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Background and Aims: The role of the microbiota in diverticulosis and diverticular disease is underexplored. This systematic review aimed to assess all literature pertaining to the microbiota and metabolome associations in asymptomatic diverticulosis, symptomatic uncomplicated diverticular disease (SUDD), and diverticulitis pathophysiology. Methods: Seven databases were searched for relevant studies published up to September 28, 2022. Data were screened in Covidence and extracted to Excel. Critical appraisal was undertaken using the Newcastle Ottawa Scale for case/control studies. Results: Of the 413 papers screened by title and abstract, 48 full‐text papers were reviewed in detail with 12 studies meeting the inclusion criteria. Overall, alpha and beta diversity were unchanged in diverticulosis; however, significant changes in alpha diversity were evident in diverticulitis. A similar Bacteroidetes to Firmicutes ratio compared with controls was reported across studies. The genus‐level comparisons showed no relationship with diverticular disease. Butyrate‐producing microbial species were decreased in abundance, suggesting a possible contribution to the pathogenesis of diverticular disease. Comamonas species was significantly increased in asymptomatic diverticulosis patients who later developed diverticulitis. Metabolome analysis reported significant differences in diverticulosis and SUDD, with upregulated uracil being the most consistent outcome in both. No significant differences were reported in the mycobiome. Conclusion: Overall, there is no convincing evidence of microbial dysbiosis in colonic diverticula to suggest that the microbiota contributes to the pathogenesis of asymptomatic diverticulosis, SUDD, or diverticular disease. Future research investigating microbiota involvement in colonic diverticula should consider an investigation of mucosa‐associated microbial changes within the colonic diverticulum itself. [ABSTRACT FROM AUTHOR]

Jejunal diverticulosis is a rare disease which normally presents for the first time with acute complications, often requiring surgical intervention. The diverticulae are acquired, occurring more commonly after middle age, but their aetiology is unclear. We discuss this condition in the context of four cases which presented to our hospital as emergencies over a five year period: small bowel obstruction, gastrointestinal haemorrhage, small bowel volvulus, and visceral perforation. Our aim is to encourage clinicians to include jejunal diverticular disease as a differential diagnosis in patients with abdominal symptoms. [ABSTRACT FROM AUTHOR]

Diverticular disease (DD) is the most frequent condition in the Western world that affects the colon. Although chronic mild inflammatory processes have recently been proposed as a central factor in DD, limited information is currently available regarding the role of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α). Therefore, we conducted a systematic review and meta-analysis aiming to assess the mucosal TNF-α levels in DD. We conducted a systematic literature search using PubMed, Embase, and Scopus to identify observational studies assessing the TNF-α levels in DD. Full-text articles that satisfied our inclusion and exclusion criteria were included, and a quality assessment was performed using the Newcastle–Ottawa Scale (NOS). The principal summary outcome was the mean difference (MD). The results were reported as MD (95% confidence interval (CI)). A total of 12 articles involving 883 subjects were included in the qualitative synthesis, out of which 6 studies were included in our quantitative synthesis. We did not observe statistical significance related to the mucosal TNF-α levels in symptomatic uncomplicated diverticular disease (SUDD) vs. the controls (0.517 (95% CI −1.148–2.182)), and symptomatic vs. asymptomatic DD patients (0.657 (95% CI −0.883–2.196)). However, the TNF-α levels were found to be significantly increased in DD compared to irritable bowel disease (IBS) patients (27.368 (95% CI 23.744–30.992)), and segmental colitis associated with diverticulosis (SCAD) vs. IBS patients (25.303 (95% CI 19.823–30.784)). Between SUDD and the controls, as well as symptomatic and asymptomatic DD, there were no significant differences in the mucosal TNF-α levels. However, the TNF-α levels were considerably higher in DD and SCAD patients than IBS patients. Our findings suggest that TNF-α may play a key role in the pathogenesis of DD in specific subgroups and could potentially be a target for future therapies. [ABSTRACT FROM AUTHOR]

Aim: The management of anastomotic leak after sigmoid colectomy for diverticular disease has not been well defined. Specifically, there is a lack of literature on optimal types of reoperations for leaks. The aim of this study was to describe and compare reoperative approaches and their postoperative outcomes. Methods: We performed a retrospective cohort study using the NSQIP Colectomy Module (2012–2019) and single‐institution chart review. Patients with diverticular disease who underwent elective sigmoid colectomy were included. Primary outcomes were anastomotic leak requiring reoperation and management of anastomotic leak. Results: Of 37,471 patients who underwent sigmoid colectomy for diverticular disease, 1003 (2.7%) suffered an anastomotic leak, of whom 583 underwent reoperation. Of the 572 patients who were not initially diverted and underwent reoperation for leak, 302 (52.8%) were managed with stoma creation – 200 (35.0%) with colostomy and 102 (17.8%) with ileostomy. The remaining 47.2% underwent colectomy with reanastomosis, suturing of large bowel, and drainage. There were no differences in length of stay, readmission, or mortality between patients who underwent ileostomy or colostomy at reoperation (p > 0.05). Single‐institution analysis demonstrated that 100% of patients with ileostomies underwent subsequent ileostomy closure, compared to 60% of patients with colostomies. Conclusions: In patients who suffer anastomotic leaks after sigmoid colectomy for diverticular disease and undergo reoperations, ileostomy at the time of reoperation appears to be safe, with comparable results to colostomy. Ileostomies were more frequently closed than colostomies. When faced with a colorectal anastomotic leak, ileostomy creation may be considered. [ABSTRACT FROM AUTHOR]

