DOI QR코드

DOI QR Code

Pathophysiology of Colon Diverticulum

대장게실의 병태 생리

  • Kim, Seong-Eun (Department of Internal Medicine, Ewha Womans University School of Medicine)
  • 김성은 (이화여자대학교 의학전문대학원 내과학교실)
  • Published : 2013.12.01

Abstract

Although the pathogenesis of diverticulum remains unclear, traditionally it has been thought to result from structural abnormalities of the colonic wall, deficiencies of dietary fiber, or disordered intestinal motility. More recently, new pathophysiologic factors including inflammation, gut flora, neurotransmitters, visceral hypersensitivity, and chemical mediators are proposed, and their mechanism of interactions in developing diverticulum is quite complex and currently poorly understood. Future studies are needed to find out the multifaceted pathogenesis of diverticulum, ultimately for the treatment and prevention of disease.

Keywords

References

  1. Strate LL, Modi R, Cohen E, Spiegel BM. Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol 2012;107:1486-1493. https://doi.org/10.1038/ajg.2012.194
  2. Jeyarajah S, Papagrigoriadis S. Review article: the pathogenesis of diverticular disease: current perspectives on motility and neurotransmitters. Aliment Pharmacol Ther 2011;33:789-800. https://doi.org/10.1111/j.1365-2036.2011.04586.x
  3. Matrana MR, Margolin DA. Epidemiology and pathophysiology of diverticular disease. Clin Colon Rectal Surg 2009;22:141-146. https://doi.org/10.1055/s-0029-1236157
  4. Painter NS. The aetiology of diverticulosis of the colon with special reference to the action of certain drugs on the behaviour of the colon. Ann R Coll Surg Engl 1964;34:98-119.
  5. Painter NS, Truelove SC, Ardran GM, Tuckey M. Segmentation and the localization of intraluminal pressure in the human colon, with special reference to the pathogenesis of colonic diverticula. Gastroenterology 1968;54(Suppl):778-780.
  6. Painter NS. Diverticulosis of the colon and diet. Br Med J 1969;2:764-765.
  7. Hobson KG, Roberts PL. Etiology and pathophysiology of diverticular disease. Clin Colon Rectal Surg 2004;17:147-153. https://doi.org/10.1055/s-2004-832695
  8. Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC. A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr 1994;60:757-764. https://doi.org/10.1093/ajcn/60.5.757
  9. Nair P, Mayberry JF. Vegetarianism, dietary fibre and gastro-intestinal disease. Dig Dis 1994;12:177-185. https://doi.org/10.1159/000171451
  10. Berry CS, Fearn T, Fisher N, Gregory JA, Hardy J. Dietary fibre and prevention of diverticular disease of colon: evidence from rats. Lancet 1984;2:294.
  11. Fisher N, Berry CS, Fearn T, Gregory JA, Hardy J. Cereal dietary fiber consumption and diverticular disease: a lifespan study in rats. Am J Clin Nutr 1985;42:788-804. https://doi.org/10.1093/ajcn/42.5.788
  12. Wess L, Eastwood MA, Edwards CA, Busuttil A, Miller A. Collagen alteration in an animal model of colonic diverticulosis. Gut 1996;38:701-706. https://doi.org/10.1136/gut.38.5.701
  13. Taylor I, Duthie HL. Bran tablets and diverticular disease. Br Med J 1976;1:988-990. https://doi.org/10.1136/bmj.1.6016.988
  14. Manousos O, Day NE, Tzonou A, et al. Diet and other factors in the aetiology of diverticulosis: an epidemiological study in Greece. Gut 1985;26:544-549. https://doi.org/10.1136/gut.26.6.544
  15. Arfwidsson S, Knock NG, Lehmann L, Winberg T. Pathogenesis of multiple diverticula of the sogmoid colon diverticular disease. Acta Chir Scand Suppl 1964;63(Suppl 342):1-68. https://doi.org/10.1111/j.1748-1716.1964.tb04118.x
