Etiology and Pathophysiology of Diverticular Disease

Diverticular disease is prevalent in Western countries and yet its pathogenesis remains poorly understood. The common theories of the cause of diverticular disease have focused on colonic motility, the structural aspects of the colonic wall, and the role of dietary factors, particularly fiber.

KEYWORDS

Diverticular disease - segmentation - elastosis - colonic motility

REFERENCES

• 1 Finney J MT. Diverticulitis and its surgical treatment.  Proc Interstate Post-Grad Med Assembly North Am. 1928;  55 57-65
• 2 Graser E. Das falsche Darmdivertikel.  Arch klin Chir. 1899;  59 638-647
• 3 Beer E. Some pathological and clinical aspects of acquired (false) diverticula of the intestine.  Am J Med Sci. 1904;  128 135-145
• 4 Parks T G. Natural history of diverticular disease of the colon: a review of 521 cases.  BMJ. 1969;  4 639-645
• 5 Hughes L E. Postmortem survey of diverticular disease of the colon. II. The muscular abnormality of the sigmoid colon.  Gut. 1969;  10 344-351
• 6 Boles Jr R S, Jordan S M. The clinical significance of diverticulosis.  Gastroenterology. 1958;  35 579-582
• 7 Zollinger R W. The prognosis in diverticulitis of the colon.  Arch Surg. 1968;  97 418-422
• 8 Rodkey G V, Welch C E. Changing patterns in the surgical treatment of diverticular disease.  Ann Surg. 1984;  200 466-478
• 9 Nakada I, Ubukata H, Goto Y et al.. Diverticular disease of the colon at a regional general hospital in Japan.  Dis Colon Rectum. 1995;  38 755-759
• 10 Chia J G, Wilde C C, Ngoi S S, Goh P M, Ong C L. Trends of diverticular disease of the large bowel in a newly developed country.  Dis Colon Rectum. 1991;  34 498-501
• 11 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;  27 531-537
• 12 Slack W W. The anatomy, pathology and some clinical features of diverticulitis of the colon.  Br J Surg. 1962;  50 185-190
• 13 Meyers M A, Volberg F, Katzen B, Alonso D, Abbott G. The angioarchitecture of colonic diverticula. Significance in bleeding diverticulosis.  Radiology. 1973;  108 249-261
• 14 Morson B C. The muscle abnormality in diverticular disease of the colon.  Proc R Soc Med. 1963;  56 798-800
• 15 Whiteway J, Morson B C. Elastosis in diverticular disease of the sigmoid colon.  Gut. 1985;  26 258-266
• 16 Hughes L E. Postmortem survey of diverticular disease of the colon. I. Diverticulosis and diverticulitis.  Gut. 1969;  10 336-344
• 17 Wess L, Eastwood M A, Wess T J, Busuttil A, Miller A. Cross-linking of collagen is increased in colonic diverticulosis.  Gut. 1995;  37 91-94
• 18 Cook J M. Spontaneous perforation of the colon: report of two cases in a family exhibiting Marfan’s stigmata.  Ohio State Med J. 1968;  64 73
• 19 Beighton P H, Murdoch J L, Votteler T. Gastrointestinal complications of the Ehlers-Danlos syndrome.  Gut. 1969;  10 1004-1008
• 20 Painter N S, Truelove S C, Ardran G M, Tuckey M. Segmentation and the localization of intraluminal pressures in the human colon, with special reference to the pathogenesis of colonic diverticula.  Gastroenterology. 1965;  49 169-177
• 21 Painter N A. 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
• 22 Parks T G, Connell A M. Motility studies in diverticular disease of the colon.  Gut. 1969;  10 534-542
• 23 Taylor I, Duthie H L. Bran tablets and diverticular disease.  BMJ. 1976;  1 988-990
• 24 Snape Jr W J, Carlson G M, Cohen S. Colonic myoelectrical activity in the irritable bowel syndrome.  Gastroenterology. 1976;  70 326-330
• 25 Taylor I, Darby C, Hammond P. Comparisons of rectosigmoid myoelectrical activity in the irritable colon syndrome during relapses and remissions.  Gut. 1978;  19 923-929
• 26 Parks T G. Rectal and colonic studies after resection of the sigmoid for diverticular disease.  Gut. 1970;  11 121-125
• 27 Trotman I F, Misiewicz J J. Sigmoid motility in diverticular disease and the irritable bowel syndrome.  Gut. 1988;  29 218-222
• 28 Bassotti G, Battaglia E, Spinozzi F, Pelli M A, 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
• 29 Katschinski M, Lederer P, Ellermann A, Ganzleben R, Lux G, Arnold R. Myoelectric and manometric patterns of human rectosigmoid colon in irritable bowel syndrome and diverticulosis.  Scand J Gastroenterol. 1990;  25 761-768