Backgrounds: Robotic colorectal surgery is a method of performing complex surgery in a minimally invasive manner. In diverticular disease, chronic inflammation obscures tissues planes and increases difficulty of resection. This study aims to assess feasibility and safety of application of a robotic approach to diverticular disease, by reviewing short‐term outcomes from a series of diverticular resections. Methods: Forty‐one patients underwent robotic colorectal surgery for diverticular disease across three centres within Melbourne from June 2016 to June 2022. Demographic, operative, and clinicopathological data were collected. Descriptive statistics were used to evaluate primary and secondary outcomes. Comparative analysis between simple and complex diverticular disease was performed to identify differences in groups regarding short term outcomes. The primary outcome in this study is to determine conversion rate from minimally invasive to open surgery. Secondary outcomes include major complication rates and length of stay. Results: Of the 41 patients, 24 (58.5%) had simple disease, and 17 (41.5%) had complex disease. One patient (2.4%) required conversion to open resection. The median length of stay for complex disease was 7 days, for simple disease 5 days (P = 0.05). Four surgical Clavien‐Dindo III or above complications occurred (9.8%), one patient required return to theatre. There were no anastomotic leaks or collections requiring radiological drainage. Thirteen patients (31.7%) underwent ureteric stenting and intraoperative indocyanine green dye ureteric identification. Conclusion: Robotic diverticular resections in this series are safe and associated with a low conversion rate of 2.4%. Robotic resection of complex disease was feasible with an acceptable safety profile. [ABSTRACT FROM AUTHOR]

Backgroundy: Colonoscopy is often performed in the initial workup of pelvic floor dysfunction, even in the absence of red flag symptoms. Current guidelines suggest colonoscopy is only required in the presence of rectal bleeding, diarrhoea or change in bowel habit. The aim of this study was to evaluate the prevalence of significant pathology found at colonoscopy in patients with pelvic floor dysfunction. Methods: Retrospective chart review was performed on all patients presenting to a functional colorectal outpatient clinic between May 2018 and August 2019. Information was collected on presenting symptoms, whether colonoscopy had been performed within 5 years, quality of bowel preparation, withdrawal time, number of polyps detected, histology, presence of diverticular disease, colorectal malignancy, inflammatory bowel disease, solitary rectal ulcer or rectal prolapse. Results: There were 260 patients seen within the study period, of which 67% had undergone recent colonoscopy within the last 5 years. The mean age was 53 and 219 (84%) patients were female. Average withdrawal time was 13 min. Polyps were found in 48.7% and adenomas in 32.4% of all colonoscopies. The adenoma detection rate was 32.7%. None of the colonoscopies found evidence of malignancy. A new diagnosis of inflammatory bowel disease was discovered in two patients. Conclusion: There was low rates of serious pathology such as malignancy or inflammatory bowel disease in patients referred to a functional clinic. However, colonoscopy is still useful in workup of pelvic floor dysfunction, as many patients have erratic bowel habits or vague symptoms, and will have adenomas found. [ABSTRACT FROM AUTHOR]

The consumption of insects as an alternative protein source is acceptable as a sustainable alternative to mainstream protein sources. Apart from containing a high protein content, insects also have dietary fiber in the form of chitin, which helps to enrich gut microbiota. The importance of the gut microbiome in general health has recently been underlined for humans, farm animals, pets, poultry, and fish. The advances in 16S RNA techniques have enabled the examination of complex microbial communities in the gastrointestinal tract, shedding more light on the role of diet in disease and immunity. The gut microbiome generates signals influencing the normal nutritional status, immune functions, metabolism, disease, and well-being. The gut microbiome depends on dietary fiber; hence, their diversity is modulated by diet, a relevant factor in defining the composition of gut microbiota. Small shifts in diet have demonstrated an enormous shift in gut microbiota. Edible insects are an excellent source of protein, fat, and chitin that could influence the gut microbiota as a prebiotic. Chitin from insects, when consumed, contributes to a healthy gut microbiome by increasing diversity in fecal microbiota. Moreover, a high fiber intake has been associated with a reduced risk of breast cancer, diverticular disease, coronary heart disease, and metabolic syndrome. This review presents edible insects with a focus on fiber found in the insect as a beneficial food component. [ABSTRACT FROM AUTHOR]

Purpose of Review: A distinctive, possibly "novel" form of a segmental inflammatory colonic disease process associated with diverticular disease (so-called SCAD or segmental-colitis-associated-diverticulosis) is reviewed. Recent Findings: Although this phenotype of inflammatory colonic disease was initially recognized decades ago, mainly in the elderly, recent evidence from long term natural history studies along with meta-analyses confirms that its clinical course is usually benign and drug-responsive. Interestingly, its appearance in some treated with monoclonal agents (eg., ipilimumab associated colitis) or infected with coronavirus-19 may have critical implications for its pathogenesis. Summary: This review further explores the implications of recognition of this pattern of colonic inflammatory disease, with relevance for physicians involved in both clinical practice and clinical trials of newer therapeutic agents. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is a major health issue, being responsible for nearly 10% of all cancer-related deaths. Since CRC is often an asymptomatic or paucisymptomatic disease until it reaches advanced stages, screening is crucial for the diagnosis of preneoplastic lesions or early CRC. The aim of this review is to summarize the literature evidence on currently available CRC screening tools, with their pros and cons, focusing on the level of accuracy reached by each test over time. We also provide an overview of novel technologies and scientific advances that are currently being investigated and that in the future may represent real game-changers in the field of CRC screening. We suggest that best screening modalities are annual or biennial FIT and colonoscopy every 10 years. We believe that the introduction of artificial intelligence (AI)-tools in the CRC screening field could lead to a significant improvement of the screening efficacy in reducing CRC incidence and mortality in the future. More resources should be put into implementing CRC programs and support research project to further increase the accuracy of CRC screening tests and strategies. [ABSTRACT FROM AUTHOR]

Ganglioneuromas (GNs) are rare, benign tumors composed of ganglion cells, nerve fibers, and glial cells. Three types of colonic GN lesions exist: polypoid GNs, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis. Less than 100 cases of GN are documented in the literature. A 10-year retrospective search of the pathology database at our institution identified eight cases of colonic GNs. All cases were incidental. Seven of the eight cases presented with colonoscopy findings of small sessile polyps (ranging between 0.1 and 0.7 cm) treated with polypectomy, whereas one case showed a 4 cm partially circumferential and partially obstructing mass in the ascending colon, treated with right hemicolectomy. Almost two-thirds of the cases (5/8) demonstrated associated diverticulosis. All cases were positive for S100 protein and Synaptophysin via immunohistochemistry (IHC). No syndromic association was identified in any of the cases. We also conducted a comprehensive review using PubMed to identify cases of colonic GN reported in the literature. In total, 173 studies were retrieved, among which 36 articles met our inclusion criteria (35 patients and 3 cases on animals). We conclude that while most GNs are incidental and solitary small sessile lesions, many can be diffuse and associated with syndromes. In these cases, the tumor can result in bowel obstruction simulating adenocarcinoma. [ABSTRACT FROM AUTHOR]