  16. Whiteway J, Morson BC. Elastosis in diverticular disease of the sigmoid colon. Gut 1985;26:258-266. https://doi.org/10.1136/gut.26.3.258
  17. Wess L, Eastwood MA, Wess TJ, Busuttil A, Miller A. Cross linking of collagen is increased in colonic diverticulosis. Gut 1995;37:91-94. https://doi.org/10.1136/gut.37.1.91
  18. Scheff RT, 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):202-204. https://doi.org/10.7326/0003-4819-92-2-202
  19. Osbak PS, Bindslev N, Poulsen SS, Kaltoft N, Tilotta MC, Hansen MB. Colonic epithelial ion transport is not affected in patients with diverticulosis. BMC Gastroenterol 2007;7:37. https://doi.org/10.1186/1471-230X-7-37
  20. Sugihara K, Muto T, Morioka Y. Motility study in right sided diverticular disease of the colon. Gut 1983;24:1130- 1134. https://doi.org/10.1136/gut.24.12.1130
  21. Bassotti G, de Roberto G, Castellani D, Sediari L, Morelli A. Normal aspects of colorectal motility and abnormalities in slow transit constipation. World J Gastroenterol 2005; 11:2691-2696. https://doi.org/10.3748/wjg.v11.i18.2691
  22. Snape WJ Jr, Carlson GM, Cohen S. Colonic myoelectric activity in the irritable bowel syndrome. Gastroenterology 1976;70:326-330.
  23. Bassotti G, Sietchiping-Nzepa F, De Roberto G, Chistolini F, Morelli A. Colonic regular contractile frequency patterns in irritable bowel syndrome: the 'spastic colon' revisited. Eur J Gastroenterol Hepatol 2004;16:613-617. https://doi.org/10.1097/00042737-200406000-00016
  24. Bassotti G, Battaglia E, Spinozzi F, Pelli MA, 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;44:1814-1820. https://doi.org/10.1007/BF02234460
  25. Camilleri M, Atanasova E, Carlson PJ, et al. Serotonintransporter polymorphism pharmacogenetics in diarrheapredominant irritable bowel syndrome. Gastroenterology 2002;123:425-432. https://doi.org/10.1053/gast.2002.34780
  26. Banerjee S, Akbar N, Moorhead J, et al. Increased presence of serotonin-producing cells in colons with diverticular disease may indicate involvement in the pathophysiology of the condition. Int J Colorectal Dis 2007;22:643-649. https://doi.org/10.1007/s00384-006-0216-4
  27. Costedio MM, Coates MD, Danielson AB, et al. Serotonin signaling in diverticular disease. J Gastrointest Surg 2008; 12:1439-1445. https://doi.org/10.1007/s11605-008-0536-5
  28. Burleigh DE. Ng-nitro-L-arginine reduces nonadrenergic, noncholinergic relaxations of human gut. Gastroenterology 1992;102:679-683. https://doi.org/10.1016/0016-5085(92)90120-N
  29. Huizinga JD, Waterfall WE, Stern HS. Abnormal response to cholinergic stimulation in the circular muscle layer of the human colon in diverticular disease. Scand J Gastroenterol 1999;34:683-688. https://doi.org/10.1080/003655299750025886
  30. Golder M, Burleigh DE, Belai A, et al. Smooth muscle cholinergic denervation hypersensitivity in diverticular disease. Lancet 2003;361:1945-1951. https://doi.org/10.1016/S0140-6736(03)13583-0
  31. Tomita R, Fujisaki S, Tanjoh K, Fukuzawa M. Role of nitric oxide in the left-sided colon of patients with diverticular disease. Hepatogastroenterology 2000;47:692-696.
  32. Milner P, Crowe R, Kamm MA, Lennard-Jones JE, Burnstock G. Vasoactive intestinal polypeptide levels in sigmoid colon in idiopathic constipation and diverticular disease. Gastroenterology 1990;99:666-675. https://doi.org/10.1016/0016-5085(90)90953-X
  33. Trivedi CD, Das KM; NDSG. Emerging therapies for diverticular disease of the colon. J Clin Gastroenterol 2008; 42:1145-1151. https://doi.org/10.1097/MCG.0b013e318188adc1
  34. Comparato G, Pilotto A, Franze A, Franceschi M, Di Mario F. Diverticular disease in the elderly. Dig Dis 2007;25: 151-159. https://doi.org/10.1159/000099480
