis along the wall of the colonic membrane. The patient had an ileus and kidney injury postoperatively but they subsequently resolved. Diverticulitis is historically common in the elderly population, but recent studies have shown a rising incidence among younger individuals. It is a common cause of obstruction but rarely causes severe complications like pneumatosis and perforation that require emergent surgery. When occluded, the mass and patent ileocecal valve can cause closed-loop bowel syndrome. Even though an unhealthy diet is a known trigger for diverticulitis, surgery is possibly another factor in rare cases. Patients of all ages should be educated on the symptoms of diverticular disease, and surgical monitoring is key in those with known diverticulosis.},
}

@article {pmid39560541,
year = {2024},
author = {Alshandeer, MH and Abd El Maksoud, WM and Abbas, KS and Al Amri, FS and Alghamdi, MA and Alzahrani, HA and Dalboh, A and Bawahab, MA and Asiri, AJ and Assiri, Y},
title = {Does type II diabetes mellitus increase the morbidity of patients with diverticulitis?.},
journal = {Medicine},
volume = {103},
number = {46},
pages = {e40567},
doi = {10.1097/MD.0000000000040567},
pmid = {39560541},
issn = {1536-5964},
mesh = {Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; *Diabetes Mellitus, Type 2/complications/epidemiology ; Saudi Arabia/epidemiology ; Aged ; Adult ; Diverticulitis, Colonic/complications/epidemiology ; Length of Stay/statistics & numerical data ; Age Factors ; Risk Factors ; },
abstract = {Diverticular disease is a common condition that has numerous complications. Understanding the impact of diabetes mellitus (DM) on these complications, especially diverticulitis, is crucial for optimizing patient care. This study aimed to determine the relationship between type II DM and the complications of colonic diverticulitis. A retrospective cohort study was conducted on 158 patients complaining of diverticulitis at Asir Central Hospital, Abha, Saudi Arabia, between January 2013 and December 2023. Data on gender, age, and chronic diseases, especially DM, were collected. Data retrieved regarding diverticulitis included the involved segment, complications, Hinchey classification, and management. We classified the patients into groups A for nondiabetics and B for diabetics. We analyzed the data using descriptive statistics, chi-square tests, t tests, and analysis of variance. Diabetic patients were significantly older than their nondiabetic counterparts. Diabetic patients showed a significantly higher complication rate (62.5%) and a higher degree of Hinchey classification compared to nondiabetic patients (43.7%). Furthermore, in comparison to individuals without diabetes, they were hospitalized for a considerably extended period (8.06 ± 7.38 days vs 5.26 ± 5.90 days, respectively). In addition, surgical intervention was observed to be considerably more common in patients with diabetes (46.9%) than in those without diabetes (16.5%). The study showed that DM adversely affected patients with diverticulitis. A greater incidence of complications and a higher category of Hinchey classification were associated with DM compared to nondiabetics. Additionally, diabetics underwent more surgical interventions and had longer hospital stays. Diabetics with diverticulitis require particular care to prevent severe complications.},
}

Humans
Male
Female
Retrospective Studies
Middle Aged
*Diabetes Mellitus, Type 2/complications/epidemiology
Saudi Arabia/epidemiology
Aged
Adult
Diverticulitis, Colonic/complications/epidemiology
Length of Stay/statistics & numerical data
Age Factors
Risk Factors

