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Pathophysiology and Therapeutic Strategies for Symptomatic Uncomplicated Diverticular Disease of the Colon.
Dig Dis Sci. 2016 Mar; 61(3):673-83.DD

Abstract

Colonic diverticulosis imposes a significant burden on industrialized societies. The current accepted causes of diverticula formation include low fiber content in the western diet with decreased intestinal content and size of the lumen, leading to the transmission of muscular contraction pressure to the wall of the colon, inducing the formation of diverticula usually at the weakest point of the wall where penetration of the blood vessels occurs. Approximately 20 % of the patients with colonic diverticulosis develop abdominal symptoms (i.e., abdominal pain and discomfort, bloating, constipation, and diarrhea), a condition which is defined as symptomatic uncomplicated diverticular disease (SUDD). The pathogenesis of SUDD symptoms remains uncertain and even less is known about how to adequately manage bowel symptoms. Recently, low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors leading to symptom development, thus changing and improving the therapeutic approach. In this review, a comprehensive search of the literature regarding on SUDD pathogenetic hypotheses and pharmacological strategies was carried out. The pathogenesis of SUDD, although not completely clarified, seems to be related to an interaction between colonic microbiota alterations, and immune, enteric nerve, and muscular system dysfunction (Cuomo et al. in United Eur Gastroenterol J 2:413-442, 2014). Greater understanding of the inflammatory pathways and gut microbiota composition in subjects affected by SUDD has increased therapeutic options, including the use of gut-directed antibiotics, mesalazine, and probiotics (Bianchi et al. in Aliment Pharmacol Ther 33:902-910, 2011; Comparato et al. in Dig Dis Sci 52:2934-2941, 2007; Tursi et al. in Aliment Pharmacol Ther 38:741-751, 2013); however, more research is necessary to validate the safety, effectiveness, and cost-effectiveness of these interventions.

Authors+Show Affiliations

Department of Medical and Surgical Science, Policlinico S.Orsola, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. elescaio@gmail.com.Department of Medical and Surgical Science, Policlinico S.Orsola, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. antonio.colecchia@aosp.bo.it.Department of Medical and Surgical Science, Policlinico S.Orsola, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. giovannimarasco89@gmail.com.Department of Medical and Surgical Science, Policlinico S.Orsola, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. ramona_schiumerini@libero.it.Department of Medical and Surgical Science, Policlinico S.Orsola, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. davide.festi@unibo.it.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26458921

Citation

Scaioli, Eleonora, et al. "Pathophysiology and Therapeutic Strategies for Symptomatic Uncomplicated Diverticular Disease of the Colon." Digestive Diseases and Sciences, vol. 61, no. 3, 2016, pp. 673-83.
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(3):673-83.
Scaioli, E., Colecchia, A., Marasco, G., Schiumerini, R., & Festi, D. (2016). Pathophysiology and Therapeutic Strategies for Symptomatic Uncomplicated Diverticular Disease of the Colon. Digestive Diseases and Sciences, 61(3), 673-83. https://doi.org/10.1007/s10620-015-3925-0
Scaioli E, et al. Pathophysiology and Therapeutic Strategies for Symptomatic Uncomplicated Diverticular Disease of the Colon. Dig Dis Sci. 2016;61(3):673-83. PubMed PMID: 26458921.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pathophysiology and Therapeutic Strategies for Symptomatic Uncomplicated Diverticular Disease of the Colon. AU - Scaioli,Eleonora, AU - Colecchia,Antonio, AU - Marasco,Giovanni, AU - Schiumerini,Ramona, AU - Festi,Davide, Y1 - 2015/10/12/ PY - 2015/07/09/received PY - 2015/10/05/accepted PY - 2015/10/14/entrez PY - 2015/10/16/pubmed PY - 2016/6/28/medline KW - Diverticular disease KW - Gut microbiota KW - Low-grade inflammation KW - Mesalazine KW - Probiotics SP - 673 EP - 83 JF - Digestive diseases and sciences JO - Dig Dis Sci VL - 61 IS - 3 N2 - Colonic diverticulosis imposes a significant burden on industrialized societies. The current accepted causes of diverticula formation include low fiber content in the western diet with decreased intestinal content and size of the lumen, leading to the transmission of muscular contraction pressure to the wall of the colon, inducing the formation of diverticula usually at the weakest point of the wall where penetration of the blood vessels occurs. Approximately 20 % of the patients with colonic diverticulosis develop abdominal symptoms (i.e., abdominal pain and discomfort, bloating, constipation, and diarrhea), a condition which is defined as symptomatic uncomplicated diverticular disease (SUDD). The pathogenesis of SUDD symptoms remains uncertain and even less is known about how to adequately manage bowel symptoms. Recently, low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors leading to symptom development, thus changing and improving the therapeutic approach. In this review, a comprehensive search of the literature regarding on SUDD pathogenetic hypotheses and pharmacological strategies was carried out. The pathogenesis of SUDD, although not completely clarified, seems to be related to an interaction between colonic microbiota alterations, and immune, enteric nerve, and muscular system dysfunction (Cuomo et al. in United Eur Gastroenterol J 2:413-442, 2014). Greater understanding of the inflammatory pathways and gut microbiota composition in subjects affected by SUDD has increased therapeutic options, including the use of gut-directed antibiotics, mesalazine, and probiotics (Bianchi et al. in Aliment Pharmacol Ther 33:902-910, 2011; Comparato et al. in Dig Dis Sci 52:2934-2941, 2007; Tursi et al. in Aliment Pharmacol Ther 38:741-751, 2013); however, more research is necessary to validate the safety, effectiveness, and cost-effectiveness of these interventions. SN - 1573-2568 UR - https://www.unboundmedicine.com/medline/citation/26458921/Pathophysiology_and_Therapeutic_Strategies_for_Symptomatic_Uncomplicated_Diverticular_Disease_of_the_Colon_ DB - PRIME DP - Unbound Medicine ER -