Background and Objectives: Sigmoid resection still bears a considerable risk of complications. The primary aim was to evaluate and incorporate influencing factors of adverse perioperative outcomes following sigmoid resection into a nomogram-based prediction model. Materials and Methods: Patients from a prospectively maintained database (2004–2022) who underwent either elective or emergency sigmoidectomy for diverticular disease were enrolled. A multivariate logistic regression model was constructed to identify patient-specific, disease-related, or surgical factors and preoperative laboratory results that may predict postoperative outcome. Results: Overall morbidity and mortality rates were 41.3% and 3.55%, respectively, in 282 included patients. Logistic regression analysis revealed preoperative hemoglobin levels (p = 0.042), ASA classification (p = 0.040), type of surgical access (p = 0.014), and operative time (p = 0.049) as significant predictors of an eventful postoperative course and enabled the establishment of a dynamic nomogram. Postoperative length of hospital stay was influenced by low preoperative hemoglobin (p = 0.018), ASA class 4 (p = 0.002), immunosuppression (p = 0.010), emergency intervention (p = 0.024), and operative time (p = 0.010). Conclusions: A nomogram-based scoring tool will help stratify risk and reduce preventable complications. [ABSTRACT FROM AUTHOR]

The purpose of the work: to analyse clinical cases and the results of treatment of patients with diverticulosis of the large intestine in order to prevent complications. Materials and methods. The results of diagnosis and treatment of 75 patients with diverticulosis of the large intestine for the years 2016-2022, who were in the Clinical highly specialised surgical center with minimally invasive technologies in the Vinnytsia Regional Clinical Hospital named after M. I. Pyrogov of the Vinnytsia Regional Council. Research results and their discussion. We analysed the results of diagnosis and treatment of 75 patients with diverticulosis of the large intestine for the years 2016-2022, who were in the Clinical highly specialised surgical center with minimally invasive technologies in the Vinnytsia Regional Clinical Hospital named after M. I. Pyrogov of the Vinnytsia Regional Council. Colon diverticular disease was clinically and instrumentally confirmed and the following forms of the disease were established: diverticular bleeding - in 46 (61.33%), intestinal perforation with the development of diffuse fecal peritonitis - in 2 (2.66%), diverticulitis - in 12 (16%), asymptomatic diverticulosis - in 2 patients (2.66%), and in 13 patients there was a combination: diverticulitis and paracolic abscess - in 8 (10.66%), diverticulitis and limited purulent peritonitis - in 2 (6.66 %), diverticulitis and intestinal obstruction - in 3 (4%). There were 36 (48%) male patients, 39 (52%) female patients. The age of the patients ranged from 40 to 90 years. The average age was 65±2 years.

Background and purpose: Diverticulosis is a major health problem in middle-aged and older adults. The cause of bleeding in the diverticulum is not clear, but arteriolar changes are considered as the main pathogenesis of diverticular bleeding. This study aimed at investigating the relationship between the risk factors for atherosclerosis and diverticular bleeding. Materials and methods: In this case-control study, 112 patients with diverticulitis over 40 years of age attending Babol Ayatollah Rouhani Hospital 2018-19 were studied in two groups of with and without diverticular bleeding. The participants were investigated in terms of high and low density lipoprotein cholesterol levels, triglyceride, systolic and diastolic blood pressure, history of diabetes, hypertension, and other factors. Results: The mean age of patients was 62.42±10.45 years. There were 62 patients (55.4%) with diverticular disease and 50 patients (44.6%) with diverticular bleeding. The risk of diverticular bleeding in patients with a history of heart disease was 4.25 times higher than that in patients without a history of non-coronary heart disease (P

Objective: Diverticular disease (DD) is one of the most prevalent conditions encountered by gastroenterologists, affecting ~50% of Americans before the age of 60. Our aim was to identify genetic risk variants and clinical phenotypes associated with DD, leveraging multiple electronic health record (EHR) data sources of 91,166 multi-ancestry participants with a Natural Language Processing (NLP) technique. Materials and methods: We developed a NLP-enriched phenotyping algorithm that incorporated colonoscopy or abdominal imaging reports to identify patients with diverticulosis and diverticulitis from multicenter EHRs. We performed genome-wide association studies (GWAS) of DD in European, African and multi-ancestry participants, followed by phenome-wide association studies (PheWAS) of the risk variants to identify their potential comorbid/pleiotropic effects in clinical phenotypes. Results: Our developed algorithm showed a significant improvement in patient classification performance for DD analysis (algorithm PPVs ≥ 0.94), with up to a 3.5 fold increase in terms of the number of identified patients than the traditional method. Ancestry-stratified analyses of diverticulosis and diverticulitis of the identified subjects replicated the well-established associations between ARHGAP15 loci with DD, showing overall intensified GWAS signals in diverticulitis patients compared to diverticulosis patients. Our PheWAS analyses identified significant associations between the DD GWAS variants and circulatory system, genitourinary, and neoplastic EHR phenotypes. Discussion: As the first multi-ancestry GWAS-PheWAS study, we showcased that heterogenous EHR data can be mapped through an integrative analytical pipeline and reveal significant genotype-phenotype associations with clinical interpretation. Conclusion: A systematic framework to process unstructured EHR data with NLP could advance a deep and scalable phenotyping for better patient identification and facilitate etiological investigation of a disease with multilayered data. [ABSTRACT FROM AUTHOR]

