Abstract
Background and Aims: Diverticulosis is a very common condition. While most patients have asymptomatic diverticulosis, around one in five develops symptomatic diverticular disease. The development of diverticulosis is rare in youth, an increase in age being a major risk factor for the development of diverticulosis. Diverticula are found in more than one-half of adults over the age of 65 years. In this study, we aimed to investigate the clinical and laboratory features of geriatric patients who developed diverticulosis and to compare them to subjects with no diverticula. Materials and Methods: This retrospective case-control study included subjects aged over 65 years who underwent a colonoscopy in the period of 2011-2016 for an indication of colorectal cancer screening. Patients with diverticulosis as detected by a colonoscopy were compared to patients without diverticulosis. The comparison parameters included demographic data, comorbidities, and laboratory parameters, including a complete blood count, blood biochemistry, erythrocyte sedimentation rate, and C-reactive protein.Results: The study included 175 patients with diverticulosis whose age and sex matched 175 patients without diverticulosis. The mean age was 75.3±5.6 years in the diverticulosis group and 74.2±6.2 years in the control group. Females comprised 37% of the diverticulosis group and 42% of the control group. Diverticula were predominantly left-sided in 53%, right-sided in 9%, and bilateral in 38%. There was no difference between the groups in terms of the presence of hy- pertension, diabetes mellitus, and hyperlipidemia. The median erythrocyte sedimentation rate was higher in the diverticulosis group than in the control group (21 mm/hour (2-67) vs 17 mm/hour (3-59), p=0.03). We could not detect any difference between the groups in terms of C-reactive protein [4 mg/L (0.3-75) vs 3.5 mg/L (1.1-43.5), p=0.71]. The only biochemical parameter that was different between the groups was creatinine. The median creatinine was higher [0.90 mg/dL (0.32-2.16)] in the diverticulosis group when compared to the control group [0.82 mg/dL (0.37-2.41)] (p=0.005). Conclusions: Contrary to previous studies, we could not detect a higher prevalence of hypertension in patients with diverticulosis when compared to control subjects in this study. Our findings suggest that higher creatinine values in patients with diverticulosis may not be associated with a renal impairment in the geriatric population; instead, it may be related to obesity, which is a well-known factor for the development of diverticulosis. Obesity in adulthood may relatively contribute to protein-energy malnutrition and sarcopenia in those of an advanced age. A higher erythrocyte sedimentation rate may be an indirect marker of the ongoing low-grade inflammation in geriatric patients with diverticulosis.
Keywords
Diverticulosis advanced age hypertension erythrocyte sedimentation rate C-reactive protein creatinine
References
- 1. Strate LL. Lifestyle factors and the course of diverticular disease. Dig Dis 2012;30:35-45.
- 2. Tursi A, Papa A, Danese S. Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Aliment Pharmacol Ther 2015;42:664-84.
- 3. Böhm, SK. Risk factors for diverticulosis, diverticulitis, diverticular perforation, and bleeding: A plea for more subtle history taking. Viszeralmedizin 2015;31:84-94.
- 4. Spiller RC. Changing views on diverticular disease: impact of aging, obesity, diet, and microbiota. Neurogastroenterol Motil 2015;27:305-12.
- 5. Azzam N, Aljebreen AM, Alharbi O, Almadi MA. Prevalence and clinical features of colonic diverticulosis in a Middle Eastern population. World J Gastrointest Endosc 2013;5:391-7.
- 6. Sakuta H, Suzuki T. Prevalence Rates of type 2 diabetes and hypertension are elevated among middle-aged Japanese men with colonic diverticulum. Environ Health Prev Med 2007;12:97-100.
- 7. Kopylov U, Ben-Horin S, Lahat A, et al. Obesity, metabolic syndrome and the risk of development of colonic diverticulosis. Digestion 2012;86:201-5.
- 8. Lameris W, van Randen A, van Gulik TM, et al. A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum 2010;53:896-904.
- 9. Andeweg CS, Knobben L, Hendriks JC, et al. How to diagnose acute left-sided colonic diverticulitis: proposal for a clinical scoring system. Ann Surg 2011;253:940-6.
- 10. Scaioli E, Colecchia A, Marasco G, et al. Pathophysiology and therapeutic strategies for symptomatic uncomplicated diverticular disease of the colon. Dig Dis Sci 2016;61:673-83.
- 11. Luciano RL, Dahl NK. Extra-renal manifestations of autosomal dominant polycystic kidney disease (ADPKD): considerations for routine screening and management. Nephrol Dial Transplant 2014;29:247-54.
