Epidemiology, Pathophysiology, and Treatment of Diverticulitis

Strate, Lisa L.; Morris, Arden M.

doi:10.1053/j.gastro.2018.12.033

Cited by 319 publications

(441 citation statements)

References 154 publications

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“…The term diverticulitis describes a peridiverticular inflammation of the bowel wall and usually the surrounding tissue. The theory that the inflammation is a result of translocation of intestinal bacteria through the mucosa of the diverticulum on the basis of a weak barrier has lately been challenged [21] and the true aetiology is unclear.…”

Section: Symptomatic Uncomplicated Diverticular Disease (Sudd)mentioning

confidence: 99%

“…Obesity is a major risk factor with a linear relationship and a relative risk for each 5-unit body mass index increase of 1.28 (95% CI 1.18-1.40) for diverticular disease, 1.31 (95% CI 1.09-1.56) for diverticulitis and 1.20 (95% CI 1.04-1.40) for complicated diverticular disease (defined as bleeding, abscess or perforation) [30]. Recent research has identified other factors, such as genetic patterns, altered tissue composition and malfunction as associated with neuro-gastrointestinal disturbances [21]. Colonic diverticula may occur in all segments of the colon but mostly in the sigmoid colon, with the second most common site in the right colon [31].…”

Section: What Are the Risk Factors For Diverticulosis Diverticulitismentioning

confidence: 99%

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European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

188

177

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Aim The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. Methods The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. Results This guideline contains 38 evidence based consensus statements on the management of diverticular disease. Conclusion This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.

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Section: Symptomatic Uncomplicated Diverticular Disease (Sudd)mentioning

confidence: 99%

Section: What Are the Risk Factors For Diverticulosis Diverticulitismentioning

confidence: 99%

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

188

177

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“…In fact of this patients' selection and indication gets even more important. 2,7 million outpatient visits and 200 000 inpatient admissions at a cost of more than $2 Billion were seen in the United States annually [22][23][24], diverticulitis is a burden for the health system. The prevalence of diverticulosis between 50-70 years is more than 30% [4,25,26] and the incidence of individuals between 40-49 years has risen by 132% between 1980 and 2007 [24,27] .…”

Section: Resultsmentioning

confidence: 99%

Early or delayed sigmoid resection in complicated diverticular disease? A single center experience

Tschann

Lechner

Feurstein

et al. 2020

Preprint

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Background:Diverticular disease appears to be one of the most common conditions in the western world. The standard approach in treatment of diverticular disease is a laparoscopic resection, usually after an inflammation free time of 4 to 6 weeks. The aim of this study was to evaluate the timing of operation.Methods:61 patients underwent left-sided colonic resection because of diverticular disease between January 2017 and February 2020. 37 patients were treated because of complicated diverticulitis (CDD stage 2a or 2b) either early within 7 days after first symptoms (group A: n = 17) or delayed about 6 weeks after the first contact and conservative therapy (group B: n = 20).Results:Overall mortality was 0%. The average operation time was shorter in the early elective group (Group A: 140,4 min vs. Group B: 151,2 min (p = 0,29). The hospital stay (group A: 9,9 d vs. group B: 16,9 d) and the postoperative stay (group A: 4,8 d vs. group B: 8,1 d) was significantly longer in group B (p = 0,01). We observed – although not reliable due to low number of patients - more postoperative complications in the delayed group (group A: 5,9% vs. group B: 15,0%) (p = 0,61).Conclusion:The data in this study confirm the early operation as safe and efficient due to lower costs. We can recommend an early approach in selected cases with the first episode of a complicated diverticulitis.

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“…Diverticular disease is the most common morphological defects of the intestinal tract and the fifth most important gastrointestinal (GI) disorder in terms of medical cost as high as >$5.4 billion in the United States [1][2][3] . Diverticular disease usually indicates asymptomatic diverticulosis (the mere presence of diverticula, a pouch-like protrusion in the colonic wall), but also includes diverticulitis (an acute or chronic inflammation of diverticula) and its clinical complications 4 . Diverticulitis occurs in approximately 4% to 15% of patients with diverticula with a high reoccurrence rate, which is associated with fever, abdominal pain, leukocytosis and potential life-threatening peritonitis [4][5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Multi-ancestry Genome- and Phenome-wide Association Studies of Diverticular Disease in Electronic Health Records with Natural Language Processing enriched phenotype algorithm

Joo¹,

Pacheco²,

Thompson

et al. 2020

Preprint

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Disclosures:The authors have no conflicts to declare Accession numbers:The genotypes and phenotypes used in this study were deposited to the NCBI Database of Genotypes and Phenotypes (dbGaP; accession number phs000888.v1.p1). Abstract Background and aims:Diverticular disease is among the most prevalent conditions encountered by gastroenterologists, affecting ~50% of Americans before the age of 60. Our aim was to identify genetic risk variants and clinical phenotypes associated with diverticular disease, utilizing the electronic health record (EHR) with Natural Language Processing (NLP). Methods:We developed a NLP-enriched phenotype algorithm that incorporated colonoscopy or abdominal imaging reports to accurately identify patients with diverticulosis and diverticulitis from multicenter EHRs. We performed genome-wide association studies (GWAS) of diverticular disease in European, African and multi-ancestry participants, followed by phenome-wide association studies (PheWAS) of the risk variants to identify their potential comorbid/pleiotropic effects in the clinical phenome. For more in-depth investigation of associated clinical phenotypes, we also performed PheWAS with the previously reported 52 GWAS susceptibility variants for diverticular disease. Results:Ancestry-stratified GWAS analyses confirmed the well-established associations between ARHGAP15 loci with diverticular disease in European cohorts, and found similar positive effect sizes in African cohorts but with non-significant p-values. With overall intensified GWAS signals in diverticulitis patients compared to diverticulosis patients, we found substantial genetic correlations between diverticulosis and diverticulitis, up to 0.997 in European ancestry. PheWAS analyses identified associations between the diverticular disease GWAS variants and circulatory system, genitourinary, and neoplastic EHR phenotypes. Conclusion:Our multiancestry GWAS-PheWAS study demonstrated an effective use of multidimensional EHR information in disease case/control classification with NLP for more comprehensive and scalable phenotyping, and implementation of an integrative analytical pipeline to facilitate etiological investigation of a disease from a clinical perspective.

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Epidemiology, Pathophysiology, and Treatment of Diverticulitis

Cited by 319 publications

References 154 publications

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Early or delayed sigmoid resection in complicated diverticular disease? A single center experience

Multi-ancestry Genome- and Phenome-wide Association Studies of Diverticular Disease in Electronic Health Records with Natural Language Processing enriched phenotype algorithm

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