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International Journal of Molecular... Jun 2022Diverticular disease is a common clinical problem, particularly in industrialized countries. In most cases, colonic diverticula remain asymptomatic throughout life and... (Review)
Review
Diverticular disease is a common clinical problem, particularly in industrialized countries. In most cases, colonic diverticula remain asymptomatic throughout life and sometimes are found incidentally during colonic imaging in colorectal cancer screening programs in otherwise healthy subjects. Nonetheless, roughly 25% of patients bearing colonic diverticula develop clinical manifestations. Abdominal symptoms associated with diverticula in the absence of inflammation or complications are termed symptomatic uncomplicated diverticular disease (SUDD). The pathophysiology of diverticular disease as well as the mechanisms involved in the shift from an asymptomatic condition to a symptomatic one is still poorly understood. It is accepted that both genetic factors and environment, as well as intestinal microenvironment alterations, have a role in diverticula development and in the different phenotypic expressions of diverticular disease. In the present review, we will summarize the up-to-date knowledge on the pathophysiology of diverticula and their different clinical setting, including diverticulosis and SUDD.
Topics: Diverticular Diseases; Diverticulosis, Colonic; Diverticulum, Colon; Humans; Inflammation
PubMed: 35743141
DOI: 10.3390/ijms23126698 -
Journal of Gastrointestinal and Liver... Dec 2019In this session different problems regarding the pathogenesis of diverticular disease were considered, including "Genetics", "Neuromuscular function abnormalities",...
In this session different problems regarding the pathogenesis of diverticular disease were considered, including "Genetics", "Neuromuscular function abnormalities", "Patterns of mucosa inflammation", and "Impact of lifestyle". The patients affected by diverticular disease have clear genetic pattern, that might predispose to the occurrence of the disease as well as to its complications. Neuromuscular abnormalities may be recognized already at the stage of diverticulosis, and inflammation may explain symptoms occurrence in symptomatic uncomplicated diverticular disease (SUDD) or symptoms persistence after an episode of acute diverticulitis. Finally, lifestyle might also have an impact on symptoms' occurrence. Specifically smoking, but also obesity seem to play an important role, while the role of low-fiber diet and constipation is now under debate.
Topics: Colon; Diverticular Diseases; Diverticulum; Gastrointestinal Motility; Genetic Predisposition to Disease; Humans; Life Style; Obesity; Sensation; Sensation Disorders; Smoking
PubMed: 31930230
DOI: 10.15403/jgld-551 -
Minerva Gastroenterologica E Dietologica Mar 2019The incidence of diverticulosis and diverticular disease of the colon is increasing worldwide. Although the majority of patients remains asymptomatic long-life, the... (Review)
Review
The incidence of diverticulosis and diverticular disease of the colon is increasing worldwide. Although the majority of patients remains asymptomatic long-life, the prevalence of diverticular disease of the colon, including acute diverticulitis, is substantial and is becoming a significant burden on National Health Systems in terms of direct and indirect costs. Fiber, non-absorbable antibiotics and probiotics seem to be effective in treating symptomatic and uncomplicated patients, and 5-aminosalicylic acid might help prevent acute diverticulitis. Unfortunately, robust evidence on the effectiveness of a medical strategy to prevent acute diverticulitis recurrence is still lacking. Focus is now being drawn on identifying a new endoscopic classification of the disease to evaluate the correct therapeutic approach by testing various treatments.
Topics: Acute Disease; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Dietary Fiber; Diverticulitis; Diverticulum; Gastrointestinal Agents; Humans; Mesalamine; Primary Prevention; Probiotics; Rifaximin; Secondary Prevention; Terminology as Topic
PubMed: 30293416
DOI: 10.23736/S1121-421X.18.02525-4 -
Current Gastroenterology Reports Jun 2023A distinctive, possibly "novel" form of a segmental inflammatory colonic disease process associated with diverticular disease (so-called SCAD or... (Review)
Review
PURPOSE OF REVIEW
A distinctive, possibly "novel" form of a segmental inflammatory colonic disease process associated with diverticular disease (so-called SCAD or segmental-colitis-associated-diverticulosis) is reviewed.
RECENT FINDINGS
Although this phenotype of inflammatory colonic disease was initially recognized decades ago, mainly in the elderly, recent evidence from long term natural history studies along with meta-analyses confirms that its clinical course is usually benign and drug-responsive. Interestingly, its appearance in some treated with monoclonal agents (eg., ipilimumab associated colitis) or infected with coronavirus-19 may have critical implications for its pathogenesis. This review further explores the implications of recognition of this pattern of colonic inflammatory disease, with relevance for physicians involved in both clinical practice and clinical trials of newer therapeutic agents.
Topics: Humans; Colitis; Diverticulum
PubMed: 37129830
DOI: 10.1007/s11894-023-00871-y -
Annals of the Royal College of Surgeons... Nov 2022We report a rare complication involving a healthy 45-year-old male patient who underwent an emergency laparoscopic appendicectomy for acute perforated gangrenous...
We report a rare complication involving a healthy 45-year-old male patient who underwent an emergency laparoscopic appendicectomy for acute perforated gangrenous appendicitis. The patient was catheterised pre- procedure and the ports were inserted under vision. Upon completion of the procedure, a 15 Fr Robinson drain was left in the pelvis and was fed through the suprapubic port hole. Postoperatively the patient developed worsening, generalised abdominal pain and high output from the drain. The patient was re-catheterised but the computed tomography (CT) cystogram did not show any injury to the bladder. The drain fluid creatinine was noted to be raised (>4,000), indicating that urine was leaking into the drain. Conventional cystogram confirmed a contrast leak from the dome around the drain. Flexible cystoscopy confirmed that the drain had transversed the vesicourachal diverticula. The drain was pulled back and converted to a suprapubic catheter with the patient subsequently being discharged. Vesicourachal diverticula is a rare and often asymptomatic anomaly. When undertaking laparoscopic surgery, precautions should be taken to prevent port site injury such as catheterising the patient to ensure the bladder is empty and inserting the ports under direct vision. It is safer to visualise muscle rather than peritoneum during port insertion. In this case, the bladder diverticula was noticed extraperitoneally. Though the indirect CT cystogram reported no injury, this was unreliable as the bladder was not distended which led to the subtle injury being missed. Traditional cystogram should be considered in cases with a negative CT cystogram and a strong suspicion of bladder injury.
