Abstracts

Fiber (Diverticulosis)

Fiber

According to this study, insoluble fiber (especially cellulose) decreases the risk for diverticular disease. In evaluating 43,881 U.S. male health professionals between 40 and 75 years of age, these researchers discovered that the insoluble component of fiber is significantly associated with a decreased risk of diverticular disease.

A Prospective Study of Dietary Fiber Types and Symptomatic Diverticular Disease in Men, Aldoori, Walid H., et al, Journal of Nutrition, 1998;128:714-719.

Africa

Africa

Among Urban Africans a prevalence of 5 per 100,000 hospital admissions was found. The pattern was different from that reported in Western communities in that, while "diverticula" were left sided in 77% of cases, 62% were right sided and 73% presented with "hemorrhage". This confirms a reported experience among African Americans. We would like to postulate that it might be the pattern during a transition from traditional to Western diet.

"Pattern of diverticular disease among Africans." Madiba, T.E. & Mokoena, T. East Afr. Med. J. 1994 Oct; 71(10):644-6.

Clinical Assessment (Diverticulosis)

Clinical Assessment

Giant colonic diverticulum is a rare complication of diverticular disease. In the English literature, only 81 cases have been described.

The significant number of complications caused by the giant diverticulum and the low morbidity and mortality rate associated with surgical treatment reinforce the importance of accurate diagnosis and elective treatment of this disorder.
Carias de Oliveira N & Welch JP: Giant diverticula of the colon: a clinical assessment. Am J Gastroenterol, 92:1092-6, 1997 Jul.

Complications (Diverticulosis)

Complications

Small-bowel diverticulosis is a rare entity that can be discovered incidentally during celiotomy, endoscopy, or radiographic imaging studies. The reported complication rate is low, giving rise to the current recommendation not to treat uncomplicated small-bowel diverticula.

Two hundred eight patients were identified. Diverticula were located in the duodenum in 79 percent; in the jejunum or ileum in 18 percent; and in duodenum, jejunum, and ileum in 3 percent. Complications developed in 42 of the 208 patients (20 percent) including bleeding in 14, diverticulitis with perforation and abscess formation in 12, and malabsorption in 8.

When assessed by location, jejunoileal diverticula were more likely to have complications than duodenal diverticula: 46 percent compared to 13 percent. Bleeding accounted for 52 percent of the duodenal complications compared to 12 percent of the jejunoileal complications. Jejunoileal diverticula were more likely to perforate and develop abscesses.

The low incidence of complications associated with duodenal diverticula justifies a nonoperative approach. The higher complication rate associated with jejunoileal diverticula will be necessary to define that approach more exactly.

Akhrass R et al., Small-bowel diverticulosis: perceptions and reality. J Am Coll Surg, 184:383-8, 1997 Apr.

Maternal Diet

Maternal Diet

Maternal diet may have an effect on the health of the offspring in middle and later life. Examine whether the fibre content of the maternal diet during pregnancy affected subsequent development of colonic diverticula in the offspring fed lifelong fibre deficient or higher fibre diets.

Offspring of rats fed a higher fibre diet from higher fibre diet fed parents had 0% incidence of colonic diverticulosis. When offspring (regardless of parental diet) were fed a low fibre diet for life the acid solubility was lowered compared with rats fed lifelong higher fibre diet; 21% had diverticulosis and there was reduced fibre fermentation.

However, when the diet of the parents of the fibre deficient diet fed rats was considered, the animals whose mothers had a fibre deficient diet had lower acid solubility and an increased incidence of colonic diverticulosis (42%) than the animals fed a fibre deficient diet from higher fibre diet fed parents.

Maternal diet and the subsequent nutrition of the progeny seem to be of importance in the development of colonic diverticulosis in the rat.

Wess L et al., An association between maternal diet and colonic diverticulosis in an animal model [see comments]. Gut, 39:423-7, 1996 Sep.

NSAIDs (Diverticulosis)

NSAIDs

Evaluated the association between nonsteroidal antiinflammatory drug (NSAID) use and upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB).

NSAID use is strongly associated with LGIB and from lesions not considered associated with mucosal ulceration such as diverticulosis.

Wilcox CM Nonsteroidal antiinflammatory drugs are associated with both upper and lower gastrointestinal bleeding. Dig Dis Sci, 42:990-7, 1997 May.

Physical Activity

Physical Activity

The relationship between physical activity and risk of symptomatic diverticular disease has not been investigated directly.

Overall physical activity was inversely associated with the risk of symptomatic diverticular disease. Most of the inverse association was attributable to vigorous activity, for extreme categories.

Several specific activities were inversely associated with the risk of diverticular disease, but jogging and running combined was the only individual activity that was statistically significant. For men in the lowest quintile for dietary fibre intake and total physical activity.

Physical activity, along with a high fibre diet, may be an important factor in the prevention of symptomatic diverticular disease.

Aldoori WH et al., Prospective study of physical activity and the risk of symptomatic diverticular disease in men [see comments]. Gut, 36:276-82, 1995 Feb.

Smoking, Caffeine, and Alcohol

Smoking, Caffeine, and Alcohol

The relationship between smoking, caffeine, and alcohol intake and the risk of symptomatic diverticular disease has not been investigated directly.

Found no association between caffeine, specific caffeinated beverages, and decaffeinated coffee and the risk of symptomatic diverticular disease.

Current smoking was not appreciably associated with risk of symptomatic diverticular disease compared to nonsmokers after adjustment for age, physical activity, and energy-adjusted intake of dietary fiber and total fat. In a subset analysis restricted to men who had undergone sigmoidoscopy or colonoscopy, a modest positive association was seen between smoking and risk of symptomatic diverticular disease.

Results suggest that smoking, caffeine, and alcohol intake are not associated with any substantially increased risk of symptomatic diverticular disease.

Aldoori WH et al., A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men. Ann Epidemiol, 5:221-8, 1995 May.