@article {pmid39533633,
year = {2024},
author = {Yoshikawa, M and Asaba, K},
title = {CCN3/NOV as a potential therapeutic target for diverticular disease: A proteome-wide Mendelian randomization study.},
journal = {Medicine},
volume = {103},
number = {45},
pages = {e40467},
doi = {10.1097/MD.0000000000040467},
pmid = {39533633},
issn = {1536-5964},
mesh = {Humans ; *Mendelian Randomization Analysis ; *Genome-Wide Association Study ; *Nephroblastoma Overexpressed Protein/genetics/metabolism/blood ; *Diverticular Diseases/genetics ; Proteome/metabolism ; Quantitative Trait Loci ; Genetic Predisposition to Disease ; Female ; Polymorphism, Single Nucleotide ; Male ; },
abstract = {Genome-wide association studies (GWAS) identified over 100 susceptibility loci and candidate causal genes for diverticular disease (DD) at the transcriptional level. However, effective therapeutics or preventions based on underlying disease mechanisms remain to be elucidated. In this study, we explored potential causal genes for DD at the protein level. We used 2 GWAS summary statistics of DD; 1 was obtained from the United Kingdom Biobank (UKBB) with 31,917 cases and 419,135 controls, and the other from the FinnGen consortium with 30,649 cases and 301,931 controls. For the primary analysis, we employed proteome-wide Mendelian randomization (MR) studies using 738 cis-acting protein quantitative trait loci (pQTLs) for 735 plasma proteins from the 5 published studies. For external validation, we conducted 2-sample MR analyses using plasma pQTLs of the screened proteins from another study by deCODE genetics. Moreover, we performed a series of sensitivity analyses including reverse MR and Bayesian colocalization tests. The primary MR identified 4 plasma proteins that were associated with DD risk including CCN3/NOV (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97-0.99; P = 1.2 × 10-11 for UKBB. OR, 0.73; 95% CI, 0.66-0.81; P = 7.2 × 10-10 for FinnGen). The validation MR well replicated the primary result of CCN3/NOV (OR, 0.95; 95% CI, 0.93-0.96; P = 1.9 × 10-11 for UKBB. OR, 0.43; 95% CI, 0.33-0.56; P = 7.0 × 10-10 for FinnGen). Sensitivity analyses supported the causal association. We prioritized plasma CCN3/NOV protein as a protective factor for DD for follow-up functional studies to elucidate the disease mechanisms and therapeutics.},
}

Humans
*Mendelian Randomization Analysis
*Genome-Wide Association Study
*Nephroblastoma Overexpressed Protein/genetics/metabolism/blood
*Diverticular Diseases/genetics
Proteome/metabolism
Quantitative Trait Loci
Genetic Predisposition to Disease
Female
Polymorphism, Single Nucleotide
Male

@article {pmid39525910,
year = {2025},
author = {Hsieh, SL and Grabill, N and Louis, M and Kuhn, B},
title = {Complicated diverticulitis: Diagnostic precision and surgical solutions in a patient with chronic kidney disease.},
journal = {Radiology case reports},
volume = {20},
number = {1},
pages = {346-351},
pmid = {39525910},
issn = {1930-0433},
abstract = {Diverticulitis, an inflammation of diverticula in the colon, can lead to severe complications such as perforation and abscess formation. A 42-year-old female with polycystic kidney disease and chronic kidney disease stage III presented with severe abdominal pain, fever, and inability to tolerate oral intake. The patient was a previous smoker who smoked 0.5 packs per day for 25 years. Initial evaluation revealed leukocytosis and elevated creatinine. A CT scan identified pneumoperitoneum and mild sigmoid diverticulitis, suggesting a perforated viscus. She underwent urgent exploratory laparotomy, which confirmed the CT findings and resulted in an appendectomy, sigmoid colon resection, and ostomy creation. Postoperatively, the patient faced complications, including recurrent pneumoperitoneum and subcutaneous emphysema, detected through follow-up CT scans, leading to further surgical interventions. CT imaging was pivotal in diagnosing, monitoring, and guiding treatment, with noncontrast CT being beneficial given her renal impairment. Early diagnosis and CT imaging are crucial in managing complicated diverticulitis. Postoperative monitoring with CT scans is essential for detecting complications. Follow-up care should include regular colonoscopies to assess diverticular disease and dietary modifications to prevent recurrence. Combining clinical, surgical, and radiologic data ensures effective management and improves patient outcomes.},
}