• 30 Milner P, Crowe R, Kamm M A, Lennard-Jones J E, Burnstock G. Vasoactive intestinal polypeptide levels in sigmoid colon in idiopathic constipation and diverticular disease.  Gastroenterology. 1990;  99 666-675
• 31 Painter N A, Burkitt D P. Diverticular disease of the colon: a deficiency disease of Western civilization.  BMJ. 1971;  2 450-454
• 32 Mendeloff A I. A critique of “fiber deficiency”.  Am J Dig Dis. 1976;  21 109-112
• 33 Fisher N, Berry C S, Fearn T, Gregory J A, Hardy J. Cereal dietary fiber consumption and diverticular disease: a lifespan study in rats.  Am J Clin Nutr. 1985;  42 788-804
• 34 Findlay J M, Smith A N, Mitchell W D, Anderson A J, Eastwood M A. Effects of unprocessed bran on colon function in normal subjects and in diverticular disease.  Lancet. 1974;  1 146-149
• 35 Manousos O, Day N E, Tzonou A. Diet and other factors in the aetiology of diverticulosis: an epidemiological study in Greece.  Gut. 1985;  26 544-549
• 36 Aldoori W H, Giovannucci E L, Rimm E B, Wing A L, Trichopoulos D V, Willett W C. A prospective study of diet and the risk of symptomatic diverticular disease in men.  Am J Clin Nutr. 1994;  60 757-764
• 37 Heaton K W, Thompson W G. Exercise and diverticular disease.  BMJ. 1995;  310 1332
• 38 Aldoori W H, Giovannuci E L, Rimm E B, Wing A L, Trichopoulos D V, Willett W C. A prospective study of alcohol, smoking, caffeine and the risk of symptomatic diverticular disease in men.  Ann Epidemiol. 1995;  5 221-228
• 39 Papagrigoriadis S, Macey L, Bourantas N, Rennie J A. Smoking may be associated with complications in diverticular disease.  Br J Surg. 1999;  86 923-926
• 40 Campbell K, Steele R J. Non-steroidal anti-inflammatory drugs and complicated diverticular disease: a case-control study.  Br J Surg. 1991;  78 190-191
• 41 Goh H, Bourne R. Non-steroidal anti-inflammatory drugs and perforated diverticular disease: a case-control study.  Ann R Coll Surg Engl. 2002;  84 93-96
• 42 Aldoori W H, Giovannucci E L, Rimm E B, Wing A L, Willett W C. Use of acetaminophen and nonsteroidal anti-inflammatory drugs: a prospective study of the risk of symptomatic diverticular disease in men.  Arch Fam Med. 1998;  7 255-260
• 43 Corder A. Steroids, non-steroidal anti-inflammatory drugs, and serious septic complications of diverticular disease.  Br Med J (Clin Res Ed). 1987;  295 1238
• 44 Wilson R G, Smith A N, Macintyre I M. Complications of diverticular disease and non-steroidal anti-inflammatory drugs: a prospective study.  Br J Surg. 1990;  77 1103-1104
• 45 Wald A, Back C, Bayless T M. Effect of caffeine on the human small intestine.  Gastroenterology. 1976;  71 738-742
• 46 Simpson J, Spiller R C. Colonic diverticular disease.  Clin Evid. 2002;  7 398-405
• 47 Simpson J, Scholefield J H, Spiller R C. Origin of symptoms in diverticular disease.  Br J Surg. 2003;  90 899-908
• 48 Shepherd N A. Diverticular disease and chronic idiopathic inflammatory bowel disease: associations and masquerades.  Gut. 1996;  38 801-802
• 49 Makapugay L M, Dean P J. Diverticular disease-associated chronic colitis.  Am J Surg Pathol. 1996;  20 94-102
• 50 Gledhill A, Dixon M F. Crohn’s-like reaction in diverticular disease.  Gut. 1998;  42 392-395
• 51 Gore S, Shepherd N A, Wilkinson S P. Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance.  Int J Colorectal Dis. 1992;  7 76-81
• 52 Imperiali G, Meucci G, Alvisi C et al.. Segmental colitis associated with diverticula: a prospective study. Gruppo di Studio per le Mallattie Infiammatorie Intestinali (GSMII).  Am J Gastroenterol. 2000;  95 1014-1016
• 53 Horgan A F, McConnell E J, Wolff B G, The S, Paterson C. Atypical diverticular disease: surgical results.  Dis Colon Rectum. 2001;  44 1315-1318
• 54 Simpson J, Haji-Suyoi A, Jenkins D, Scholefield J H, Spiller R C. Quantification of neurological changes in resection specimens with complicated and uncomplicated diverticular disease.  Gastroenterology. 2002;  122 A314
• 55 Stead R H. Nerve remodelling during intestinal inflammation.  Ann N Y Acad Sci. 1992;  664 443-455
• 56 Brewer D B, Thompson H, Haynes I G, Alexander-Williams J. Axonal damage in Crohn's disease is frequent, but non-specific.  J Pathol. 1990;  161 301-311