Skip to main content

Advertisement

SpringerLink
Log in

Low frequency of polyps in colonic regions with diverticulosis

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Conflicting evidence exists regarding any association between diverticulosis and adenomatous polyps. We evaluated the prevalence of polyps and cancer in colonic regions containing diverticula.

Methods

Six hundred consecutive colonoscopy reports from a single endoscopist were reviewed to determine prevalence and location of diverticulosis and polyps. Additionally, pathology reports of 88 colon cancer resection specimens were reviewed for the presence of diverticulosis, and compared with expected prevalence of diverticulosis in that colonic region based on the collected colonoscopy data.

Results

Overall, rates of detected polyps were comparable between patients with and without diverticulosis. However, analyzing the data by colonic segment containing diverticulosis, the prevalence of adenomatous polyps was reduced in regions of diverticulosis compared to the same colonic segment unaffected by diverticulosis (7 vs. 17% for rectosigmoid (p = 0.005); 5 vs. 18% for descending (p < 0.0001); and 17 vs. 27% for ascending colon (p = 0.0495)). Among colon cancer resection specimens, the prevalence of diverticulosis was significantly reduced in the rectosigmoid and ascending colon, compared with expected rates of diverticulosis in those regions. (13 vs. 42% in rectosigmoid (p = 0.0006); 3 vs. 17% in ascending colon (p = 0.043)).

Conclusion

Despite similar overall frequency of polyps in patients with and without diverticulosis, polyps were significantly less likely in the colonic segment affected by diverticulosis. Additionally, the frequency of diverticulosis in areas of cancer in the rectosigmoid and ascending colon was significantly lower than expected compared with the expected frequency of diverticulosis for those colonic regions. These observations suggest a true negative association between colonic neoplasia and diverticulosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Painter NS, Burkitt DP (1971) Diverticular disease of the colon: a deficiency disease of Western civilization. Br Med J 2(5759):450–454

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Parks TG (1975) Natural history of diverticular disease of the colon. Clin Gastroenterol 4(1):53–69

    CAS  PubMed  Google Scholar 

  3. Hirata T, Kawakami Y, Kinjo N, Arakaki S, Arakaki T, Hokama A, Kinjo F, Fujita J (2008) Association between colonic polyps and diverticular disease. World J Gastroenterol 14(15):2411–2413

    Article  PubMed  PubMed Central  Google Scholar 

  4. 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(9):1323–1329. https://doi.org/10.3346/jkms.2010.25.9.1323

    Article  PubMed  PubMed Central  Google Scholar 

  5. Loffeld RJ, Van Der Putten AB (2002) Diverticular disease of the colon and concomitant abnormalities in patients undergoing endoscopic evaluation of the large bowel. Color Dis 4(3):189–192

    Article  Google Scholar 

  6. Morini S, de Angelis P, Manurita L, Colavolpe V (1988) Association of colonic diverticula with adenomas and carcinomas. A colonoscopic experience. Dis Colon rectum 31(10):793–796

  7. Muhammad A, Lamendola O, Daas A, Kumar A, Vidyarthi G (2014) Association between colonic diverticulosis and prevalence of colorectal polyps. Int J Color Dis 29(8):947–951. https://doi.org/10.1007/s00384-014-1908-9

    Article  Google Scholar 

  8. 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 Color Dis 23(10):979–984. https://doi.org/10.1007/s00384-008-0510-4

    Article  CAS  Google Scholar 

  9. 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(12):1694–1697. https://doi.org/10.1038/ajg.2015.359

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L (2007) Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 132(1):96–102. https://doi.org/10.1053/j.gastro.2006.10.027

    Article  PubMed  Google Scholar 

  11. Singh S, Singh PP, Murad MH, Singh H, Samadder NJ (2014) Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis. Am J Gastroenterol 109(9):1375–1389. https://doi.org/10.1038/ajg.2014.171

    Article  PubMed  Google Scholar 

  12. Kieff BJ, Eckert GJ, Imperiale TF (2004) Is diverticulosis associated with colorectal neoplasia? A cross-sectional colonoscopic study. Am J Gastroenterol 99(10):2007–2011. https://doi.org/10.1111/j.1572-0241.2004.30332.x

    Article  PubMed  Google Scholar 

  13. Krones CJ, Klinge U, Butz N, Junge K, Stumpf M, Rosch R, Hermanns B, Heussen N, Schumpelick V (2006) The rare epidemiologic coincidence of diverticular disease and advanced colonic neoplasia. Int J Color Dis 21(1):18–24. https://doi.org/10.1007/s00384-005-0742-5

    Article  CAS  Google Scholar 

  14. Lee SJ, Kim SA, BH K, Kim HY, Kim JY, Chang DK, Son HJ, Shim SG, Rhee PL, Kim JJ, Rhee JC, Kim YH (2012) Association between colorectal cancer and colonic diverticulosis: case-control study based on computed tomographic colonography. Abdom Imaging 37(1):70–73. https://doi.org/10.1007/s00261-011-9743-8

    Article  CAS  PubMed  Google Scholar 

  15. Bersentes K, Fennerty MB, Sampliner RE, Garewal HS (1997) Lack of spontaneous regression of tubular adenomas in two years of follow-up. Am J Gastroenterol 92(7):1117–1120

    CAS  PubMed  Google Scholar 

  16. Jenkins DJ, Jenkins AL, Wolever TM, Rao AV, Thompson LU (1986) Fiber and starchy foods: gut function and implications in disease. Am J Gastroenterol 81(10):920–930

    CAS  PubMed  Google Scholar 

  17. Stollman NH, Raskin JB (1999) Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 94(11):3110–3121. https://doi.org/10.1111/j.1572-0241.1999.01501.x

    Article  CAS  PubMed  Google Scholar 

  18. Stefansson T, Ekbom A, Sparen P, Pahlman L (1993) Increased risk of left sided colon cancer in patients with diverticular disease. Gut 34(4):499–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Lawrence Brandt for the critical review and evaluation of the manuscript. Additionally, the authors thank Dr. Jaun Lin for the help with data analysis.

Author information

Authors and Affiliations

  1. Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA

    Irving Levine

  2. MedStar Georgetown University Hospital, Washington, DC, 20007, USA

    Amol S. Rangnekar

  3. Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Aaron Z. Tokayer

Authors
  1. Irving Levine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amol S. Rangnekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aaron Z. Tokayer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Irving Levine.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Performed in Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, Bronx NY.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Levine, I., Rangnekar, A.S. & Tokayer, A.Z. Low frequency of polyps in colonic regions with diverticulosis. Int J Colorectal Dis 32, 1597–1602 (2017). https://doi.org/10.1007/s00384-017-2895-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-017-2895-4

Keywords

Search

Navigation