@article {pmid39514266,
year = {2024},
author = {Tursi, A and Turroni, S and De Bastiani, R and Procaccianti, G and D'Amico, F and Allegretta, L and Antonino, N and Baldi, E and Casamassima, C and Casella, G and Ciuffi, M and De Bastiani, M and Lazzarotto, L and Licci, C and Mancuso, M and Penna, A and Pranzo, G and Sanna, G and Tosetti, C and Zamparella, M and Picchio, M},
title = {Gut microbiota in symptomatic uncomplicated diverticular disease stratifies by severity of abdominal pain.},
journal = {European journal of gastroenterology & hepatology},
volume = {},
number = {},
pages = {},
doi = {10.1097/MEG.0000000000002884},
pmid = {39514266},
issn = {1473-5687},
abstract = {OBJECTIVE: Patients with symptomatic uncomplicated diverticular disease (SUDD) may have a disrupted gut microbiota. However, current data are from small sample studies, and reported associations vary widely across studies. We aimed to profile the fecal microbiota in SUDD patients enrolled in primary care.

METHODS: A retrospective study was conducted in SUDD (N = 72) and asymptomatic diverticulosis (AD) (N = 30), the latter serving as a control group.

RESULTS: No significant differences in alpha and beta diversity were found between SUDD and AD, but SUDD was discriminated by a higher relative abundance of the family Streptococcaceae and the genera Alistipes, Agathobacter, and Butyricimonas. Interestingly, the gut microbiota of SUDD patients stratified by the severity of abdominal pain [according to the visual analog scale (VAS)]. In particular, higher diversity and health-associated taxa (such as Bifidobacterium, Eubacterium coprostanoligenes group, and Dorea) characterized mild (VAS score 1-3) SUDD, Proteobacteria, Veillonellaceae and Blautia moderate (VAS score 4-7) SUDD, and Prevotellaceae and Megasphaera severe (VAS score 8-10) SUDD.

CONCLUSION: Our analysis suggests that specific taxa may be related to SUDD, but the associations vary depending on the severity of abdominal pain. In addition to advancing our ecological understanding of this complex disease, our findings may pave the way for the incorporation of gut microbiota profiling into clinical practice to aid patient management, including stratification and treatment.},
}

@article {pmid39505824,
year = {2024},
author = {Petrusic, A and Mongelli, F and Sabbatini, F and Christoforidis, D and Pini, R and Merlo, E and Popeskou, SG and La Regina, D and Iaquinandi, F},
title = {Is histopathological analysis necessary in patients undergoing sigmoidectomy for diverticular disease? A retrospective study.},
journal = {Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland},
volume = {},
number = {},
pages = {},
doi = {10.1111/codi.17220},
pmid = {39505824},
issn = {1463-1318},
abstract = {AIM: The purpose of this study was to assess the utility of routine histopathological examination in patients undergoing elective sigmoidectomy for diverticular disease after full colonoscopy 1 year prior to surgery.

METHODS: We retrospectively analysed medical records of all patients undergoing sigmoidectomy for diverticular disease with a documented colonoscopy within 1 year before surgery from January 2013 to December 2023. We collected preoperative, intraoperative and postoperative data of all patients. The primary endpoint was the percentage of patients with an unexpectedly abnormal histopathological report compared to colonoscopy.

RESULTS: During the study period, 207 patients undergoing sigmoidectomy for diverticular disease were included. Mean age was 62.7 ± 13.0 years and 97 (46.9%) patients were men. In eight (3.9%) cases an unexpected finding was noted on the histopathological examination: five (2.4%) of them were hyperplastic polyps with no dysplasia and no clinical relevance, two (1.0%) were polyps with low-grade dysplasia and in one case (0.5%) a diffuse large B-cell lymphoma was present in a patient with history of lymphoma treated in the past 10 years. The Goodman and Kruskal's G index was 0.953 (95% lower limit of 0.913), which indicated high concordance between the colonoscopy and the definitive histopathological examination.

