Diverticular Disease and Colorectal Neoplasms: Association between Left Sided Diverticular Disease with Colorectal Cancers and Right Sided with Colonic Polyps

  • Wong, E Ru (Institute of Health Sciences, PAPRSB, Universiti Brunei Darussalam) ;
  • Idris, Fazean (Institute of Health Sciences, PAPRSB, Universiti Brunei Darussalam) ;
  • Chong, Chee Fui (Department of Surgery, RIPAS Hospital) ;
  • Telisinghe, Pemasari Upali (Department of Pathology, RIPAS Hospital) ;
  • Tan, Jackson (Institute of Health Sciences, PAPRSB, Universiti Brunei Darussalam) ;
  • Chong, Vui Heng (Institute of Health Sciences, PAPRSB, Universiti Brunei Darussalam)
  • Published : 2016.05.01


Background: Both colorectal cancer (CRC) and diverticular disease (DD) are common in the affluent West, and their prevalence is also increasing in the rest of the world with economic development. Both diseases have common epidemiologic characteristics; increasing incidence, more common with advancing age and related to specific dietary changes. However, studies of associations between the two have generated mixed results with some showing positive correlations, whilst others have shown no or negative links. Most of these studies have been from the West with study populations that were predominantly Caucasians. Here the focus was on DD and colorectal neoplasms, including CRC, in Brunei. Materials and Methods: All patients who had undergone complete colonoscopy between 2011 and 2014 were identified and retrospectively reviewed. Patients under the age of 18 years old or had previous colonic surgeries (including previous CRC resection) were excluded. Results: The total number of colonoscopies included in the study was 2,766 (mean age $53.2{\pm}14.8$ years old, male 51.8%), of which DD, CRC and colonic polyps were detected in 17.3%, 4.7% and 28.2% respectively. The proportions of DD, polyps and CRC increased proportionally with age (<30 years, 30-49, 50-69 and ${\geq}70$). Overall, there was no association between the presence of DD and CRC (3.6% vs. 5.0%, p=0.179) but there was a significant association between CRC and left sided DD (p=0.034 by trend). There were also a significant association between presence of DD and polyps (36.1% vs. 28.2%, p=0.001), in particular with right-sided and pan-DD (p=0.001 for trend). Conclusions: Our study showed that the prevalence of DD, CRC and polyps increases with age. There were significant associations between presence of left-sided DD with CRC and right-sided or pan-DD with colonic polyps. This suggests shared risk factors. Further studies are required to assess links in other countries of the Asian Pacific region.


