Diverticulosis, Symptoms and Colonic Inflammation: A Population-Based Colonoscopy Study.

INTRODUCTION: Low-grade chronic inflammation has been suggested to play a role in uncomplicated asymptomatic and symptomatic diverticular disease. However, population-based studies are lacking. We investigated whether community participants with diverticulosis, with or without symptoms, would have colonic inflammation on histology and serology. METHODS: In a nested case-control study of 254 participants from the population-based colonoscopy (PopCol) study, colonic histological inflammatory markers and serological C-reactive protein levels were analyzed in cases with diverticulosis and controls without diverticulosis. Statistical methods included logistic and linear regression models. RESULTS: Background variables including age (P = 0.92), sex (P = 1.00), body mass index (P = 0.71), smoking (P = 0.34), and recent antibiotic exposure (P = 0.68) were similar between cases and controls. Cases reported more abdominal pain (P = 0.04) and diarrhea symptoms (mushy and high-frequency stools) than controls (P = 0.01 and P = 0.03, respectively) but were otherwise similar. The median C-reactive protein levels were similar among cases and controls [1.05 mg/L (0.3, 2.7) vs 0.8 (0.4, 2.2), P = 0.53]. There was a trend of increased numbers of cecal lymphoid aggregates in cases vs controls (P = 0.07), but no other associations between diverticulosis and inflammatory markers on histology were found. Similarly, no serological or mucosal inflammation was associated with symptomatic cases of diarrhea or abdominal pain vs asymptomatic controls. CONCLUSIONS: In a general community sample, both asymptomatic and symptomatic diverticulosis are not associated with colonic mucosal inflammation. Other explanations for symptomatic colonic diverticulosis need to be identified.

A case of diverticular colitis with lesions resembling ulcerative colitis and correlation of tumor necrosis factor-alpha staining with clinical manifestations.

A 45-year-old male with a 3-month history of abdominal pain and melena underwent colonoscopy (CS) at our hospital in May 2009. He was diagnosed with diverticular colitis based on findings of redness around diverticula in the sigmoid colon and biopsy findings of non-specific inflammation. The second CS, which was performed in July 2009 to investigate relapse, showed diffuse redness around diverticula in the sigmoid colon. As seen in active ulcerative colitis (UC), the formation of crypt abscesses was observed in the biopsy. Although the patient was making satisfactory progress after administration of oral mesalazine, CS was performed again in September 2011 because of recurrence of melena, which revealed redness and erosion around diverticula in the ascending and sigmoid colon. Biopsy findings were similar to those of active UC. Immunohistochemical staining of the biopsy specimen with anti-tumor necrosis factor (TNF)-a antibody showed 80 % of lymphocytes were positive for TNF-a compared with 20 % at the first biopsy. The patient's symptoms subsided with an increase in the dose of mesalazine and concurrent administration of prednisolone at 10 mg. He has remained on oral mesalazine and is currently asymptomatic. The findings of this study suggested a correlation between clinical manifestations and the proportion of TNF-a-positive lymphocytes.

[Inflammatory nature of colon diverticula].

On the basis of morphological and immunological study of biopsies of the colon in patients with diverticulosis was revealed that microscopic inflammation of the mouth of the diverticulum is characterized by several features that include excessive proliferation of the epithelium, the predominance of macrophage reaction in the development of the immune response, increased cell adhesion and unusual ratio between the expression of cytokines and other regulatory molecules. Changes in the structure of the formed diverticula tissue are associated with dysregulation of many processes of tissue metabolism and morphogenesis. These include the dysregulation of cell renewal of the epithelium (increased level of proliferation of epithelial cells and inhibition of apoptosis), degradation of extracellular matrix components, moderate vascular reaction. All these processes take place on the background a particular form of immune protection and adaptation mechanisms.

[Etiology and pathogenesis of diverticular disease of the colon].

The article presents the literature on the etiology and pathogenesis of diverticular disease, a comparison of opposing points of view are presented results of their research.

Prospective randomized study on perioperative enteral immunonutrition in laparoscopic colorectal surgery.