CONCLUSIONS: In our series, the preoperative colonoscopy reliably predicted the result of the histopathological specimen findings in patients undergoing sigmoidectomy for diverticular disease. Only one (0.5%) high-risk patient had an unexpected clinically significant finding. Therefore, routine histopathological examination may not be justified for all patients.},
}

@article {pmid39495781,
year = {2024},
author = {Miller, A and Anderson, JC},
title = {Strategies, Technologies, and Tips for Successful Cecal Intubation.},
journal = {Journal of clinical gastroenterology},
volume = {},
number = {},
pages = {},
doi = {10.1097/MCG.0000000000002096},
pmid = {39495781},
issn = {1539-2031},
abstract = {Successful cecal intubation is crucial in ensuring a complete evaluation of the colonic mucosa. Although completion of colonoscopies should be successful in close to 100% of all examinations in the hands of experienced gastroenterologists, there are some patients with colons which can be difficult to navigate. Factors such as older age, presence of diverticular disease, as well as high or low body mass index can present challenges for endoscopists. Challenges can be divided into those that are left sided and are associated with severe angulations of the colon versus those that are right sided and present as redundant colons. Both require different strategies to achieve completion. This review will cover methods, technologies as well the evolution of colonoscope insertion tubes which can help in navigating colons, especially those that are challenging. There will also be a discussion about basic principles and techniques that should be employed in all colonoscopies.},
}

@article {pmid39492836,
year = {2024},
author = {Morasso, C and Daveri, E and Bonizzi, A and Truffi, M and Colombo, F and Danelli, P and Albasini, S and Rivoltini, L and Mazzucchelli, S and Sorrentino, L and Corsi, F},
title = {Raman spectroscopy on dried blood plasma allows diagnosis and monitoring of colorectal cancer.},
journal = {MedComm},
volume = {5},
number = {11},
pages = {e774},
pmid = {39492836},
issn = {2688-2663},
abstract = {Colorectal cancer (CRC) remains challenging to diagnose, necessitating the identification of a noninvasive biomarker that can differentiate it from other conditions such as inflammatory bowel diseases (IBD) and diverticular disease (DD). Raman spectroscopy (RS) stands out as a promising technique for monitoring blood biochemical profiles, with the potential to identify distinct signatures identifying CRC subjects. We performed RS analysis on dried plasma from 120 subjects: 32 CRC patients, 37 IBD patients, 20 DD patients, and 31 healthy controls. We also conducted longitudinal studies of CRC patient's postsurgery to monitor the spectral changes over time. We identified six spectral features that showed significant differences between CRC and non-CRC patients, corresponding to tryptophan, tyrosine, phenylalanine, lipids, carotenoids, and disulfide bridges. These features enabled the classification of CRC patients with an accuracy of 87.5%. Moreover, longitudinal analysis revealed that the spectral differences normalized over 6 months after surgery, indicating their association with the presence of the disease. Our study demonstrates the potential of RS to identify specific biomolecular signatures related to CRC. These results suggest that RS could be a novel screening and monitoring tool, providing valuable insights for the development of noninvasive and accurate diagnostic methods for CRC.},
}

@article {pmid39475015,
year = {2024},
author = {Dharmavaram, S and Unnam, S and Joacquim, MA},
title = {Rectosigmoid Endometriosis Causing Large Bowel Obstruction.},
journal = {British journal of hospital medicine (London, England : 2005)},
volume = {85},
number = {10},
pages = {1-7},
doi = {10.12968/hmed.2024.0118},
pmid = {39475015},
issn = {1750-8460},
mesh = {Humans ; *Endometriosis/complications/surgery ; *Intestinal Obstruction/etiology/surgery ; Female ; *Sigmoid Diseases/etiology/surgery ; *Rectal Diseases/etiology/surgery ; Adult ; Tomography, X-Ray Computed ; },
abstract = {Large bowel obstruction is most commonly due to colorectal carcinoma, diverticular disease or volvulus. Rare causes of large bowel obstruction like endometriosis may occur in premenopausal women and diagnosis of large bowel endometriosis can be challenging to confirm preoperatively. Hence, clinicians should maintain a high index of suspicion for rare causes of large bowel obstruction like endometriosis. This may require complete surgical resection of the involved bowel to eliminate the risk of local recurrence.},
}

