Advertisement

International Journal of Colorectal Disease

, Volume 33, Issue 9, pp 1277–1283 | Cite as

Ulcerative colitis and the aging-related development of colonic diverticula

  • Riccardo Nascimbeni
  • Silvia Casiraghi
  • Rosanna Cannatelli
  • Francesco Lanzarotto
  • Claudio Casella
  • Chiara Ricci
  • Vincenzo Villanacci
  • Nazario Portolani
  • Dario Moneghini
Original Article
  • 100 Downloads

Abstract

Purpose

Aim of this observational case-control study was to assess the prevalence, features, and risk factors of colonic diverticula in patients with ulcerative colitis (UC).

Methods

The data of 896 UC patients aged ≥ 30 years from Brescia IBD database were retrospectively analyzed. Individuals with colonic diverticula were identified and prevalence was compared with that of control patients undergoing screening colonoscopy after gender/age matching. A nested cohort study was then conducted among UC patients in order to define eventual association of diverticula with specific clinico-pathologic parameters.

Results

Prevalence of subjects with diverticula was 11.4% among 465 UC patients aged 49 years and older, significantly lower than 35.1% prevalence in control patients of same age and gender (p < 0.001). Advancing age was a significant risk factor for diverticula development in both groups. Among UC patients, a short duration and a late onset of UC were both significantly associated to the presence of diverticula. Moreover, UC patients with diverticula had a significantly lower frequency of flares per year, even if maximal flare severity and frequency of hospital admission were similar to those of subjects without diverticula. UC patients with diverticula had a trend toward more frequent extension of UC to the left colon, possibly because of their older age. The majority of those patients had few sigmoid diverticula without symptoms.

Conclusions

Development of colonic diverticula is substantially reduced in patients with UC, markedly among those with an early onset, a long history of inflammatory disease, and a high flare frequency. This study reinforces the hypothesis sustaining a protective role of UC against colonic diverticula.

