Pathogenesis of Colonic Diverticular Disease

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2012 Jun 20

PMID 22711236

Citations 15

Authors

Burkhard H A von Rahden

Christoph-Thomas Germer

Affiliations

Soon will be listed here.

Abstract

Purpose: This paper aims to review the current evidence regarding pathogenesis of colonic diverticular disease and its complications, which are a major health problem in the Western world.

Methods: Based on selective Medline searches, relevant literature was indentified regarding pathogenesis of (1) diverticulosis/formation of diverticula, (2) diverticulitis/inflammation of diverticula, (3) complicated diverticulitis/perforation, and (4) diverticular bleeding.

Results: Pathogenesis of colonic diverticula is regarded as a multifactorial process, involving dietary factors (Western low-fiber diet), structural changes of the colonic wall (altered musculature, collagen, elastin, etc.) and functional changes (motility disorder, increased intraluminal pressure). Genetic changes are also discussed and aging is also a key factor. Pathogenesis of inflammation (diverticulosis) is regarded as a result of "microperforations" at the fundus of the diverticulum, and not an "abscessed diverticulum" due to an impacted fecolith. Histamine and its receptors do also seem to play a role, corresponding with the promising prophylactic approach with probiotics. Pathogenesis of complicated diverticulitis is characterized by perforation, which is the cardinal feature. Furthermore, an intensive inflammatory infiltrate with macrophages is found in surgical specimens, even after antibiotic pretreatment. Steroid intake and immunosuppression are risk factors and only recently a glucocorticoid-induced tumor necrosis factor-receptor has been suggested to resemble the molecular link. Diverticular bleeding is a distinct disease process-which does usually take place without diverticulitis-and is due to eccentric rupture of the vas rectum.

Conclusions: The pathophysiology of diverticular disease is multifactorial. Some of the current evidence has important implications for clinical practice, e.g., the suggested role of steroid intake and immunosuppression for complicated diverticulitis.

Citing Articles

Genetic, epigenetic and environmental factors in diverticular disease: systematic review.

Humphrey H, Sibley P, Walker E, Keller D, Pata F, Vimalachandran D BJS Open. 2024; 8(3).

PMID: 38831715 PMC: 11148476. DOI: 10.1093/bjsopen/zrae032.

Prior abdominal surgery as a potential risk factor for colonic diverticulosis or diverticulitis.

Ariam E, Richter V, Bermont A, Sandler Y, Cohen D, Shirin H World J Clin Cases. 2023; 11(35):8320-8329.

PMID: 38130607 PMC: 10731208. DOI: 10.12998/wjcc.v11.i35.8320.

Colorectal Perforation in Patients with Connective Tissue Disease.

Sugimoto K, Sakamoto K, Okazawa Y, Takahashi R, Mizukoshi K, Ro H Emerg Med Int. 2019; 2019:5852438.

PMID: 31321099 PMC: 6607726. DOI: 10.1155/2019/5852438.

Effects of Burdock tea on recurrence of colonic diverticulitis and diverticular bleeding: An open-labelled randomized clinical trial.

Mizuki A, Tatemichi M, Nakazawa A, Tsukada N, Nagata H, Kinoshita Y Sci Rep. 2019; 9(1):6793.

PMID: 31043657 PMC: 6494891. DOI: 10.1038/s41598-019-43236-0.

Intestinal Perforation in ACTH-Dependent Cushing's Syndrome.

Shahidi M, Phillips R, Chik C Biomed Res Int. 2019; 2019:9721781.

PMID: 31001560 PMC: 6436364. DOI: 10.1155/2019/9721781.

References

Giaccari S, Tronci S, Falconieri M, Ferrieri A . Long-term treatment with rifaximin and lactobacilli in post-diverticulitic stenoses of the colon. Riv Eur Sci Med Farmacol. 1993; 15(1):29-34. View

Radhi J, Ramsay J, Boutross-Tadross O . Diverticular disease of the right colon. BMC Res Notes. 2011; 4:383. PMC: 3206858. DOI: 10.1186/1756-0500-4-383. View

Mimura T, Bateman A, Lee R, Johnson P, McDonald P, Talbot I . Up-regulation of collagen and tissue inhibitors of matrix metalloproteinase in colonic diverticular disease. Dis Colon Rectum. 2004; 47(3):371-8. DOI: 10.1007/s10350-003-0050-5. View