Humans
*Endometriosis/complications/surgery
*Intestinal Obstruction/etiology/surgery
Female
*Sigmoid Diseases/etiology/surgery
*Rectal Diseases/etiology/surgery
Adult
Tomography, X-Ray Computed

@article {pmid39467839,
year = {2024},
author = {},
title = {Diagnosis and management of diverticular disease in primary care.},
journal = {The Nurse practitioner},
volume = {49},
number = {11},
pages = {29-30},
doi = {10.1097/01.NPR.0000000000000253},
pmid = {39467839},
issn = {1538-8662},
}

@article {pmid39467838,
year = {2024},
author = {Pateneaude, C and Lyden, C},
title = {Diagnosis and management of diverticular disease in primary care.},
journal = {The Nurse practitioner},
volume = {49},
number = {11},
pages = {23-29},
doi = {10.1097/01.NPR.0000000000000243},
pmid = {39467838},
issn = {1538-8662},
mesh = {Humans ; *Diverticular Diseases/diagnosis/therapy ; Primary Health Care ; Primary Care Nursing ; Nursing Diagnosis ; Nurse Practitioners ; Anti-Bacterial Agents/therapeutic use ; },
abstract = {Each year, more than 1 million ambulatory patient visits occur for diverticular disease, with nearly 75% of these patients seen in outpatient clinics. Although diverticulitis historically had been considered a disease of the older adult, it has become increasingly prevalent among the younger population. Likewise, in the past, antibiotics were considered first-line treatment for uncomplicated diverticulitis (Hinchey classification 0 and Ia); however, two large clinical trials compared treatment with antibiotics versus without antibiotics in uncomplicated cases of the disease and found no significant difference in patient outcomes. Based on these findings, first-line management now constitutes clear-liquid diet along with bowel rest for resolution of symptoms in these patients. Proper management with lifestyle modifications can help prevent complications and improve outcomes for patients with this condition; patient education is therefore critical.},
}

Humans
*Diverticular Diseases/diagnosis/therapy
Primary Health Care
Primary Care Nursing
Nursing Diagnosis
Nurse Practitioners
Anti-Bacterial Agents/therapeutic use

@article {pmid39466460,
year = {2024},
author = {Agnesi, S and Virgilio, F and Frontali, A and Zoni, G and Giugliano, M and Missaglia, C and Balla, A and Sileri, P and Vignali, A},
title = {Inferior mesenteric artery preservation techniques in the treatment of diverticular disease: a systematic review of the literature.},
journal = {International journal of colorectal disease},
volume = {39},
number = {1},
pages = {174},
pmid = {39466460},
issn = {1432-1262},
mesh = {Humans ; *Mesenteric Artery, Inferior/surgery ; Treatment Outcome ; Laparoscopy/adverse effects ; Diverticular Diseases/surgery ; Female ; Male ; Middle Aged ; Organ Sparing Treatments/methods ; Operative Time ; Length of Stay ; Postoperative Complications/etiology ; },
abstract = {PURPOSE: The aim of this study is to analyze the impact of different surgical techniques used to preserve the inferior mesenteric artery on patient outcomes following left colonic resection.

METHODS: A search was conducted in PubMed, Embase and Web of Science, founding 4795 articles. The review was registered on PROSPERO (registration number: CRD42024572291).

