[Colorectal neo- and dysplasia in acromegaly].

Colorectal disorders can be not only an independent disease, but also manifestation of acromegaly--a neuroendocrine disease which is characterized by chronic pathological hypersecretion of the growth hormone (GH) and the increased concentration of insulino-like growth factor type 1 (IGF-1). In clinical recommendations on diagnosis and treatment of acromegaly, colonic polyps are marked as one of most pathognomonic manifestations of acromegaly. Prevalence of coloni polyps in acromegalic is 2,5-3 times higher than in the general population. Moreover, frequency of diverticula and dolichocolon is increased in patients with acromegaly compared with general population (in 3,6 and 12 times, accordingly). Colorectal cancer incidence with a tendency to more aggressive current is also increased (by 4,4 times). When these colonic diseases is diagnosed, especially in patients of young age, it is necessary to define the IGF-1 blood level as the first stage of acromegaly identification. If diagnosis of acromegaly is confirmed, gastroenterologist with endocrinologist together should direct treatment on correction of intestinal pathology as well as on achievement of the biochemical control over acromegaly.

[Anti-recurrent treatment of colon diverticulitis].

The article presents the recent data of individual studies and meta-analyses of the frequency of relapses after one, two or more episodes of acute colon diverticulitis, lits different opinions about the predictors of the recurrent course of the disease. The bigger part of the article is devoted to the analysis of the results of different variants of anti-recurrent treatment of diverticulitis with the assessment of the effectiveness of therapy, with the conclusion that today the problem of the most effective method of treatment exists.

Pathophysiology and prevention of diverticulitis and perforation.

OBJECTIVE: This article gives an overview of the current evidence and theories in the pathophysiology of diverticulosis, diverticulitis and perforation and discusses its prevention. BACKGROUND: Diverticular disease is one of the most common diseases related to the gastrointestinal tract in Western countries. The pathogenesis of this disease process is probably multifactorial, but remains poorly understood and inadequately investigated. METHODS: A literature search was performed in order to give an overview of the current evidence and theories in the pathophysiology of diverticula formation and the factors related to progression towards inflammation and even perforation. Strategies for prevention of (perforated) diverticulitis are also discussed. RESULTS/CONCLUSION: The pathogenesis of diverticular disease and its complications seems to be a result of a complex interaction between exposure to a low-fibre diet, possible genetic influences, the coexistence of other bowel diseases and the impact of medicine use. This eventually leads to alterations in colonic pressures and motility and structural changes of the colon wall. Unfortunately the evidence is frequently conflicting in the present literature or lacking altogether.

[Dietary fibre: more than a matter of dietetics. II. Preventative and therapeutic uses]. / Ballaststoffe: Mehr als ein Diätmittel. II. Präventive und therapeutische Anwendungen.

A nutrition rich in fibre has a preventive effect against constipation, colon diverticulosis, carcinoma of the large bowel and stomach, type 2-diabetes, metabolic syndrome and cardiovascular disease. In case of constipation, diverticulosis and diabetes this effect solely depends on dietary fibre. Regarding carcinomas and cardiovascular diseases, so far unknown factors integrated in or associated with fibre-rich food may also contribute to the preventive effect. Therapy with dietary fibre is indicated for constipation, colon diverticulosis, diarrhea, diabetes, and hypercholesterinemia. The individual dietary fibres differ substance-specifically. Food-integrated dietary fibre such as whole-grain bread, vegetables and fruit have their place in prevention. Dietary fibre preparations such as wheat bran, flax seed or sugar-beet fibre are useful in the treatment of constipation, colon diverticulosis and adiposity. Oat bran is preferentially used in hypercholesterinemia. Purified dietary fibres such as cellulose, guar, psyllium, and beta-glucan have an anti-diabetic, all viscous fibres an anti-lipaemic effect. The therapeutic dosages of dietary fibre preparations are 20-40 g/day and of purified fibres substances 10-20 g/day respectively.

Do calcium channel blockers and antimuscarinics protect against perforated colonic diverticular disease? A case control study.

BACKGROUND: The aetiology of perforated colonic diverticular disease (PCDD) remains largely unknown. Perforation may result from a combination of high intracolonic pressures, secondary to excessive colonic segmentation, and impairment of the mucosal barrier. Calcium channel blockers and antimuscarinic drugs, which reduce colonic contractility and tone, could potentially protect against perforation. The aim of this study was to test this hypothesis using a case control design. METHODS: All cases of acute PCDD were identified over a five year period in two hospitals in Norfolk, UK. Each case was matched for age, sex, and date of admission to two controls groups: (1) patients undergoing cataract surgery and (2) patients with basal cell carcinoma. Data on drug use prior to hospital admission were obtained from medical and nursing records and compared between cases and controls. RESULTS: A total of 120 cases of PCDD were identified and matched to 240 controls in each group. A statistically significant protective association was seen between calcium channel blocker use and PCDD using both control groups. The odds ratios were 0.41 (95% confidence interval (CI) 0.18-0.93) using the ophthalmology control group and 0.36 (95% CI 0.16-0.82) using the dermatology control group. CONCLUSIONS: This study has shown for the first time that a protective association exists between calcium channel blockers and PCDD. The validity of this association is supported by the consistent finding in both control groups and the plausible biological mechanisms. Further studies are required to confirm this association but calcium channel blockers may represent a potential preventive therapy in PCDD.

Prospective study of physical activity and the risk of symptomatic diverticular disease in men.

