Postmortem survey of diverticular disease of the colon. II. The muscular abnormality of the sigmoid colon.

Hughes, L. E.

doi:10.1136/gut.10.5.344

Cited by 92 publications

(54 citation statements)

References 12 publications

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“…Muscle thickening is correlated with the degree of diverticular involvement, but not with the severity of the clinical symptoms [2]. Increased elastin deposits in the longitudinal muscles [3] result in the contraction of the taeniae coli with shortening of the intestinal tube [4].…”

Section: Structural Changes/pathogenesismentioning

confidence: 99%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

134

117

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Background: Diverticular disease is one of the most common disorders of the gastrointestinal tract. 28-45% of the population develop colonic diverticula, while about 25% suffer symptoms and about 5% complications. Aim: To create formal guidelines for diagnosis and management. Methods: Six working groups with 44 participants analyzed key questions in subject areas assigned to them. Following a systematic literature search, 451 publications were included. Consensus was obtained by agreement within the working groups, two Delphi processes and a guideline conference. Results: Targeted management of diverticular disease requires a classificatory diagnosis. A new classification was created. In addition to the clinical examination, intestinal ultrasound or computed tomography is the determining factor. Interval colonoscopy is recommended to exclude comorbidities. A low-fiber diet, obesity, lack of exercise, smoking and immunosuppression have an adverse impact on diverticulosis. This can lead to diverticulitis. Antibiotics are no longer recommended in uncomplicated diverticulitis if no risk factors such as immunosuppression are present. If close monitoring is ensured, uncomplicated diverticulitis can be treated on an outpatient basis. Complicated diverticulitis should be treated in hospital, involving broad-spectrum antibiotic therapy, where necessary abscess drainage, and surgery, if possible laparoscopically. In the case of chronic relapsing diverticulitis, the risk of perforation decreases with each episode, so that surgery is no longer recommended after the second episode but only following individual assessment. Conclusions: New findings on diverticular disease call into question the overuse of antibiotics and excessive indications for surgery. Targeted treatment requires a precise diagnosis and intensive interdisciplinary cooperation. i 2014 S. Karger AG, Basel

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Section: Structural Changes/pathogenesismentioning

confidence: 99%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

134

117

View full text Add to dashboard Cite

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“…Die Verdickung der Tunica muscularis betrifft sowohl die Ring-als auch die Längsmuskelschicht [26][27][28][29][30][31]. Die Muskelverdickung wurde als häufiger Befund im divertikeltragenden Kolonsegment beschrieben und kann auch bei reizloser Divertikulose auftreten [26,31].…”

Section: Hintergrundunclassified

“…Die Muskelverdickung wurde als häufiger Befund im divertikeltragenden Kolonsegment beschrieben und kann auch bei reizloser Divertikulose auftreten [26,31]. Die Muskelverdickung korreliert zwar mit dem Ausmaß des Divertikelbefalls, nicht jedoch mit dem Schweregrad der klinischen Symptomatik [26]. Histopathologisch wurden mehrheitlich bandartige und weniger häufig zirkumferentielle Muskelverdickungen beobachtet [26,31].…”

Section: Hintergrundunclassified

“…Die Muskelverdickung korreliert zwar mit dem Ausmaß des Divertikelbefalls, nicht jedoch mit dem Schweregrad der klinischen Symptomatik [26]. Histopathologisch wurden mehrheitlich bandartige und weniger häufig zirkumferentielle Muskelverdickungen beobachtet [26,31]. Es ließen sich fischgrätenartige und aberrant verlaufende Muskelzüge beobachten [29].…”

Section: Hintergrundunclassified

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Failure to Use Ultrasound Is a Glaring Shortcoming

Läng¹

2018

Deutsches Ärzteblatt International

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“…One well-established factor triggering the development of diverticula is increasing age [2,3,4]. Whereas this condition is uncommon under the age of 40, the prevalence increases rapidly from approximately 20% at the age of 50 to around 60% at the age of 70.…”

Section: Established Etiological Factorsmentioning

confidence: 99%

Abnormalities of Neuromuscular Anatomy in Diverticular Disease

Böttner¹,

Wedel²

2012

Dig Dis

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The pathogenesis of diverticular disease is still poorly understood and considered to be multifactorial. Whereas classical pathogenetic concepts have focused on risk factors including increasing age, low-fiber diet and connective tissue disorders, novel concepts take into account that patients with diverticular disease exhibit disturbed intestinal motility patterns (that may result in functional obstruction and painful sensations) therefore postulating an underlying enteric neuro-/myopathy. Recent studies including quantitative evaluations of the enteric nervous system (ENS) in diverticular disease yielded hypoganglionic conditions of both myenteric and submucosal plexus as well as a nerve tissue remodeling in chronic diverticular disease. The disturbed neuromuscular communication was proven by demonstrating alterations in several enteric neurotransmitter systems, exemplified for the cholinergic, serotonergic, nitrergic system as well as for vasointestinal peptide, galanin and tachykinins. Novel lines of evidence have added the involvement of neurotrophic factors such as glial cell line-derived neurotrophic factor which is supposed to regulate ENS development and maintenance and which is downregulated in patients with diverticular disease. Consistent with the hypothesis of an enteric myopathy, deficits in smooth muscle integrity and composition such as hypertrophy, fibrotic transformation and gene expression deficits could be delineated. Taken together, the structural and functional findings on alterations of the ENS and the enteric musculature in diverticular disease provide evidence to strengthen the hypothesis that an enteric neuro-/myopathy may contribute to the development of colonic diverticula and the generation of symptoms in the course of the disease.

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Postmortem survey of diverticular disease of the colon. II. The muscular abnormality of the sigmoid colon.

Cited by 92 publications

References 12 publications

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Failure to Use Ultrasound Is a Glaring Shortcoming

Abnormalities of Neuromuscular Anatomy in Diverticular Disease

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