Diverticular disease is a common gastrointestinal disorder with increasing prevalence in advanced age. This study aimed to investigate the impact of age and complexity of diverticulitis on health-related quality of life (HRQoL) and stress-related disorders. A cross-sectional study was conducted on 180 patients, including adults (18–64 years) with complicated diverticular disease, the elderly (≥65 years) with complicated diverticular disease, and a control group with uncomplicated symptomatic diverticular disease. HRQoL and stress-related disorders were assessed using the SF-36, GIQLI, HADS, and PHQ-9 questionnaires at baseline and six months after the initial episode of diverticulitis. At diagnosis, the adult group had significantly lower mean physical and mental scores compared with the elderly and control groups (p < 0.001). At the 6-month follow-up, the mean physical score increased for all groups, but the difference between adults and the elderly remained significant (p = 0.028). The adult group had a significantly lower mean GIQLI score at diagnosis compared with the elderly and control groups (p < 0.001), although after 6 months it increased and the difference became insignificant. Anxiety scores at diagnosis were significantly higher in the adult group compared with the control group (p = 0.009). The complexity of diverticulitis and age significantly impacted HRQoL at diagnosis, with adults having lower physical and mental scores compared with elderly patients and controls. Although improvements were observed after 6 months, the difference between adults and the elderly remained significant for physical HRQoL scores. This highlights the need for tailored management strategies and psychosocial support to optimize patient outcomes across age groups and diverticulitis complexity. [ABSTRACT FROM AUTHOR]

Background Colonic diverticulosis and colon polyps are common findings on colonoscopy. There is currently no consensus regarding a possible connection between the development of polyps and diverticulosis. Multiple research studies have sought to analyze whether the presence of both conditions is associated with the development of colorectal cancer. Our study aims to add to this body of data and to better assess the relationship between diverticulosis and colon polyps. Methods A retrospective chart review was performed of all patients who underwent screening and diagnostic colonoscopies between January 2011 and December 2020. Data collection included patient demographics; number, pathology, and location of colon polyps; incidence of colon cancer; and presence and location of colonic diverticulosis. Results Our study demonstrated that the overall presence of diverticulosis in any location increases the likelihood of having nearby colon polyps, regardless of subtype. The presence of left colonic diverticulosis was particularly associated with adjacent adenomatous and non-adenomatous colon polyps. Conclusions Colonic diverticulosis in any location may lead to an increased incidence of adenomatous colon polyps. It is important to perform careful examination of the mucosa surrounding colon diverticulosis to avoid missing colon polyps. [ABSTRACT FROM AUTHOR]

Acute diverticulitis of the colon is a disease with increasing frequency, encountered by general practitioners and gastroenterologists, and also by surgeons under circumstances of emergency, not only in Western countries, but also in Bulgaria. An international multidisciplinary team of experts, according to their shared experience and the results of studies published in the medical literature, updated the consensus guidelines on diagnosis and behavior in respect of the various manifestations of acute diverticulitis. [ABSTRACT FROM AUTHOR]

Introduction: One of the most critical factors determining survival in cases of colorectal cancer is diagnosis and treatment at an early stage. Diagnosis at an early stage is possible with screening programs carried out within preventive health services. Aim: In this study, we aimed to compare the results of patients who underwent colonoscopy because of a positive fecal occult blood test (FOBT) with those over 50 years of age who underwent colonoscopy due to other complaints and to reveal whether an FOBT test is still essential for screening programs. Methods: This study included patients who underwent colonoscopy between January 2016 and December 2021. The patients were analyzed in two groups, according to the reasons for colonoscopy: Group I (FOBT-positive) and Group II (other reasons). Results: A total of 3393 patients were included in the study. They were divided into two groups for evaluation: those who underwent colonoscopy after a positive FOBT (Group I) and patients over 50 years of age who underwent colonoscopy for other reasons (Group II). When the colonoscopy findings were compared between the groups, inflammatory bowel disease (p = 0.03) was more prevalent in Group I, while normal colonoscopy (p = 0.03) was found to be more common in Group II. Polyps, malignancy, diverticulosis, and perianal diseases appeared to be statistically similar between the groups. Conclusion: FOBT can still be used in colorectal screening because it is inexpensive and widely available, is more acceptable to patients due to its non-invasiveness, and can be applied outside of clinical settings. [ABSTRACT FROM AUTHOR]

Background: Duodenal diverticulum occurs in approximately 20% of the population and can lead to life‐threatening complications such as perforation. Most perforations are secondary to diverticulitis, with iatrogenic causes being exceptionally rare. This systematic review explores the aetiology, prevention and outcomes of iatrogenic perforation of duodenal diverticulum. Methods: A systematic review was performed according to the PRISMA guidelines. Four databases were searched, including Pubmed, Medline, Scopus and Embase. The primary data extracted were clinical findings, type of procedure, prevention and management of perforation and outcomes. Results: Forty‐six studies were identified, of which 14 articles met inclusion criteria and comprised 19 cases of iatrogenic duodenal diverticulum perforation. Four cases identified duodenal diverticulum pre‐intervention, nine were identified peri‐intervention, and the remainder were identified post‐intervention. Perforation secondary to endoscopic retrograde cholangiopancreatography (n = 8) was most common, followed by open and laparoscopic surgery (n = 5), gastroduodenoscopy (n = 4) and other (n = 2). Operative management with diverticulectomy was the most frequent treatment (63%). Iatrogenic perforation was associated with 50% morbidity and 10% mortality. Conclusion: Iatrogenic perforation of duodenal diverticulum is exceptionally rare and associated with high morbidity and mortality. There are limited guidelines surrounding standard perioperative steps to prevent iatrogenic perforations. A review of preoperative imaging helps identify potential aberrant anatomy, such as a duodenal diverticulum, to allow for recognition and prompt management initiation in the event of perforation. Intraoperative recognition and immediate surgical repair are safe options for this complication. [ABSTRACT FROM AUTHOR]

