Colonic Diverticula Are Not Associated With Mucosal Inflammation or Chronic Gastrointestinal Symptoms

Anne F. Peery; Temitope O. Keku; Cassandra Addamo; Amber N. McCoy; Christopher F. Martin; Joseph A. Galanko; Robert S. Sandler

Disclosures

Clin Gastroenterol Hepatol. 2018;16(6):884-891. 

In This Article

Results

Our analysis included 619 participants. Among our participants, 255 (41%) had 1 or more colonic diverticula. Participants with colonic diverticula were more likely to be older, male, and overweight or obese than those without diverticula (Table 1). Among those with colonic diverticula, 28% had 1 to 3 diverticula, 36% had 4 to 10 diverticula, and 36% had 10 or more diverticula. Among those with colonic diverticula, 61% had only distal diverticula, 29% had distal and proximal diverticula, and 7% had only proximal diverticula.

Colonic Diverticulosis and Mucosal Inflammation

After adjusting for age, sex, and body mass index, there was no association between all cases with diverticulosis and gene expression levels of TNF-α (OR, 0.85; 95% CI, 0.63–1.16) and no association with CD4 (OR, 1.18; 95% CI, 0.87–1.60), CD8 (OR, 0.97; 95% CI, 0.71–1.32), or CD57 (OR, 0.80; 95% CI, 0.59–1.09). Furthermore, there was no association with mast cell tryptase (OR, 1.02; 95% CI, 0.75–1.39). There was a reduced likelihood of mucosal concentrations of IL6 (OR, 0.58; 95% CI, 0.41–0.83) and IL10 (OR, 0.67; 95% CI, 0.49–0.91) (Table 2).

Compared with controls, individuals with 1 to 3 colonic diverticula had a reduced mRNA gene expression of IL6 (OR, 0.59; 95% CI, 0.36–0.96) and TNF-α (OR, 0.55; 95% CI, 0.34–0.90). There was a reduced likelihood of mucosal concentrations of the anti-inflammatory cytokine IL10 (OR, 0.50; 95% CI, 0.31–0.82) (Table 2). There was no association between a greater burden of colonic diverticula and cytokine gene expression or immune cells (Table 2). The median cytokine expression levels and immunohistochemistry markers by case–control status are shown in Supplementary Table 1.

Because gross inflammation (diverticulitis) is more common in the sigmoid colon, we conducted an analysis stratified by the location of colonic diverticula. Individuals with only distal diverticula compared with no colonic diverticula had a reduced likelihood of IL6 (OR, 0.53; 95% CI, 0.35–0.81) (Table 3). There were no other associations with distal diverticula. Individuals with pan-diverticula had a reduced likelihood of CD57 (OR, 0.59; 95% CI, 0.36–0.94). Individuals with only proximal diverticula had a reduced likelihood of CD8 cell density (OR, 0.36; 95% CI, 0.14–0.93) and an increased likelihood of a CD4/CD8 ratio (OR, 4.52; 95% CI, 1.24–16.51).

Colonic Diverticulosis and Gastrointestinal Symptoms

Our analysis included 448 participants who completed the symptom interview. Of these, 12% met the Rome III diagnostic criteria for irritable bowel syndrome and 14% reported chronic abdominal pain (pain or discomfort at least 2–3 days a month for at least 6 months). When examining the extremes of bowel movement frequency, 2.4% had 2 or fewer bowel movements per week, and 0.9% had 22 or more bowel movements per week. Regarding bowel consistency, 11% reported types 1 and 2 Bristol Stool type (hard lumps) and 8% reported types 6 and 7 (watery, mushy) most of the time. Participants with irritable bowel syndrome were younger, more likely to be female, and overweight or obese than those without irritable bowel syndrome (Supplementary Table 2).

Adjusting for age, sex, and body mass index, individuals with 1 or more colonic diverticula had no significant association with irritable bowel syndrome (OR, 0.53; 95% CI, 0.26–1.05) (Table 4). Moreover, there was no association between the number of colonic diverticula and the odds of irritable bowel syndrome (Table 4). Similarly, there was no association between having colonic diverticula and chronic abdominal pain (OR, 0.68; 95% CI, 0.38–1.23). Compared with Bristol Stool types 3, 4, and 5, there was no association between colonic diverticulosis and stool types 1 and 2 (OR, 1.03; 95% CI, 0.52–2.05) or types 6 and 7 (OR, 1.20; 95% CI, 0.55–2.61).

Colonic Diverticula, Gastrointestinal Symptoms, and Mucosal Inflammation

We identified 42 participants who met the criteria for Rome III irritable bowel syndrome and had mucosal biopsies. Among these participants, 11 had colonic diverticulosis and 31 did not have diverticulosis. In bivariate comparisons, there were no differences in mucosal inflammatory markers, IL6, IL10, TNF, CD4, CD8, or mast cell tryptase (Table 5). Likewise, we identified 63 participants with chronic abdominal pain. Among these participants, 22 had colonic diverticulosis and 41 did not have diverticulosis. In bivariate comparisons, there were no differences in the mucosal inflammatory markers, IL6, IL10, TNF, CD4, CD8, or mast cell tryptase (Table 5).

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