Colonic Diverticular Disease: Abnormalities of Neuromuscular Function

Abstract

Although diverticular disease of the colon (diverticulosis) is a frequent finding in Western countries, its pathophysiologic grounds are still only partially understood. Traditionally considered as an age-related condition, colonic diverticulosis is probably the final result of several factors concurring together to determine the anatomo-functional abnormalities eventually causing outpouching of the viscus’ mucosa. Among these factors, a relevant role seems to be played by an abnormal neuromuscular function of the large bowel, as shown by abnormal myoelectrical and motor function repeatedly described in these patients, as well as by altered visceral perception. These anomalies might be related to the recent demonstration of derangement of enteric innervation (especially involving interstitial cells of Cajal and enteric glial cells), mucosal neuropeptides, and mucosal inflammation. The latter may have a role of paramount importance in the development of visceral hypersensitivity, responsible for abdominal pain in a subset of patients.

Altered Expression Pattern of Molecular Factors Involved in Colonic Smooth Muscle Functions: An Immunohistochemical Study in Patients with Diverticular Disease

“…Of note, patients with DD have been shown to display an increase in both overall and rhythmic colonic contractions [2], [46]. Since studies on rat [47] and human [48] colonic muscle have suggested that ICCs are likely to inhibit colonic motility by nitric oxide release, the reduction of intramuscular ICC, as observed in the colon of DD patients, might result in an increment of SMC contractility, as repeteadly observed in these patients [4].…”

“…Its pathogenesis is likely multifactorial in nature, involving dietary habits as well as changes in colonic pressure, motility and wall structure associated with ageing [1]. Abnormalities of colonic motility, including increments of the overall motor activity, as well as abnormal responses to physiologic stimuli and retro-propagation of mass movements, might predispose to the formation of pulsion diverticula by herniation of colonic wall [2]–[4].…”

Constipation and a Low-Fiber Diet Are Not Associated With Diverticulosis

“…19–25 Most of these studies measured pressures in the rectum or rectosigmoid junction, and they were commonly underpowered and limited by selection bias. 26 No study measured colonic motility prior to the development of diverticula.…”

Constipation is not associated with diverticular disease – Analysis of 976 patients

“…Some studies have reported that age related changes in collagen composition led to the formation of diverticular disease [3]. In addition, abnormalities in myoelectrical and motor function in the large bowel were considered as potential etiological factors [4]. In particular, recent investigations observed significantly decreased numbers of Cajal 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 cells in colonic diverticular specimen [5].…”