Abstract
Giriş ve Amaç: Divertikülozis sık görülen bir durumdur. Hastaların çoğunda asemptomatik divertikülozis gözlenirken yaklaşık beşte birinde semptomatik divertiküler hastalık gelişir. Divertikülozis gelişimi gençlikte nadirken, yaşlılıkta görülme sıklığı artar. Altmış beş yaş üstü erişkinlerin yarısından fazlasında divertiküller bulunur. Bu çalışmada, divertikül gelişen yaşlı hastaların klinik ve laboratuvar özelliklerinin belirlenmesi ve divertikülü olmayanlarla karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Bu retrospektif vaka kontrol çalışması, 2011-2016 yılları arasında kolorektal kanser taraması için kolonoskopi yapılan 65 yaş üzeri bireyleri kapsamaktadır. Kolonoskopi ile divertikülozis saptanan hastalar, divertikülozis saptanmayanlarla karşılaştırılmıştır. Karşılaştırma parametreleri demografik veriler, komorbid hastalıklar ve tam kan sayımı, biyokimya, eritrosit sedimantasyon hızı ve C-reaktif proteinden oluşan laboratuvar parametreleridir.Bulgular: Çalışma divertikülozis saptanan 175 hasta ve divertikülozisi olmayan yaş ile cinsiyet yönünden benzer 175 hasta üzerine yapıldı. Ortalama yaş divertikülozis grubunda 75,3±5,6 yıl, kontrol grubunda 74,2±6,2 yıldı. Kadınlar divertikü- lozis grubunun %37’sini, kontrol grubunun %42’sini oluşturuyordu. Divertiküller hastaların %53’ünde sol kolonda, %9’unda sağ kolonda ve %38’inde bilateral yerleşimliydi. Gruplar arasında hipertansiyon, diyabetes mellitus ve hiperlipidemi bulunması açısından fark gözlenmedi. Ortanca eritrosit sedimantasyon hızı, divertikülozis grubunda, kontrol grubundan daha yüksekti [21 (2-67) mm/saate karşı 17 (3-59) mm/saat, p=0.03]. C-reaktif protein açısından gruplar arası fark saptanmadı [4 (0,3-75) mg/L’e karşı 3,5 (1,1- 43,5) mg/L, p=0,71]. Gruplar arasında farklı tek biyokimyasal parametre kreatinindi. Ortanca kreatinin değeri divertikülozis grubunda [0,90 mg/dL (0,32-2,16)], kontrol grubuna göre [0,82 mg/dL (0,37-2,41)] daha yüksekti (p=0,005). Sonuç: Önceki çalışmaların aksine, bu çalışmada, kontrollerle karşılaştırıldığında, divertikülozisli hastalarda yüksek hipertansiyon prevalansı saptanmadı. Bulgularımız, geriatrik popülasyonda, divertikülozisli hastalarda gözlenen daha yüksek kreatinin değerlerinin renal bozukluktan ziyade, iyi bilinen bir divertikülozis risk faktörü olan obezite ile ilişkili olabileceğini düşündürmektedir. Erişkin dönemde görülen obezite, ileri yaş- larda, protein-enerji malnütrisyonu ve sarkopeni gelişiminden kısmi olarak koruyucu olabilir. Divertikülozisli yaşlı hastalarda gözlenen yüksek eritrosit sedimantasyon hızı değerleri devam eden düşük düzey inflamasyonun indirekt bir göstergesi olabilir.
Keywords
Divertikülozis ileri yaş hipertansiyon eritrosit sedimantasyon hızı C reaktif protein kreatinin
References
- 1. Strate LL. Lifestyle factors and the course of diverticular disease. Dig Dis 2012;30:35-45.
- 2. Tursi A, Papa A, Danese S. Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Aliment Pharmacol Ther 2015;42:664-84.
- 3. Böhm, SK. Risk factors for diverticulosis, diverticulitis, diverticular perforation, and bleeding: A plea for more subtle history taking. Viszeralmedizin 2015;31:84-94.
- 4. Spiller RC. Changing views on diverticular disease: impact of aging, obesity, diet, and microbiota. Neurogastroenterol Motil 2015;27:305-12.
- 5. Azzam N, Aljebreen AM, Alharbi O, Almadi MA. Prevalence and clinical features of colonic diverticulosis in a Middle Eastern population. World J Gastrointest Endosc 2013;5:391-7.
- 6. Sakuta H, Suzuki T. Prevalence Rates of type 2 diabetes and hypertension are elevated among middle-aged Japanese men with colonic diverticulum. Environ Health Prev Med 2007;12:97-100.
- 7. Kopylov U, Ben-Horin S, Lahat A, et al. Obesity, metabolic syndrome and the risk of development of colonic diverticulosis. Digestion 2012;86:201-5.
- 8. Lameris W, van Randen A, van Gulik TM, et al. A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum 2010;53:896-904.
- 9. Andeweg CS, Knobben L, Hendriks JC, et al. How to diagnose acute left-sided colonic diverticulitis: proposal for a clinical scoring system. Ann Surg 2011;253:940-6.
- 10. Scaioli E, Colecchia A, Marasco G, et al. Pathophysiology and therapeutic strategies for symptomatic uncomplicated diverticular disease of the colon. Dig Dis Sci 2016;61:673-83.
- 11. Luciano RL, Dahl NK. Extra-renal manifestations of autosomal dominant polycystic kidney disease (ADPKD): considerations for routine screening and management. Nephrol Dial Transplant 2014;29:247-54.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Articles |
| Authors | |
| Publication Date | January 2, 2017 |
| Published in Issue | Year 2016 Volume: 24 Issue: 3 |