RESULTS: Eleven articles published between 2001 and 2023, including 989 patients were the object of the present systematic review. Two hundred sixty-two patients (26.5%) underwent Valdoni's technique (Group A), which involves the skeletonization of the IMA, 272 (27.5%) underwent tubular resection (Group B), and 455 (46%) underwent peripheral dissection on sigmoid vessels (Group C). Laparoscopic surgery was predominant in Groups B (100%) and C (94.7%), while Group A had fewer laparoscopic procedures (44.6%). Patients in Group A experienced longer operative times (174.5 ± 27.4 min) and hospital stays (11.4 ± 3.6 days) compared to Groups B and C (165.9 min and 152.35 ± 46.9 min; 8.4 ± 5.7 days and 8.3 ± 3.6 days, respectively). Group A exhibited higher rates of anastomotic leakage (5%) compared to Group C (1.1%) and a higher incidence of bleeding (13%) compared to Group B (1.8%).

CONCLUSION: Valdoni's technique is less favourable for IMA preservation in left colon resection for diverticular disease. Peripheral dissection of sigmoid vessels or tubular resection is recommended for IMA preservation in this context.},
}

Humans
*Mesenteric Artery, Inferior/surgery
Treatment Outcome
Laparoscopy/adverse effects
Diverticular Diseases/surgery
Female
Male
Middle Aged
Organ Sparing Treatments/methods
Operative Time
Length of Stay
Postoperative Complications/etiology

@article {pmid39459415,
year = {2024},
author = {Alfaris, AM and Al Awaji, NN and Alabdulkarim, SA and Mallisho, AM and Hamdoun, AO and Bawazir, SM and AlAjroush, NA},
title = {Oral and Pharyngeal Diverticula: A Rare Case of Dysphagia and Diagnostic Challenges.},
journal = {Medicina (Kaunas, Lithuania)},
volume = {60},
number = {10},
pages = {},
doi = {10.3390/medicina60101628},
pmid = {39459415},
issn = {1648-9144},
mesh = {Humans ; Male ; *Deglutition Disorders/etiology/diagnosis ; Middle Aged ; Diverticulum/complications/diagnosis/diagnostic imaging ; Saudi Arabia ; Fluoroscopy ; },
abstract = {This report describes the case of a 62-year-old male patient in Saudi Arabia who developed a diverticular pouch in his oral cavity. Diverticula are rare conditions that appear as protrusions or pouches within the digestive tract's inner lining. The condition can occur in different parts of the digestive system, but the colon is the most affected part. As part of the patient's symptoms, he presented with dysphagia, weight loss, and globus sensations. Multiple diagnostic tests, including ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI), did not identify the diverticula. Barium and upper gastrointestinal studies were the diagnostic tests that provided accurate diagnoses where several diverticula were discovered during the videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES). Surgical intervention was recommended by the multidisciplinary team; however, the patient rejected this treatment option. This report highlights the necessity for instrumental swallowing diagnostic evaluation in the workup of the infrequent etiologies of dysphagia and suggests a gap in the current knowledge, prompting further studies on the etiology, incidence, and optimum management of upper gastrointestinal (GI) tract diverticular disease.},
}

Humans
Male
*Deglutition Disorders/etiology/diagnosis
Middle Aged
Diverticulum/complications/diagnosis/diagnostic imaging
Saudi Arabia
Fluoroscopy

@article {pmid39440345,
year = {2024},
author = {Huang, TH and Marker, M and Urdahl, T and Manivel, J and Rezcallah, AT},
title = {Mid-jejunal diverticulitis with closed-loop bowel obstruction, strangulation, and contained perforation.},
journal = {Clinical case reports},
volume = {12},
number = {10},
pages = {e9489},
pmid = {39440345},
issn = {2050-0904},
abstract = {KEY CLINICAL MESSAGE: Closed-loop bowel obstruction and contained perforation secondary to acute on chronic jejunal diverticulitis is rare and should be included in the differential diagnosis of acute abdomen. The association between polymyalgia rheumatica and diverticular disease requires further research but may prompt clinicians to consider appropriate therapies in patients with both diseases.

