Diverticulosis, Symptoms and Colonic Inflammation: A Population-Based Colonoscopy Study

Abstract

INTRODUCTION: Low-grade chronic inflammation has been suggested to play a role in uncomplicated asymptomatic and symptomatic diverticular disease. However, population-based studies are lacking. We investigated whether community participants with diverticulosis, with or without symptoms, would have colonic inflammation on histology and serology. METHODS: In a nested case–control study of 254 participants from the population-based colonoscopy (PopCol) study, colonic histological inflammatory markers and serological C-reactive protein levels were analyzed in cases with diverticulosis and controls without diverticulosis. Statistical methods included logistic and linear regression models. RESULTS: Background variables including age (P = 0.92), sex (P = 1.00), body mass index (P = 0.71), smoking (P = 0.34), and recent antibiotic exposure (P = 0.68) were similar between cases and controls. Cases reported more abdominal pain (P = 0.04) and diarrhea symptoms (mushy and high-frequency stools) than controls (P = 0.01 and P = 0.03, respectively) but were otherwise similar. The median C-reactive protein levels were similar among cases and controls [1.05 mg/L (0.3, 2.7) vs 0.8 (0.4, 2.2), P = 0.53]. There was a trend of increased numbers of cecal lymphoid aggregates in cases vs controls (P = 0.07), but no other associations between diverticulosis and inflammatory markers on histology were found. Similarly, no serological or mucosal inflammation was associated with symptomatic cases of diarrhea or abdominal pain vs asymptomatic controls. CONCLUSIONS: In a general community sample, both asymptomatic and symptomatic diverticulosis are not associated with colonic mucosal inflammation. Other explanations for symptomatic colonic diverticulosis need to be identified.

International Consensus on Diverticulosis and Diverticular Disease. Statements from the 3rd International Symposium on Diverticular Disease

“…The fourth and fifth statements point out the significant role of neuromuscular abnormalities in the pathogenesis of diverticulosis and DD [15][16][17][18][19][20]. The sixth and the seventh statement point out that diverticulosis is a merely expression of an anatomical alteration [21][22][23], while symptomatic uncomplicated diverticular disease (SUDD) may have overt inflammation microscopic inflammation even without any endoscopic inflammation [24,25]. The last two statements point out the role of high fiber diet in reducing the risk of acute diverticulitis [26][27][28][29][30], and more recent evidences are available about the role of obesity on occurrence of DD complications [31,32].…”

What’s New in Diagnosing Diverticular Disease

“…A recent study in real life confirms the significant agreement for this classification in clinical settings, even for endoscopists not expert with this disease [26]. DICA classification has become the standard reference for the studies assessing DD by an endoscopic point of view [27][28][29]. A prospective, international study is currently ongoing.…”

Course of the Diverticular Disease: What is changing?

“…Specifically, it is still unclear which is the origin of symptoms in patients with SUDD. For example, two large, community-based studies evaluated patients undergoing routine colonoscopy and having chronic abdominal symptoms [8,9]: both found no evidence of mucosal inflammation either based on immune markers, serum CRP or histopathology in patients with diverticulosis regardless of symptoms [8,9]. In addition, the good clinical response to rifaximin may also be a confounding factor, since rifaximin was found effective in symptoms' relief in both diseases [6,10,11].…”