Topics: Male; Humans; Middle Aged; Urinary Bladder; Diverticulum; Urinary Bladder Diseases; Cystoscopy
PubMed: 35446699
DOI: 10.1308/rcsann.2021.0344 -
JAMA Sep 2016
Topics: Diverticulitis; Diverticulum; Humans
PubMed: 27623476
DOI: 10.1001/jama.2016.3592 -
Medicina Clinica Sep 2022
Topics: Cough; Diverticulum; Humans; Lung; Tomography, X-Ray Computed; Tracheal Diseases; Tracheobronchomegaly
PubMed: 35659422
DOI: 10.1016/j.medcli.2022.03.008 -
Minerva Medica Oct 2017The incidence of diverticulosis and diverticular disease (DD) of the colon, including acute diverticulitis, is increasing worldwide, and becoming a significant burden on... (Review)
Review
The incidence of diverticulosis and diverticular disease (DD) of the colon, including acute diverticulitis, is increasing worldwide, and becoming a significant burden on national health systems in terms of direct and indirect costs. Thus, significant efforts are now being focused to identify the correct therapeutic approach to treat symptomatic patients and to prevent diverticulitis. Fiber, non-absorbable antibiotics, 5-aminosalicylic acid and probioticsare currently being investigated in this way. Unfortunately, current evidences on the effectiveness of some medical treatment in preventing acute diverticulitis recurrence are still lacking. The effectiveness and the future perspectives of these treatments are discussed herein.
Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Dietary Fiber; Diverticulum; Humans; Incidence; Italy; Mesalamine; Probiotics; Treatment Outcome
PubMed: 28466633
DOI: 10.23736/S0026-4806.17.05201-6 -
Clinical Gastroenterology and... Nov 2014Zenker's diverticulum (ZD) is an outpouching of tissue through the Killian triangle that is believed to be caused by dysfunction of the cricopharyngeal muscle. ZD is a... (Review)
Review
Zenker's diverticulum (ZD) is an outpouching of tissue through the Killian triangle that is believed to be caused by dysfunction of the cricopharyngeal muscle. ZD is a relatively uncommon disorder occurring in the elderly. The predominant symptom of ZD is dysphagia, and the most serious consequence is pulmonary aspiration. Videofluoroscopy confirms the diagnosis. Therapy of symptomatic ZD has evolved from an open surgical approach to less invasive transoral endoscopic techniques. Transoral endoscopic therapy using rigid instruments is performed primarily by otorhinolaryngologists, whereas transoral therapy using flexible endoscopes is performed by surgical endoscopists and gastroenterologists. The common goal of all modalities is severing of the septum between the esophageal lumen and the diverticulum containing the cricopharyngeal muscle. Although flexible endoscopic therapy was described nearly 20 years ago, it has experienced a recent resurgence paralleling the advancements of therapeutic endoscopy in other areas, such as endoscopic submucosal dissection. Direct head-to-head comparisons of rigid and flexible endoscopic therapy are lacking, and each approach has variations in techniques as well as advantages and disadvantages. In this article, we review the pathophysiology and management of patients with ZD with an emphasis on flexible endoscopic therapy.
Topics: Endoscopy; Humans; Zenker Diverticulum
PubMed: 24055983
DOI: 10.1016/j.cgh.2013.09.016 -
World Journal of Gastroenterology Jan 2024Esophageal intramural pseudodiverticulosis (EIPD) is a disease of unknown pathogenesis characterized by usually systemic, cystic dilatation of the excretory ducts of... (Review)
Review
Esophageal intramural pseudodiverticulosis (EIPD) is a disease of unknown pathogenesis characterized by usually systemic, cystic dilatation of the excretory ducts of esophageal submucosal glands. In this article, I review the epidemiology, clinical manifestations, endoscopic findings, esophagographic findings, and histopathology of EIPD. I also discuss the etiology and possible pathogenesis of EIPD based on my experiences with this disease and a review of the literature. EIPD usually presents with dysphagia in middle-aged individuals. It is often complicated with secondary infections, most commonly candidiasis. On esophagography, EIPD is delineated as small, multiple, flask-shaped outward projections within the esophageal wall. In recent years, EIPD has been mainly diagnosed by endoscopic findings of multiple, localized, small mucosal depressions. The orifices of the "pseudodiverticula" periodically open and close, and excrete mucus onto the mucosal surface. On histopathological examination, the luminal surface of dilated ducts in EIPD is covered by multilayered, hyperplastic epithelial cells, but myoepithelial cells in the glandular acini are well preserved. Treatment of EIPD is usually symptomatic therapy, and prevention of the infectious complications is important. The etiology and pathogenesis of EIPD are largely unknown, but functional abnormalities of autonomic nerve fibers innervating the esophageal glands likely play an important role, since the structures of the glands are basically preserved in this disease.
Topics: Middle Aged; Humans; Diverticulum, Esophageal; Deglutition Disorders; Diverticulum; Mucous Membrane; Esophageal Stenosis
PubMed: 38312118
DOI: 10.3748/wjg.v30.i2.137