BACKGROUND: Perioperative nutrition for patients undergoing colon surgery seems to be effective in reducing catabolism and improving immunologic parameters. A relatively low-fiber and highly absorbable diet may facilitate the intestinal cleansing and loop relaxation fundamental for laparoscopic surgery with a lower dose of iso-osmotic laxative. METHODS: From 1 February 2004 to 30 July 2005, 28 patients referred to our unit with colon disease (neoplasms and diverticular disease) amenable to laparoscopic surgery were prospectively randomized into two groups of 14 patients each. For 6 days preoperatively, the patients in group 1 were given 750 ml/day of a diet enriched with arginine, omega-3 fatty acids, and ribonucleic acid (RNA) associated with low-fiber foods. They had 1 day of intestinal preparation with 3 l of iso-osmotic laxative. On postoperative day 2, they were fed orally with the same diet. The patients in group 2 preoperatively received a low-fiber diet. They had 2 days of preparation with iso-osmotic laxative (3 l/day). On postoperative day 3, oral nutrition was restored. Intraoperatively, we evaluated loop relaxation and intestinal cleanliness. Clinical trends were monitored in both groups, as well as adverse reactions to early nutrition. The nutritional (albumin, prealbumin) and immunologic (lymphocyte subpopulations, immunoglobulins) biohumoral parameters were evaluated at the first visit, on the day before surgery, on postoperative day 7, and 1 month after surgery. RESULTS: The two groups did not differ in terms of age, gender, distribution of disease, or baseline anthropometric, biohumoral, or immunologic parameters. There was a significant increase in CD4 lymphocytes on the day before surgery as compared with baseline parameters (p < 0.05) in group 1, but not in group 2. There was no statistically significant difference between the two groups in intestinal loop relaxation or cleanliness or in postoperative infectious complications. CONCLUSIONS: Perioperative immunonutrition proved to be safe and useful in increasing the perioperative immunologic cell response. It may contribute toward improving the preparation and relaxation of the intestinal loops despite the shorter intestinal preparation.

In vitro anticolon antibody production by mucosal or peripheral blood lymphocytes from patients with ulcerative colitis.

Serum anticolon antibody and in vitro anti-colon antibody production by peripheral blood and mucosal lymphocytes was investigated in patients with ulcerative colitis. The frequency of serum anticolon antibody was 71% in 41 patients with ulcerative colitis, estimated by enzyme linked immunosorbent assay (ELISA) using isolated rat colon epithelial cells. This finding confirms our previous report on the frequency of serum anticolon antibody detected by flow cytometry analysis. The estimated frequencies of IgG anticolon antibody secreting cells were 1.5-12.5/10(6) cells in the colonic mucosa and 0.1-0.5/10(6) cells in peripheral blood, from patients with ulcerative colitis when Epstein-Barr virus (EBV) was used as a B cell polyclonal activator. Poisson analysis of limiting dilution culture showed that about one per 140 IgG cells in the colonic mucosa synthesised anticolon antibody. Two monoclonal IgG antibodies were obtained from EBV transformed anticolon antibody secreting cells by limiting dilution method. One reacted with goblet cells in the intestine, and the other reacted mainly with colonic epithelial cells. These results suggest that heterogeneous anticolon antibodies are present in patients with ulcerative colitis and that colonic mucosa may be the main source of anticolon antibody. Local autoimmune reaction might have an important role in causing the inflammation of colonic mucosa in this disease.

Carcinoembryonic antigen in an unselected elderly population: a four year follow up.

Sera obtained in 1969 from 956 unselected elderly persons in Busselton, Western Australia were tested for carcinoembryonic antigen (CEA) by a "double antibody" microradioimmunoassay. Forty-four (4-5%) were positive for CEA (5 ng/ml or greater). Review of health records for the 4-year period subsequent to accession of sera showed that 6 (14%) of the 44 persons positive for CEA died of CEA associated cancers, 15 were heavy smokers, 2 had colonic diverticula and 1 a peptic ulcer. On the other hand, 18 (2%) of the 912 persons negative for CEA developed CEA associated cancers. Thus, a significantly greater proportion of cancers (P = 0-01) was found in the persons positive for CEA. Furthermore, when 21 persons who were positive for CEA in 1969, but clinically well 4 years later, were examined 2 had occult cancer of lung and colon respectively. However, the relatively low yield of diagnosis of cancer from our present population survey led to the conclusion that, if screening for cancer were to be solely dependent on testing for CEA, increased specificity and sensitivity of test systems should be awaited.