Background and Aim: The clinical severity and course of acute lower gastrointestinal bleeding (ALGIB) are believed to differ between inpatient‐onset and outpatient‐onset cases, but no reports have investigated these issues in detail. We aimed to evaluate the clinical differences between inpatient‐onset and outpatient‐onset ALGIB. Methods: Medical records of patients who had undergone emergency colonoscopy for ALGIB were retrospectively reviewed. The severity was evaluated using the NOBLADS score. Patients with obvious ALGIB relapse and/or persistent iron‐deficiency anemia after emergency colonoscopy were considered to exhibit a poor clinical course. Results: We reviewed 723 patients with ALGIB and divided them into the inpatient‐onset cohort (172 patients) and outpatient‐onset cohort (551 patients). Compared with the outpatient‐onset cohort, the inpatient‐onset cohort had a significantly higher proportion of patients with a poor clinical course (51.2% vs 21.6%; P < 0.001) and a significantly higher mean NOBLADS score (3.6 ± 1.1 vs 2.5 ± 1.0; P < 0.001). The most common bleeding source was acute hemorrhagic rectal ulcer (52.3%) in the inpatient‐onset cohort and colonic diverticular bleeding (29.4%) in the outpatient‐onset cohort. Multivariate analysis showed that a platelet count < 15 × 104/μL and albumin concentration < 3 g/dL were significantly associated with a poor clinical course in the inpatient‐onset cohort. Conclusions: The clinical course was significantly worse in the inpatient‐onset cohort than in the outpatient‐onset cohort. The bleeding source, clinical characteristics, and clinical course differed between the inpatient‐onset and outpatient‐onset cohorts. The clinical course in the inpatient‐onset cohort may depend on the patient's condition at ALGIB onset. [ABSTRACT FROM AUTHOR]

Background and Aim: Colorectal cancer (CRC) diagnosed following a cancer‐negative colonoscopy is termed as post‐colonoscopy CRC (PCCRC). The World Endoscopy Organization has recently standardized the definition of PCCRC‐3Y (CRC developing within 3 years of a cancer‐negative colonoscopy). In the present study, we sought to assess PCCRC‐3Y rate, perform root‐cause analyses, and identify factors associated with development of PCCRC at a tertiary referral hospital in Australia. Methods: All patients undergoing colonoscopy from 2011 to 2018 were matched to a population‐based cancer register. PCCRC‐3Y rate was assessed for years 2011–2015. All PCCRC cases that developed within 6–48 months after a cancer‐negative colonoscopy underwent root‐cause analyses. Descriptive statistics were used to summarize data. Results: Among 17 828 patients undergoing colonoscopy, 367 CRC cases were diagnosed during the study period. This included nine PCCRC cases, which developed at a median of 14 months (range 7–34 months) after cancer‐negative colonoscopy. The PCCRC‐3Y rate for years 2011–2015 was 2.16% (95% CI 0.91–5.15). All nine PCCRC cases were moderately or poorly differentiated adenocarcinomas; seven of nine were early‐stage CRC (stages I and II) and six of nine probably represented missed lesions at index colonoscopy despite an apparently adequate examination. History of inflammatory bowel disease (IBD) (odds ratio [OR] 21.9, 95% confidence interval [CI] 4.6–103.7, P < 0.001) and diverticulosis (OR 5.4, 95% CI 1.4–20.5, P = 0.01) were significantly associated with development of missed CRC. Conclusions: In our tertiary referral colonoscopy cohort, PCCRC‐3Y rate was 2.16% (95% CI 0.91–5.15). IBD and diverticulosis were significantly associated with risk of PCCRC. The majority of PCCRC lesions were likely missed at index colonoscopy, despite an apparently adequate examination. [ABSTRACT FROM AUTHOR]

The role of dietary habits as risk factor for the development of diverticular complications has strongly emerged in the last years. We aimed to evaluate possible differences in dietary habits between patients with diverticular disease (DD) and matched controls without diverticula. Dietary habits were obtained from standardized food frequency questionnaires collected at entry to the Diverticular Disease Registry (REMAD). We compared controls (C) (n = 119) with asymptomatic diverticulosis (D) (n = 344), symptomatic uncomplicated diverticular disease (SUDD) (n = 154) and previous diverticulitis (PD) (n = 83) patients, in terms of daily calories, macro and micronutrients and dietary vitamins. Daily kcal intake and lipids, both saturated and unsaturated, were significantly lower in patients with DD than C. Total protein consumption was lower in PD than D, with differing consumption of unprocessed red meat, white meat and eggs between groups. Consumption of fibre, both soluble and insoluble, was lower in patients with PD compared to patients with SUDD, D and C, whereas dietary vitamins A, C, D and E and Oxygen Radical Adsorbance Capacity index were lower in all DD groups compared to C. This observational study showed that DD patients have different dietary habits, mainly in terms of caloric, fat, fibre and vitamin intake, compared to control subjects. [ABSTRACT FROM AUTHOR]

Background: Despite the known advantages of minimally invasive surgery (MIS) for diverticular disease, the impact of conversions to open (CtO) colectomy remains understudied. The present study used a nationally representative database to characterize risk factors and outcomes associated with CtO in patients with diverticular disease. Methods: All elective adult hospitalizations entailing colectomy for diverticulitis were identified in the 2017–2019 Nationwide Readmissions Database. Annual institutional caseloads of MIS and open colectomy were independently tabulated. Restricted cubic splines were utilized to non-linearly estimate the risk-adjusted association between hospital volumes and CtO. Additional regression models were developed to evaluate the association of CtO with outcomes of interest. Results: Of an estimated 110,281 patients with diverticulitis who met study criteria, 39.3% underwent planned open colectomy, 53.3% completed MIS, and 7.4% had a CtO. Following adjustment, an inverse relationship between hospital MIS volume and risk of CtO was observed. In contrast, increasing hospital open volume was positively associated with greater risk of CtO. On multivariable analysis, CtO was associated with lower odds of mortality (AOR 0.3, p = 0.001) when compared to open approach, and similar risk of mortality when compared to completed MIS (AOR 0.7, p = 0.436). Conclusion: In the present study, institutional MIS volume exhibited inverse correlation with adjusted rates of CtO, independent of open colectomy volume. CtO was associated with decreased rates of mortality compared to planned open approach but equivalence risk relative to completed MIS. Our findings highlight the importance of MIS experience and suggest that MIS may be safely pursued as the initial surgical approach among diverticulitis patients. [ABSTRACT FROM AUTHOR]

