Trend and Risk Factors of Diverticulosis in Japan: Age, Gender, and Lifestyle/Metabolic-Related Factors May Cooperatively Affect on the Colorectal Diverticula Formation

Abstract

BackgroundDespite the marked increase of diverticulosis, its risk factors have not been adequately elucidated. We therefore aim to identify significantly associated factors with diverticulosis. We also aim to investigate the present state of diverticulosis in Japan.MethodsWe reviewed the medical records from 1990 to 2010 that included the data of consecutive 62,503 asymptomatic colonoscopy examinees from the general population in Japan. Most recent 3,327 examinees were analyzed with 16 background factors.ResultsAmong the 62,503 subjects (47,325 men and 15,178 women; 52.1 ± 9.2 years old), diverticulosis was detected in 11,771 subjects (18.8%; 10,023 men and 1,748 women). The incidences of diverticulosis in 1990-2000 and 2001-2010 were respectively 13.0% (3,771 of 29,071) and 23.9% (8,000 of 33,432): the latter was much higher than the former in all age groups and for both genders. Considering the anatomical locations of colorectal diverticula, left-sided ones have markedly increased with age but not significantly changed with times. Univariate analyses of the 3,327 subjects showed significant association of diverticulosis with four basic factors (age, sex, body mass index, blood pressure), three life style-related factor (smoking, drinking, severe weight increase in adulthood), and two blood test values (triglyceride, HbA1c). The multiple logistic analysis calculating standardized coefficients (β) and odds ratio (OR) demonstrated that age (β = 0.217-0.674, OR = 1.24-1.96), male gender (β = 0.185, OR = 1.20), smoking (β = 0.142-0.200, OR = 1.15-1.22), severe weight increase in adulthood (β = 0.153, OR = 1.17), HbA1c (β = 0.136, OR = 1.15), drinking (β = 0.109, OR = 1.11), and serum triglyceride (β = 0.098, OR = 1.10) showed significantly positive association with diverticulosis whereas body mass index and blood pressure did not.ConclusionsThe large-scale data of asymptomatic colonoscopy examinees from the general population from 1990 to 2010 indicated that the prevalence of diverticulosis is still increasing in Japan. Age, male gender, smoking, severe weight increase in adulthood, serum HbA1c, drinking, and serum triglyceride showed significant positive association with diverticulosis.

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

“…Another study of individuals with a mean age of 55 years showed the prevalence of diverticula was 42% [26]. According to statistics published during 2001-2010 in Japan, the prevalence of colonic diverticula in individuals with a mean age of 52 years was 23.9% [2]. These findings indicate that the proportion of individuals with colonic diverticula is lower in Japan than that in the West.…”

“…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.…”

“…In Japan, opportunities to treat patients with colonic diverticular disease (diverticular bleeding and diverticulitis) have been increasing in recent years as the prevalence of colonic diverticula has increased [1,2]. In particular, the number of reports of colonic diverticular bleeding from Japan has been increasing in the past 2 or 3 years [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Comparative analysis of upper gastrointestinal endoscopy, double-contrast upper gastrointestinal barium X-ray radiography, and the titer of serum anti-Helicobacter pylori IgG focusing on the diagnosis of atrophic gastritis

“…Serum anti-H. pylori IgG, serum pepsinogen I and II, and other factors Serum anti-H. pylori IgG and pepsinogens were measured using commercial kits (E-plate; EIKEN, Tokyo, Japan) [26][27][28][29][30]. According to the manufacturer's instructions, a titer of anti-H. pylori IgG C10 U/ml was considered as positive for H. pylori infection.…”

The Burden of Diverticular Disease and Its Complications: West versus East

“…The prevalence of colonic diverticulosis is increasing in Western and Asian countries [1][2][3]. Diverticular disease is defined as clinically significant and symptomatic diverticulosis complicated by diverticulitis, diverticular bleeding, segmental colitis associated with diverticula, or symptomatic uncomplicated diverticular disease; these DOI: 10.1159/000492178 are the so-called complications of colonic diverticulosis.…”