Alcohol and Smoking Affect Risk of Uncomplicated Colonic Diverticulosis in Japan

Abstract

Colonic diverticula are located predominantly on the right side in Asia and on the left side in Europe and the United States. Factors associated with uncomplicated colonic diverticulosis and its distribution pattern have been unknown. Our aims are to investigate the prevalence and risk factors for uncomplicated colonic diverticulosis. We conducted a prospective cross-sectional study in adults who underwent colonoscopy. Alcohol, alcohol related flushing, smoking, medications, and comorbidities were assessed by interview on the colonoscopy day. Alcohol consumption was categorized as nondrinker, light (1–180 g/week), moderate (181–360 g/week), and heavy (≥361 g/week). Smoking index was defined as the number of cigarettes per day multiplied by the number of smoking years and categorized as nonsmoker, <400, 400–799, and ≥800. A total of 2,164 consecutive patients were enrolled. Overall, 542 patients (25.1%) had uncomplicated colonic diverticulosis located on the right side (50%), bilaterally (29%), and on the left side (21%). Univariate analysis revealed age, male, smoking index, alcohol consumption, aspirin use, anticoagulants use, corticosteroid use, hypertension, and atherosclerotic disease as factors significantly associated with diverticulosis. Alcohol related flushing was not associated with the disease. Multivariate analysis showed increasing age (P<0.01), increasing alcohol consumption (P<0.01) and smoking (P<0.01), and atherosclerotic disease (P<0.01) as significantly associated factors. Alcohol and smoking were associated with right-sided and bilateral diverticula. In conclusion, one in four Japanese adults have colonic diverticulosis (50% right-sided). Age, alcohol consumption, and smoking were found to be significant risk factors for uncomplicated colonic diverticulosis, particularly right-sided and bilateral.

Alcohol consumption and cardiovascular diseases in rural China

“…This result is consistent with most previous studies [36][37][38][39]. This result, combined with a particularly high prevalence of hypertension (51%) in this region, suggests that changing this modifiable risk factor may provide a significant benefit in long-term health.…”

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

“…However, the incidence of colonic diverticula on the left side increases with age to the point where 60% of patients aged ≥70 years have diverticula on the left side of the colon, with 25% of these patients having colonic diverticula only on the left side of the colon [2,27,28]. In the United States, 80% of colonic diverticula occur on the left side including 70% occurring in the sigmoid colon, which account for the majority of colonic diverticula.…”

Visceral fat accumulation affects risk of colonic diverticular hemorrhage

“…A significant proportion of patients with colonic diverticula experience severe or recurrent bleeding, necessitating a blood transfusion and prolonged hospitalization [2,3]. Due to the growing elderly population in both Western and Eastern countries [4], there will be an increased need for clinical management of this disease [5,6].…”

“…Colonoscopy has enabled the detection of incidental diverticulosis [6,7,14] and is also an essential diagnostic tool for detecting diverticular bleeding [15,16]; however, no data are available from colonoscopic studies regarding the association of diverticular bleeding and obesity. In this study, we conducted a case-control (endoscopically verified colonic diverticula versus bleeding diverticula) study of Japanese adults who underwent colonoscopy and CT.…”