Purpose: If could be a potential pathophysiological connection between colonic diverticula and colonic superficial neoplastic lesions, beyond the shared risk factors, has been a subject of debate in the last years. This study tries to evaluate the association between diverticulosis and colonic neoplastic lesions. Methods: This is a cross-sectional study including asymptomatic patients who underwent a screening colonoscopy (patients with a positive fecal occult blood test under the regional program of colorectal cancer (CRC) screening), surveillance after polypectomy resection, or familiarity (first-degree relatives) between 2020 and 2021 to evaluate the association between diverticula and colonic polyps. A multivariate analysis with multiple logistic regression and odds ratio (OR) to study the independent association between adenomas and adenocarcinomas was performed. Results: One thousand five hundred one patients were included. A statistically significant association between adenomas or CRC alone and colonic diverticula was found (p = 0.045). On a multivariate analysis of demographic (age, gender) and clinical parameters (familiarity for diverticula and adenoma/CRC), only age was significantly associated with the development of colorectal adenomas or cancer (OR 1.05, 95% CI 1.03–1.07, p < 0.0001). Conclusions: This study showed a statistically significant association between diverticula and colonic adenomas. However, it is impossible to establish a cause-effect relationship due to the intrinsic characteristics of this study design. A study with a prospective design including both patients with diverticulosis and without colonic diverticula aimed at establishing the incidence of adenoma and CRC could help to answer this relevant clinical question, since a potential association could indicate the need for closer endoscopic surveillance. [ABSTRACT FROM AUTHOR]

Introduction: Fluorescence‐guided surgery has emerged as a complement of traditional laparoscopic surgery with the advantage that is adaptable to existent platforms. The purpose of this article is to describe our technique for ureteral identification with indocyanine green (ICG) during laparoscopic colorectal surgery. Materials and Surgical Technique: We report a case series of all patients who underwent laparoscopic colorectal surgery and ureteral injection of ICG in a private third level hospital. Results: We performed 30 laparoscopic colorectal surgeries in which we used this technique to identify the ureters. Mean age was 52.6 ± 15.28 years; 16 (53.3%) were men. The indication for surgery was diverticulitis in 18 patients. Mean urological operative time was 22.4 minutes. There were no immediate or delayed adverse effects attributable to intra‐ureteral ICG administration. Discussion: Although ureteric iatrogenic injury is uncommon, when it does happen, it significantly increases the patient's morbidity. We consider this technique has the potential to make laparoscopic surgeries safer mostly in patients with cancer, diverticular disease or endometriosis who have extensive fibrosis, adhesions, and inflammation. [ABSTRACT FROM AUTHOR]

We report the case of a 71-year-old woman with multiple comorbidities who was admitted to the hospital due to hematochezia, without hemodynamic instability. Initial investigations, including colonoscopy and upper endoscopy, did not reveal the cause of bleeding. However, the patient experienced increased bleeding, anemia, and hemodynamic instability during her hospital stay. Subsequent selective angiography did not show any signs of active bleeding. In light of the persistent shock, surgical intervention was performed, which revealed blood originating from multiple diverticula in the jejunum. [ABSTRACT FROM AUTHOR]

Background/Aims Diverticular peroral endoscopic myotomy (D-POEM) is known to be a safe and feasible technique for managing diverticular diseases of the esophagus. In this study, we aim to report our experience with D-POEM and to investigate the usefulness of endoscopic functional luminal imaging probe (EndoFLIP) in determining the need for cardiomyotomy with septotomy for symptomatic epiphrenic diverticulum. Methods Consecutive patients who underwent D-POEM for symptomatic epiphrenic diverticulum between September 2019 and September 2021 were eligible for this study. EndoFLIP and high-resolution manometry results and endoscopic treatment outcomes were retrospectively investigated. Results A total of 9 patients with symptomatic epiphrenic diverticulum were included. The median size of the diverticulum and septum was 50 (interquartile range [IQR], 48-80) mm and 20 (IQR, 20-30) mm, respectively. The overall technical success rate was 100%, with a median procedure time of 60 (IQR, 46-100) minutes. The 5 patients (high-resolution manometry results; 3 normal, 1 ineffective esophageal motility, and 1 Jackhammer esophagus) who had decreased esophagogastric junction distensibility index on pre-procedure EndoFLIP underwent cardiomyotomy with septotomy regardless of the presence of esophageal motility disorders, and the distensibility index increased and normalized after procedure. The mean dysphagia score decreased from 2.0 ± 1.0 pre-procedure to 0.4 ± 0.7 during a median follow-up of 11 (IQR, 4-21) months post-procedure. No serious adverse events that required surgical intervention or delayed discharge were noted. Conclusions EndoFLIP may help decide whether to perform combined cardiomyotomy and septotomy for the treatment of an epiphrenic diverticulum. Further large-scale studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the potential correlation between muscle mass/muscle quality and risk of complications or recurrence in patients presenting with acute uncomplicated diverticulitis. It was also to study if low muscle mass/quality correlated to prolonged hospital stay. The study population comprised 501 patients admitted to Helsingborg Hospital or Skåne University Hospital between 1 January 2015 and 31 December 2017, who had been diagnosed with acute uncomplicated diverticulitis and undergone computed tomography upon admission. The scans were used to estimate skeletal muscle mass and muscle radiation attenuation (an indicator for muscle quality). Skeletal muscle index was obtained by adjusting skeletal muscle mass to the patients' height. Values of below the fifth percentile of a normal population were considered low. There were no differences between the patients with normal versus those with low skeletal muscle mass, skeletal muscle index or muscle radiation attenuation regarding risk of complications or recurrence of diverticular disease. However, as only 11 patients had complications, no conclusion as to a potential correlation can be made. Low muscle quality correlated to longer hospital stay, also when adjusting for other potential confounders. Muscle mass/quality do not seem to serve as predictor of risk for recurrent disease in patients with acute uncomplicated diverticulitis. However, low muscle radiation attenuation was associated with prolonged hospital stay. This indicates that muscle quality, assessed by computed tomography scan, might be used in clinical practise to identify patients at risk of longer hospitalisation. [ABSTRACT FROM AUTHOR]