Colorectal neoplasms;colon cancer;diverticular disease;polyps


  1. Ashktorab H, Panchal H, Shokrani B, et al (2015). Association between Diverticular Disease and Pre-Neoplastic Colorectal Lesions in an Urban African-American Population. Digestion, 92, 60-65.
  2. Azzam N, Aljebreen AM, Alharbi O, Almadi MA (2103). Prevalence and clinical features of colonic diverticulosis in a Middle Eastern population. World J Gastrointest Endosc, 5, 391-7.
  3. Baniasadi N, Moghtader E, Khajehkazemi R, Mohebbi E (2015). Increasing trend in colorectal cancer incidence in the Southeast of Iran 2003-2013, a population based cancer registry study. Asian Pac J Cancer Prev, 16, 5257-60.
  4. Choi CS, Choi SC, et al (2007). Association between diverticulosis and colonic neoplasm in Koreans. Korean J Gastroenterol, 49, 364-8.
  5. Chong VH, Abdullah MS, Telisinghe PU, Jalihal A (2009). Colorectal cancer, incidence and trend in Brunei Darussalam. Singapore Med J, 50, 1085-9.
  6. Chong VH, Tan S, Jalihal A (2012). Spectrum of endoscopic findings among patients referred for colonoscopy in RIPAS Hospital. Brunei Int Med J, 8, 27-33.
  7. Chong VH, Telisinghe PU, Bickle I, Abdullah MS, Lim E, Chong CF (2015). Increasing incidence of colorectal cancer, starting at a younger age for rectal compared to colon cancer in Brunei Darussalam. Asian Pac J Cancer Prev, 16, 5063-7.
  8. Cooper GS, Xu F, Schluchter MD, Koroukian SM, Barnholtz Sloan JS (2014). Diverticulosis and the risk of interval colorectal cancer. Dig Dis Sci, 59, 2765-72.
  9. Ekbom A (2012). Is diverticular disease associated with colonic malignancy? Dig Dis, 30, 46-50.
  10. Fong SS, Tan EY, Foo A, Sim R, Cheong DM (2011). The changing trend of diverticular disease in a developing nation. Colorectal Dis, 13, 312-6.
  11. Granlund J, Svensson T, Granath F, et al (2011). Diverticular disease and the risk of colon cancer - a population-based case-control study. Aliment Pharmacol Ther, 34, 675-81.
  12. Interantional Agency for Research on Cancer (2012). GLOBOCAN 2012; Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012.
  13. Hirata T, Kawakami Y, Kinjo N, et al (2008). Association between colonic polyps and diverticular disease. World J Gastroenterol, 14, 2411-3.
  14. Huang WY, Lin CC, Jen YM, et al (2014). Association between colonic diverticular disease and colorectal cancer, a nationwide population-based study. Clin Gastroenterol Hepatol, 12, 1288-94.
  15. Kieff BJ, Eckert GJ, Imperiale TF (2004). Is diverticulosis associated with colorectal neoplasia? A cross-sectional colonoscopic study. Am J Gastroenterol, 99, 2007-11.
  16. Koh KS, Telisinghe PU, Bickle I, Abdullah MS, Chong CF, Chong VH (2015). Characteristics of young colorectal cancer in brunei darussalam, an epidemiologic study of 29 years (1986-2014). Asian Pac J Cancer Prev, 16, 3279-83.
  17. Lee KM, Paik CN, Chung WC, Jung SH, Chang UI, Yang JM (2010). Clinical significance of colonic diverticulosis associated with bowel symptoms and colon polyp. J Korean Med Sci, 25, 1323-9.
  18. Meurs-Szojda MM, Terhaar sive Droste JS, Kuik DJ, Mulder CJ, Felt-Bersma RJ (2008). Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies. Int J Colorectal Dis, 23, 979-84.
  19. Morini S, Zullo A, Hassan C, Tomao S, Campo SM (2008). Diverticulosis and colorectal cancer, between lights and shadows. J Clin Gastroenterol, 42, 763-70.
  20. Muhammad A, Lamendola O, Daas A, Kumar A, Vidyarthi G (2014). Association between colonic diverticulosis and prevalence of colorectal polyps. Int J Colorectal Dis, 29, 947-51.
  21. Peery AF, Martin CF, Levinson SE, Sandler RS (2015). Colonic diverticula are not associated with an increased risk of colorectal adenomas. Am J Gastroenterol, 110, 1694-7.
  22. Rajendra S, Ho JJ (2005). Colonic diverticular disease in a multiracial Asian patient population has an ethnic predilection. Eur J Gastroenterol Hepatol, 17, 871-5.
  23. Rondagh EJ, Sanduleanu S, le Clercq CM, Winkens B, Masclee AA (2011). Diverticulosis and colorectal polyps at younger age, a possible link? Eur J Gastroenterol Hepatol, 23, 1050-5.
  24. Song Y, Liu M, Yang FG, Cui LH, Lu XY, Chen C (2015). Dietary fibre and the risk of colorectal cancer, a case- control study. Asian Pac J Cancer Prev, 16, 3747-52.
  25. Stefansson T, Ekbom A, Sparen P, Pahlman L (1993). Increased risk of left sided colon cancer in patients with diverticular disease. Gut, 34, 499-502.
  26. Stefansson T, Ekbom A, Sparen P, Pahlman L (1995). Cancers among patients diagnosed as having diverticular disease of the colon. Eur J Surg, 161, 755-60.
  27. Stefansson T, Ekbom A, Sparen P, Pahlman L (2004). Association between sigmoid diverticulitis and left-sided colon cancer, a nested, population-based, case control study. Scand J Gastroenterol, 39, 743-7.
  28. Templeton AW, Strate LL (2013). Updates in diverticular disease. Curr Gastroenterol Rep, 15, 339.
  29. Xie WC, Chan MH, Mak KC, Chan WT, He M (2012). Trends in the incidence of 15 common cancers in Hong Kong, 1983-2008. Asian Pac J Cancer Prev, 13, 3911-6.