  35. Gledhill A, Dixon MF. Crohn's-like reaction in diverticular disease. Gut 1998;42:392-395. https://doi.org/10.1136/gut.42.3.392
  36. Makapugay LM, Dean PJ. Diverticular disease-associated chronic colitis. Am J Surg Pathol 1996;20:94-102. https://doi.org/10.1097/00000478-199601000-00011
  37. Imperiali G, Meucci G, Alvisi C, et al. Segmental colitis associated with diverticula: a prospective study. Gruppo di Studio per le Malattie Infiammatorie Intestinali (GSMII). Am J Gastroenterol 2000;95:1014-1016. https://doi.org/10.1111/j.1572-0241.2000.01943.x
  38. Stead RH. Nerve remodelling during intestinal inflammation. Ann N Y Acad Sci 1992;664:443-455. https://doi.org/10.1111/j.1749-6632.1992.tb39782.x
  39. Tursi A, Brandimarte G, Daffina R. Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon. Dig Liver Dis 2002;34:510-515. https://doi.org/10.1016/S1590-8658(02)80110-4
  40. Sheth A, Floch M. Probiotics and diverticular disease. Nutr Clin Pract 2009;24:41-44. https://doi.org/10.1177/0884533608329230
  41. Tursi A, Brandimarte G, Giorgetti GM, Elisei W. Mesalazine and/or Lactobacillus casei in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomized, open-label study. J Clin Gastroenterol 2006;40:312-316. https://doi.org/10.1097/01.mcg.0000210092.77296.6d
  42. Tursi A, Brandimarte G, Giorgetti GM, Elisei W, Aiello F. Balsalazide and/or high-potency probiotic mixture (VSL#3) in maintaining remission after attack of acute, uncomplicated diverticulitis of the colon. Int J Colorectal Dis 2007;22: 1103-1108. https://doi.org/10.1007/s00384-007-0299-6
  43. Clemens CH, Samsom M, Roelofs J, van Berge Henegouwen GP, Smout AJ. Colorectal visceral perception in diverticular disease. Gut 2004;53:717-722. https://doi.org/10.1136/gut.2003.018093
  44. Hughes LE. Postmortem survey of diverticular disease of the colon: II. the muscular abnormality of the sigmoid colon. Gut 1969;10:344-351. https://doi.org/10.1136/gut.10.5.344
  45. Acosta JA, Grebenc ML, Doberneck RC, McCarthy JD, Fry DE. Colonic diverticular disease in patients 40 years old or younger. Am Surg 1992;58:605-607.
  46. Freischlag J, Bennion RS, Thompson JE Jr. Complications of diverticular disease of the colon in young people. Dis Colon Rectum 1986;29:639-643. https://doi.org/10.1007/BF02560326
  47. Vignati PV, Welch JP, Cohen JL. Long-term management of diverticulitis in young patients. Dis Colon Rectum 1995; 38:627-629. https://doi.org/10.1007/BF02054123
  48. Spivak H, Weinrauch S, Harvey JC, Surick B, Ferstenberg H, Friedman I. Acute colonic diverticulitis in the young. Dis Colon Rectum 1997;40:570-574. https://doi.org/10.1007/BF02055381
  49. Etzioni DA, Cannom RR, Ault GT, Beart RW Jr, Kaiser AM. Diverticulitis in California from 1995 to 2006: increased rates of treatment for younger patients. Am Surg 2009;75: 981-985.
  50. Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL. Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology 2009;136:115-122.e1. https://doi.org/10.1053/j.gastro.2008.09.025
  51. Aldoori WH, Giovannucci EL, Rimm EB, et al. Prospective study of physical activity and the risk of symptomatic diverticular disease in men. Gut 1995;36:276-282. https://doi.org/10.1136/gut.36.2.276
  52. Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC. A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men. Ann Epidemiol 1995;5: 221-228. https://doi.org/10.1016/1047-2797(94)00109-7

Cited by

  1. What is the Difference Between Right- and Left-Sided Colonic Diverticulitis? vol.32, pp.6, 2016, https://doi.org/10.3393/ac.2016.32.6.206