A 71-year-old man was diagnosed with advanced non-small cell lung carcinoma and treated with chemotherapy developed ileocecal diverticulitis three times over the last 2 months of receiving second-line treatment. During the fourth diverticulitis event, the patient presented with fever and abdominal pain, worsening after 5 days. Abdominal computed tomography showed ascites and intra-abdominal free air, suggesting bowel perforation with acute diffuse peritonitis. We performed emergency surgery; the surgical findings showed diverticulosis with perforated diverticula in the ileocecal region. We performed ileocecal resection, an ileostomy and a mucous fistula of the ascending colon. Histopathological examinations revealed pseudodiverticula at the perforation, where the mucosa was depressed through the muscularis propria. Hence, we diagnosed perforated ileal diverticulitis. Repeated diverticulitis triggered by chemotherapy might have resulted in perforation. Small bowel diverticula are rare, but diverticulitis can occur in patients receiving chemotherapy and with cases of unexplained fever and abdominal pain. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We conducted a Mendelian randomization (MR) study to examine the associations of type 2 diabetes and glycemic traits with gastrointestinal diseases (GDs). RESEARCH DESIGN AND METHODS: Uncorrelated genetic variants associated with type 2 diabetes (n = 231), fasting insulin (n = 38), fasting glucose (n = 71), and hemoglobin A1c (n = 75) at the genome-wide significance were selected as instrument variables. Genetic associations with 23 common GDs were obtained from the FinnGen and UK Biobank studies and other large consortia. RESULTS: Genetic liability to type 2 diabetes was associated with the risk of 12 GDs. Per 1-unit increase in the log-transformed odds ratio (OR) of type 2 diabetes, the OR was 1.06 (95% CI, 1.03–1.09) for gastroesophageal reflux disease, 1.12 (95% CI, 1.07–1.17) for gastric ulcer, 1.11 (95% CI, 1.03–1.20) for acute gastritis, 1.07 (95% CI, 1.01–1.13) for chronic gastritis, 1.08 (95% CI, 1.03–1.12) for irritable bowel syndrome, 1.04 (95% CI, 1.01–1.07) for diverticular disease, 1.08 (95% CI, 1.02–1.14) for acute pancreatitis, 1.09 (95% CI, 1.05–1.12) for cholelithiasis, 1.09 (95% CI, 1.05–1.13) for cholelithiasis with cholecystitis, 1.29 (95% CI, 1.17–1.43) for nonalcoholic fatty liver disease, 1.12 (95% CI, 1.03–1.21) for liver cirrhosis, and 0.93 (95% CI, 0.89–0.97) for ulcerative colitis. Genetically predicted higher levels of fasting insulin and glucose were associated with six and one GDs, respectively. CONCLUSIONS: Associations were found between genetic liability to type 2 diabetes and an increased risk of a broad range of GDs, highlighting the importance of GD prevention in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

High‐grade gastroenteropancreatic neuroendocrine neoplasms (HG GEP‐NEN) typically disseminate early. Treatment of metastatic disease has limited benefit and prognosis is generally discouraging. Data on the clinical impact of mutations in HG GEP‐NEN are scarce. There is an unmet need for reliable biomarkers to predict treatment outcome and prognosis in metastatic HG GEP‐NEN. Patients with metastatic HG GEP‐NEN diagnosed at three centres were selected for KRAS‐, BRAF mutation and microsatellite instability (MSI) analyses. Results were linked to treatment outcome and overall survival. After pathological re‐evaluation, 83 patients met inclusion criteria: 77 (93%) GEP neuroendocrine carcinomas (NEC) and six (7%) GEP neuroendocrine tumours (NET) G3. NEC harboured higher frequency of mutations than NET G3. Colon NEC harboured a particular high frequency of BRAF mutations (63%). Immediate disease progression on first‐line chemotherapy was significantly higher for NEC with BRAF mutation (73%) versus wild‐type (27%) (p =.016) and for colonic primary (65%) versus other NEC (28%) (p =.011). Colon NEC had a significant shorter PFS compared to other primary sites, a finding independent of BRAF status. Immediate disease progression was particularly frequent for BRAF mutated colon NEC (OR 10.2, p =.007). Surprisingly, BRAF mutation did not influence overall survival. KRAS mutation was associated with inferior overall survival for the whole NEC population (HR 2.02, p =.015), but not for those given first‐line chemotherapy. All long‐term survivors (>24 m) were double wild‐type. Three NEC cases (4.8%) were MSI. Colon NEC with BRAF mutation predicted immediate disease progression on first‐line chemotherapy, but did not affect PFS or OS. Benefit of first‐line platinum/etoposide treatment seems limited for colon NEC, especially for BRAF mutated cases. KRAS mutations did not influence treatment efficacy nor survival for patients receiving first‐line chemotherapy. Both frequency and clinical impact of KRAS/BRAF mutations in digestive NEC differ from prior results on digestive adenocarcinoma. [ABSTRACT FROM AUTHOR]

Background: There are no specific recommendations regarding the optimalmanagement of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: Amulticenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intraabdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P=0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P=0.023), with 88% of success compared to 96% without free fluid (P<0.001). The rate of treatment failure with nonoperative management during the first year of followup was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation. [ABSTRACT FROM AUTHOR]

Background: Whether the positive associations of smoking and alcohol consumption with gastrointestinal diseases are causal is uncertain. We conducted this Mendelian randomization (MR) to comprehensively examine associations of smoking and alcohol consumption with common gastrointestinal diseases. Methods: Genetic variants associated with smoking initiation and alcohol consumption at the genome-wide significance level were selected as instrumental variables. Genetic associations with 24 gastrointestinal diseases were obtained from the UK Biobank, FinnGen study, and other large consortia. Univariable and multivariable MR analyses were conducted to estimate the overall and independent MR associations after mutual adjustment for genetic liability to smoking and alcohol consumption. Results: Genetic predisposition to smoking initiation was associated with increased risk of 20 of 24 gastrointestinal diseases, including 7 upper gastrointestinal diseases (gastroesophageal reflux, esophageal cancer, gastric ulcer, duodenal ulcer, acute gastritis, chronic gastritis, and gastric cancer), 4 lower gastrointestinal diseases (irritable bowel syndrome, diverticular disease, Crohn's disease, and ulcerative colitis), 8 hepatobiliary and pancreatic diseases (non-alcoholic fatty liver disease, alcoholic liver disease, cirrhosis, liver cancer, cholecystitis, cholelithiasis, and acute and chronic pancreatitis), and acute appendicitis. Fifteen out of 20 associations persisted after adjusting for genetically predicted alcohol consumption. Genetically predicted higher alcohol consumption was associated with increased risk of duodenal ulcer, alcoholic liver disease, cirrhosis, and chronic pancreatitis; however, the association for duodenal ulcer did not remain statistically significant after adjustment for genetic predisposition to smoking initiation. Conclusions: This study provides MR evidence supporting causal associations of smoking with a broad range of gastrointestinal diseases, whereas alcohol consumption was associated with only a few gastrointestinal diseases. Funding: The Natural Science Fund for Distinguished Young Scholars of Zhejiang Province; National Natural Science Foundation of China; Key Project of Research and Development Plan of Hunan Province; the Swedish Heart Lung Foundation; the Swedish Research Council; the Swedish Cancer Society. [ABSTRACT FROM AUTHOR]

