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Prevalence and clinical features of colonic diverticulosis in a Middle Eastern population
Nahla Azzam1, Abdulrahman M Aljebreen, Othman Alharbi
1Nahla Azzam, Abdulrahman M Aljebreen, Othman Alharbi, Majid A Almadi, Division of Gastroenterology, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia.
Insights
Colonic diverticulosis affects 7.4% of patients, predominantly in the left colon. Age, hypertension, and rectal bleeding are key predictors of this condition, which is linked to adenomatous polyps.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Epidemiology
Background:
- Colonic diverticulosis is a common condition, but its prevalence, clinical associations, and role in lower gastrointestinal bleeding require further investigation.
- Understanding these factors is crucial for effective patient management and risk stratification.
Purpose of the Study:
- To determine the prevalence and location of colonic diverticulosis.
- To identify clinical features and associations, including comorbidities and adenomatous polyps.
- To assess the role of diverticular disease as a cause of lower gastrointestinal bleeding.
Main Methods:
- Retrospective review of medical records of 3649 patients undergoing colonoscopy.
- Data collection included demographics, comorbidities, and colonoscopy findings.
- Statistical analysis to measure associations between diverticulosis, polyps, comorbidities, and bleeding.
Main Results:
- Prevalence of colonic diverticulosis was 7.4% (270/3649 patients), with a mean age of 60.8 years.
- Diverticula were predominantly left-sided (62%).
- Significant associations found between diverticulosis and adenomatous polyps (P<0.001), hypertension (P<0.0001), and diabetes mellitus (P<0.0016).
- Diverticular disease was the second leading cause of lower gastrointestinal bleeding (33.6%), after internal hemorrhoids (44.6%).
- Hypertension (OR=2.30), rectal bleeding (OR=2.57), and age increment (OR=1.05) predicted diverticulosis presence.
Conclusions:
- Colonic diverticulosis has a low prevalence, is primarily left-sided, and is associated with adenomatous polyps.
- Age, hypertension, and rectal bleeding are significant predictors for the presence of diverticular disease.
- Diverticular disease is a notable cause of lower gastrointestinal bleeding.
Aim:
To determine the prevalence, location, associations and clinical features of colonic-diverticulosis and its role as a cause of lower-gastroenterology-bleeding.
Methods:
We retrospectively reviewed the medical records of 3649 consecutive patients who underwent a colonoscopy for all indications between 2007 and 2011 at King Khalid University Hospital, Riyadh, Saudi Arabia. The demographic data were collected retrospectively through the hospital's information system, electronic file system, endoscopic e-reports, and manual review of the files by two research assistants. The demographic information included the age, sex, comorbidities and indication for the colonoscopy. The association among colonic polyps, comorbidities and diverticular disease was also measured.
Results:
A total of 270 patients out of 3649 were diagnosed with colonic diverticulosis, with a prevalence of 7.4%. The mean age was 60.82 years ± 0.833, (range 12-110). Females comprised 38.89% (95%CI: 33-44.7) of the study population. The major symptoms were rectal bleeding in 33.6%, abdominal pain in 19.3%, constipation in 12.8% and anemia in 6%. Diverticula were predominantly left-sided (sigmoid and descending colon) in 62%, right-sided in 13% and in multiple locations in 25%. There was an association between the presence of diverticulosis and adenomatous polyps (P-value < 0.001), hypertension (P-value < 0.0001) and diabetes mellitus (P-value < 0.0016). Diverticular disease was the second most common cause of lower gastrointestinal bleeding, in 33.6% (95%CI: 27.7-39.4), after internal hemorrhoids, in 44.6% (95%CI: 40.3-48.9). On multivariable logistic regression, hypertension (OR = 2.30; 95%CI: 1.29-4.10), rectal bleeding (OR = 2.57; 95%CI: 1.50-4.38), and per year increment in age (OR = 1.05; 95%CI: 1.03-1.07) were associated with diverticulosis but not with bleeding diverticular disease.
Limitations:
A small proportion of the patients included had colonoscopies performed as a screening test.
Conclusion:
Colonic-diverticulosis was found to have a low prevalence, be predominantly left-sided and associated with adenomatous-polyps. Age, hypertension and rectal bleeding predict the presence of diverticular disease.
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