Keywords

Ulcerative colitis Colonic diverticula Diverticular disease Natural history of ulcerative colitis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Cosnes J, Gower-Rousseau C, Seksik P, Cortot A (2011) Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 140:1785–1794.  https://doi.org/10.1053/j.gastro.2011.01.055 CrossRefPubMedGoogle Scholar
  2. 2.
    Rispo A, Pasquale L, Cozzolino A, Di Girolamo E, De Palma GD, Grassia R, Compagna A, Chierchia MR, Castiglione F (2007) Lower prevalence of diverticulosis in patients with ulcerative colitis. Dis Colon Rectum 50:1164–1168.  https://doi.org/10.1007/s10350-007-0218-5 CrossRefPubMedGoogle Scholar
  3. 3.
    Lahat A, Avidan B, Bar-Meir S, Chowers Y (2007) Long-standing colonic inflammation is associated with a low prevalence of diverticuli in inflammatory bowel disease patients. Inflamm Bowel Dis 13:733–736.  https://doi.org/10.1002/ibd.20065 CrossRefPubMedGoogle Scholar
  4. 4.
    Cassieri C, Pica R, Avallone EV, Zippi M, Crispino P, De Nitto D, Paoluzi P, Brandimarte G, Lecca PG, Elisei W, Picchio M, Tursi A (2016) Prevalence of colonic diverticulosis in patients affected by ulcerative colitis: a prospective study. J Clin Gastroenterol 50(Suppl 1):S33–S35.  https://doi.org/10.1097/MCG.0000000000000631 CrossRefPubMedGoogle Scholar
  5. 5.
    Kinnucan TJ, Tomal J, Rubin DT (2015) U.S. patients with ulcerative colitis do not have a decreased risk of diverticulosis. Inflamm Bowel Dis 21:2154–2147.  https://doi.org/10.1097/MIB.0000000000000467 CrossRefPubMedGoogle Scholar
  6. 6.
    Magro F, Langner C, Driessen A, Ensari A, Geboes K, Mantzaris GJ, Villanacci V, Becheanu G, Borralho Nunes P, Cathomas G, Fries W, Jouret-Mourin A, Mescoli C, de Petris G, Rubio CA, Shepherd NA, Vieth M, Eliakim R, European Society of Pathology (ESP); European Crohn’s and Colitis Organisation (ECCO) (2013) European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis 7:827–851.  https://doi.org/10.1016/j.crohns.2013.06.001 CrossRefPubMedGoogle Scholar
  7. 7.
    Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006) The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 55:749–753.  https://doi.org/10.1136/gut.2005.082909 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sultan K, Fields S, Panagopoulos G, Korelitz BI (2006) The nature of inflammatory bowel disease in patients with coexistent colonic diverticulosis. J Clin Gastroenterol 40:317–321.  https://doi.org/10.1097/01.mcg.0000210095.44123.6d CrossRefPubMedGoogle Scholar
  9. 9.
    Strate LL, Modi R, Cohen E, Spiegel BM (2012) Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights. Am J Gastroenterol 107:1486–1493.  https://doi.org/10.1038/ajg.2012.194 CrossRefPubMedGoogle Scholar
  10. 10.
    Bassotti G, Battaglia E, Spinozzi F, Pelli MA, Tonini M (2001) Twenty-four hour recordings of colonic motility in patients with diverticular disease: evidence for abnormal motility and propulsive activity. Dis Colon Rectum 44:1814–1820CrossRefPubMedGoogle Scholar
  11. 11.
    Bassotti G, Antonelli E, Villanacci V, Baldoni M, Dore MP (2014) Colonic motility in ulcerative colitis. United European Gastroenterol J 2:457–462.  https://doi.org/10.1177/2050640614548096 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Reddy SN, Bazzocchi G, Chan S, Akashi K, Villanueva-Meyer J, Yanni G, Mena I, Snape WJ Jr (1991) Colonic motility and transit in health and ulcerative colitis. Gastroenterology 101:1289–1297CrossRefPubMedGoogle Scholar
  13. 13.
    Rieder F, Fiocchi C, Rogler G (2017) Mechanisms, management, and treatment of fibrosis in patients with inflammatory bowel diseases. Gastroenterology 152:340–350.  https://doi.org/10.1053/j.gastro.2016.09.047 CrossRefPubMedGoogle Scholar
  14. 14.
    de Bruyn JR, Meijer SL, Wildenberg ME, Bemelman WA, van den Brink GR, D’Haens GR (2015) Development of fibrosis in acute and longstanding ulcerative colitis. J Crohns Colitis 9:966–972.  https://doi.org/10.1093/ecco-jcc/jjv133 CrossRefPubMedGoogle Scholar
  15. 15.
    Gordon IO, Agrawal N, Willis E, Goldblum JR, Lopez R, Allende D, Liu X, Patil DY, Yerian L, El-Khider F, Fiocchi C, Rieder F (2018) Fibrosis in ulcerative colitis is directly linked to severity and chronicity of mucosal inflammation. Aliment Pharmacol Ther 6:922–939.  https://doi.org/10.1111/apt.14526 CrossRefGoogle Scholar
  16. 16.
    Ananthakrishnan AN, Shi HY, Tang W, Law CC, Sung JJ, Chan FK, Ng SC (2016) Systematic review and meta-analysis: phenotype and clinical outcomes of older-onset inflammatory bowel disease. J Crohns Colitis 10:1224–1236.  https://doi.org/10.1093/ecco-jcc/jjw054 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Riccardo Nascimbeni
    • 1
    • 2
  • Silvia Casiraghi
    • 1
  • Rosanna Cannatelli
    • 3
  • Francesco Lanzarotto
    • 4
  • Claudio Casella
    • 1
  • Chiara Ricci
    • 3
  • Vincenzo Villanacci
    • 5
  • Nazario Portolani
    • 6
  • Dario Moneghini
    • 7
  1. 1.General Surgery, Dipartimento di Medicina Molecolare e TraslazionaleUniversità di BresciaBresciaItaly
  2. 2.Chirurgia Generale 3, ASST Spedali Civili BresciaUniversità di BresciaBresciaItaly
  3. 3.Gastroenterology, Dipartimento di Scienze Cliniche e SperimentaliUniversità di BresciaBresciaItaly
  4. 4.Gastroenterology, ASST Spedali Civili di BresciaBresciaItaly
  5. 5.Pathology, ASST Spedali Civili di BresciaBresciaItaly
  6. 6.Clinical Surgery, Dipartimento di Scienze Cliniche e SperimentaliUniversità di BresciaBresciaItaly
  7. 7.Endoscopy, ASST Spedali Civili di BresciaBresciaItaly

Personalised recommendations