The relationship between physical activity and risk of symptomatic diverticular disease has not been investigated directly. This association was examined in a prospective cohort of 47,678 American men, 40 to 75 years of age, and free of diagnosed diverticular disease, colon or rectal polyp, ulcerative colitis, and cancer before 1988. During four years of follow up, 382 newly diagnosed cases of symptomatic diverticular disease were documented. After adjustment for age, energy adjusted dietary fibre, and energy adjusted total fat, overall physical activity was inversely associated with the risk of symptomatic diverticular disease (for highest versus lowest extremes, relative risk (RR) = 0.63 (95% confidence interval (CI) 0.45, 0.88). Most of the inverse association was attributable to vigorous activity, for extreme categories RR = 0.60 (95% CI 0.41, 0.87). For activity that was not vigorous the RR was 0.93 (95% CI 0.67, 1.69). Several specific activities were inversely associated with the risk of diverticular disease, but jogging and running combined was the only individual activity that was statistically significant (p for trend = 0.03). For men in the lowest quintile for dietary fibre intake and total physical activity (compared with those in the opposite extreme), the RR was 2.56 (95% CI 1.36, 4.82). Physical activity, along with a high fibre diet, may be an important factor in the prevention of symptomatic diverticular disease.

[Etiopathogenesis of colonic diverticular disease; role of dietary fiber and therapeutic perspectives]. / Etiopathogénie de la maladie diverticulaire colique; rôle des fibres alimentaires et perspectives thérapeutiques.

The authors review the literature about the aetiopathogenesis, the epidemiology and the treatment of uncomplicated diverticular disease of the colon. The influence of dietary fibre deficiency explaining the increasing prevalence in industrialized countries and the variable geographical distribution are explained, as well as the effects of dietary fibres on colonic functions. Progressive elastosis of the taeniae may explain the influence of age on the incidence of diverticulosis. The rationale for the introduction of dietary fibre into the treatment is based on the observation that a high fibre diet such as coarse bran is lowering the colonic pressure and therefore may prevent the development of new diverticula and complications, although an effect on symptoms is not always obtained.

Etiology and pathogenesis of diverticulosis coli: a new approach.

The paper describes a hypothesis as to the etiology and pathogenesis of diverticulosis coli. Colonic diverticulosis develops as a result of excessive straining at defecation due to habitual bowel emptying in a sitting posture, which is typical of Western man. The magnitude of straining during habitual bowel emptying in a sitting posture is at least three-fold more than in a squatting posture and upon urge. The latter defecation posture is typical of latrine pit users in underdeveloped nations. The bowels of Western man are subjected to lifelong excessive pressures which result in protrusions of mucosa through the bowel wall at points of least resistance. This hypothesis is consistent with recent findings of elastosis of the bowel wall muscles, the distribution of diverticula along the colon, as well as with epidemiological data on the emergence of diverticulosis coli as a medical problem and its geographic prevalence.

The role of dietary fiber in gastrointestinal disease.

The most consistent benefit of consumption of adequate dietary fiber is regular laxation; this effect alone justifies inclusion of fiber in the diet, in view of the enormous expenditure on drugs for digestive diseases. Dietary fiber has proved effective in decreasing symptoms of diverticular disease, Crohn's disease, and hemorrhoids in a limited number of small clinical studies. Fiber may also reduce the incidence of gallstone formation. Fiber is currently being touted as protection against colon cancer. However, the epidemiological and experimental data do not provide convincing evidence that fiber alone is a major determinant of risk for colon cancer. Furthermore, the data from international comparisons indicating that fiber is protective against colon cancer can be used in a similar simplistic manner to suggest that fiber may be a risk factor for stomach cancer. This should not dissuade individuals from obtaining adequate fiber from a wide variety of foods but should caution them against consumption of excessive amounts of fiber from a single source or from dietary supplements.

Cereal dietary fiber consumption and diverticular disease: a lifespan study in rats.

The relationship between consumption of dietary fiber (DF) from white bread, wholemeal bread, or bran and the development of diverticular disease of the colon has been investigated in a lifespan study using 1800 Wistar rats in nine diet groups. Use of the rat as a model for the human condition was validated by demonstration of significant relationships between fiber intake and fecal output and transit time, and the observation of true acquired diverticula, both single and multiple. Significant inverse relationships (mostly with p less than 0.001) were observed between the incidence of diverticula (and prediverticula) and the concentrations of fiber in the diets, measured by the neutral detergent fiber and Southgate methods. The study offers strong support to the Painter-Burkitt view of human diverticular disease as being due to fiber deficiency, if the extrapolation from rat to man is valid. On the same assumption, the amount of additional fiber required to be consumed in order to achieve a substantial reduction in incidence of the disease is very large. Effects of fiber on body weight, food intake, mineral levels, blood composition and properties, mortality, organ weights, and incidence of tumors and lesions are reported. Significantly fewer mammary tumors were found in rats fed the very high fiber stock diet than in those fed the purified diets.

Diverticular disease. Current trends in therapy.

Colonic diverticulosis is a common problem in the United States, apparently related to low dietary intake of fiber. Diverticula may bleed or cause local infection or perforation. When antibiotic treatment of infection fails, surgical intervention is necessary. Currently, the most common procedures are primary resection and anastomosis for limited disease and a two-stage Hartmann procedure for severe disease or abscess. If the fiber hypothesis of diverticular formation is correct, then addition of fiber to the diet should prevent diverticular disease.