ABSTRACT: Jejunal diverticulosis is a sac-like outpouching of the intestinal wall that can cause complications such as diverticulitis, obstruction, abscess, perforation, or fistula formation. Complicated jejunal diverticulosis may present with acute abdomen and nonspecific symptoms which can lead to misdiagnosis and delayed treatment. A 76-year-old male with a remote history of polymyalgia rheumatica (PMR) presented with sudden onset abdominal pain, fever, nausea, vomiting, and inability to pass flatus. Physical exam revealed a distended and diffusely tender abdomen with signs of peritonitis. Laboratory test results were significant for neutrophil-dominant leukocytosis and elevated inflammatory markers. CT scan of the abdomen with IV contrast revealed a contained perforation and a closed-loop small bowel obstruction in the mid-abdomen. The patient underwent emergent exploratory laparotomy and resection of 100 cm of mid-jejunum which was found to have numerous diverticula surrounding the closed-loop obstruction and contained perforation. Pathology findings showed evidence of acute on chronic jejunal diverticulitis. Jejunal diverticulosis with complications may present with an acute abdomen and peritonitis. Closed-loop bowel obstruction and contained perforation secondary to acute on chronic jejunal diverticulitis is uncommonly thought of and should be considered in the differential diagnosis. Additionally, the association between PMR and diverticular disease is notable. While the patient had a remote history but no active PMR on presentation, studies suggest a possible association between gut inflammation and rheumatologic disease. This association should prompt clinicians to consider appropriate therapies and bear in mind the potential risk for diverticular perforation if glucocorticoids are given to treat PMR. Jejunal diverticulosis with multiple complications such as closed-loop bowel obstruction and contained perforation secondary to acute on chronic jejunal diverticulitis is rare and may present with an acute abdomen and nonspecific symptoms. Including rare pathologies as such in the differential diagnosis may prevent misdiagnosis and delayed treatment. While further investigation is needed, the association between diverticulosis and PMR is noteworthy as patients who present with both diseases would require mindful management due to the potential risk of diverticular perforation after treatment with steroids.},
}

@article {pmid39436838,
year = {2024},
author = {Gazzetta, J and Fesmire, A and Orjionwe, R and Benedict, LA and Nix, S},
title = {30-Day Readmissions and the Need for Emergency Surgery Following Non-Operative Management of Perforated Diverticulitis.},
journal = {Surgical infections},
volume = {},
number = {},
pages = {},
doi = {10.1089/sur.2024.101},
pmid = {39436838},
issn = {1557-8674},
abstract = {Background: Limited data are available on the evaluation and outcomes of patients with perforated diverticulitis who were treated without surgery. Aims: This retrospective review was aimed at investigating the 30-day non-elective re-admission rates for patients hospitalized with perforated diverticular disease who were treated without surgery, rates of patients requiring surgery on re-admission, and the independent predictors of re-admission. Methods: A total of 143,546 patients from the National Readmission Database, between 2016 and 2020, who were admitted with perforated diverticulitis and treated non-operatively were reviewed. Re-admitted patients were compared with those not re-admitted. Comparisons for continuous and categoric variables were made using the student t-test and chi-squared test, respectively. A logistic regression model was used to determine independent factors associated with re-admission. All analyses were done with SAS 9.4; p values <0.05 identified significance. Results: Among patients with perforated diverticulitis who were treated non-operatively, 17,868 (12.4%) were re-admitted within 30 days and 4,924 (27.6%) of patients re-admitted required surgical intervention. The greatest independent predictors of re-admission include patient insurance status, index length of stay, undergoing a drainage procedure, and patient disposition. Comorbidities predicting re-admission include renal failure, chronic pulmonary disease, diabetes mellitus, fluid and electrolyte disorders, and hypertension. Hospital total charges were greater at the index admission for patients requiring re-admission. Conclusion: Non-operative management of perforated diverticulitis is safe for many patients, but the risks for re-admission and subsequent need for emergency surgery require special consideration.},
}

@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.},
}