Sugihara K, Muto T, Morioka Y, Asano A, Yamamoto T . Diverticular disease of the colon in Japan. A review of 615 cases. Dis Colon Rectum. 1984; 27(8):531-7. DOI: 10.1007/BF02555517. View

CLUNIE G, Mason J . Visceral diverticula and the Marfan syndrome. Br J Surg. 1962; 50:51-2. DOI: 10.1002/bjs.18005021913. View

Scheff R, Zuckerman G, Harter H, Delmez J, Koehler R . Diverticular disease in patients with chronic renal failure due to polycystic kidney disease. Ann Intern Med. 1980; 92(2 Pt 1):202-4. DOI: 10.7326/0003-4819-92-2-202. View

Floch M . A hypothesis: is diverticulitis a type of inflammatory bowel disease?. J Clin Gastroenterol. 2006; 40 Suppl 3:S121-5. DOI: 10.1097/01.mcg.0000225502.29498.ba. View

Nakaji S, Danjo K, Munakata A, Sugawara K, MacAuley D, Kernohan G . Comparison of etiology of right-sided diverticula in Japan with that of left-sided diverticula in the West. Int J Colorectal Dis. 2002; 17(6):365-73. DOI: 10.1007/s00384-002-0403-x. View

Hughes L . Postmortem survey of diverticular disease of the colon. II. The muscular abnormality of the sigmoid colon. Gut. 1969; 10(5):344-51. PMC: 1552861. DOI: 10.1136/gut.10.5.344. View

10.

Dominguez Fernandez E, Albrecht K, Heemann U, Kohnle M, Erhard J, Stoblen F . Prevalence of diverticulosis and incidence of bowel perforation after kidney transplantation in patients with polycystic kidney disease. Transpl Int. 1998; 11(1):28-31. DOI: 10.1007/s001470050098. View

11.

Ritz J, Lehmann K, Loddenkemper C, Frericks B, Buhr H, Holmer C . Preoperative CT staging in sigmoid diverticulitis--does it correlate with intraoperative and histological findings?. Langenbecks Arch Surg. 2010; 395(8):1009-15. DOI: 10.1007/s00423-010-0609-2. View

12.

Foutch P . Diverticular bleeding: are nonsteroidal anti-inflammatory drugs risk factors for hemorrhage and can colonoscopy predict outcome for patients?. Am J Gastroenterol. 1995; 90(10):1779-84. View

13.

Aldoori W, Giovannucci E, Rimm E, Wing A, Willett W . Use of acetaminophen and nonsteroidal anti-inflammatory drugs: a prospective study and the risk of symptomatic diverticular disease in men. Arch Fam Med. 1998; 7(3):255-60. DOI: 10.1001/archfami.7.3.255. View

14.

Meyers M, Alonso D, Gray G, Baer J . Pathogenesis of bleeding colonic diverticulosis. Gastroenterology. 1976; 71(4):577-83. View

15.

Makins R, Irving P . Diverticular disease of the colon. Lancet. 2004; 363(9418):1397. DOI: 10.1016/S0140-6736(04)16060-1. View

16.

Painter N, Burkitt D . Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol. 1975; 4(1):3-21. View

17.

Sethbhakdi S . Pathogenesis of colonic diverticulitis and diverticulosis. Postgrad Med. 1976; 60(6):76-81. DOI: 10.1080/00325481.1976.11708406. View

18.

Eliashar R, Sichel J, Biron A, Dano I . Multiple gastrointestinal complications in Marfan syndrome. Postgrad Med J. 1999; 74(874):495-7. PMC: 2360879. DOI: 10.1136/pgmj.74.874.495. View

19.

Aldoori W, Giovannucci E, Rimm E, Wing A, Trichopoulos D, Willett W . A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men. Ann Epidemiol. 1995; 5(3):221-8. DOI: 10.1016/1047-2797(94)00109-7. View

20.

Bassotti G, Battaglia E, Spinozzi F, Pelli M, Tonini M . Twenty-four hour recordings of colonic motility in patients with diverticular disease: evidence for abnormal motility and propulsive activity. Dis Colon Rectum. 2001; 44(12):1814-20. DOI: 10.1007/BF02234460. View