Ureteral injury is one of the major complications related to colorectal and gynecologic procedures. Injuries are sometimes identified intraoperatively, but the diagnosis of ureteral injury is often delayed. Ureterocolic fistula is a relatively rare condition and mostly due to obstructing calculi, diverticular disease of the colon, radiotherapy, cancer, or trauma. Here in, we present a boy with an iatrogenic left ureterocolic fistula following multiple colonic surgeries that were complicated by an un-noticed left ureteric injury. This injury was not diagnosed early and the patient presented later with recurrent UTIs and decreased left differential renal function which necessitated open left nephroureterectomy. [ABSTRACT FROM AUTHOR]

Introduction: Diverticulitis is inflammation of one or more adjacent diverticulums and the surrounding colon. Patients with diverticulitis typically present with acute or subacute abdominal pain in the left lower quadrant. Most patients are over 50; however, the disease is increasingly common in the younger. Diverticulitis may present with an acute abdomen by causing intra-abdominal perforation. Although it is infrequent, diverticulitis perforation should be considered when diagnosing young patients with acute abdomen. Case Presentation: We present the case of a 23-year-old male with an acute abdomen secondary to diverticulitis perforation. The patient's physical examination and computed tomography scan were interpreted as perforation. We performed explorative laparotomy. During the operation, the stomach and other lumen organs were intact. There were diverticula in the sigmoid colon, intense inflammation in the colon serosa in the region of the diverticula, and a perforation area of 1 cm in diameter. Conclusion: Diverticulitis usually presents with abdominal pain in the left lower quadrant of the elderly patient. However, it may present with an acute abdomen by causing intra-abdominal perforation. Although it is infrequent, diverticulitis perforation should be considered in the differential diagnosis of young patients presenting with acute abdomen. [ABSTRACT FROM AUTHOR]

Introduction: Growing evidence supports the role of the intestinal microbiome in the development of different intestinal and extraintestinal diseases. Diverticular disease (DD) is one of the most common disorders in western countries. In the last years, different articles have suggested a possible role of the intestinal microbiome in DD pathogenesis and in the development of acute diverticulitis (AD). This systematic review aimed to clarify the current knowledge on the role of the intestinal microbiome in colonic diverticulitis in different stages according to the 2009 PRISMA guidelines. Materials and Methods: Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, Cochrane Oral Health Group Specialized Register, ProQuest Dissertations and Theses Database, and Google Scholar. Patients with any stage of disease were included. The Newcastle-Ottawa scale for case-control and cohort studies was used for the quality assessment of the selected articles. Results: Overall, nine studies were included in the review. Only one article was focused on patients with AD, while all other articles only considered patients with DD without acute inflammation signs. Enterobacteriaceae seems to be the microbiota most associated with the disease, followed by Bifidobacteria. Conclusions: All the included studies showed great heterogeneity in population characteristics and sampling methods. Therefore, given the high prevalence of colonic diverticulitis in the general population, further studies are needed to clarify the role of the intestinal microbiome, paving the way to new target therapies with important social implications. [ABSTRACT FROM AUTHOR]

Background: The association between diverticular disease and atherosclerotic cardiovascular disease (ASCVD) has been demonstrated previously, mainly in symptomatic subjects. Aims: To evaluate 10 years cardiovascular risk, exercise performance and association to ASCVD among subjects with asymptomatic diverticulosis. Methods: A retrospective cross-sectional cohort of self-referred participants in a medical screening program, who underwent a screening colonoscopy. Demographics, clinical and laboratory variables, ASCVD score, and metabolic equivalents (METs) during treadmill stress test were compared between subjects with and without diverticulosis as diagnosed on screening colonoscopy. Results: 4586 participants underwent screening colonoscopy; 799 (17.4%) had diverticulosis. Among 50–69 yo participants, diverticulosis subjects had a higher ASCVD score compared to non-diverticulosis subjects. Exercise performance was comparable between the groups, across all age groups. Using logistic regression analysis, advanced age group (50–59 yo Adjusted odds ratio (AOR) [95% confidence interval (CI)] 2.57 (1.52–4.34), p < 0.001; 60–69 yo, AOR 2.87 (2.09–3.95), p < 0.001; ≥ 70 yo AOR 4.81 (3.23–7.15), p < 0.001; compared to < 50 yo age group), smoking [AOR 1.27 (1.05–1.55), p = 0.016], HTN [AOR 1.27 (1.03–1.56), p = 0.022], obesity [AOR 1.36 (1.06–1.74), p = 0.014] and male sex [AOR 1.29 (1.02–1.64), p = 0.036] were associated with diverticular detection during screening colonoscopy. Among males, achieving METs score ≥ 10 was inversely associated with diverticular detection during screening colonoscopy [AOR 0.64 (0.43–0.95), p = 0.027]. Conclusions: Ten years probability for ASCVD estimated by the ASCVD score is higher among subjects with asymptomatic diverticulosis compared to subjects without diverticulosis. Improved exercise performance is demonstrated for the first time to correlate with decreased probability for diverticular disease in screening colonoscopy. [ABSTRACT FROM AUTHOR]

Background: Mesalazine is among the medications most prescribed by gastroenterologists, with variable and controversial use in different settings. We aimed to explore the use of mesalazine in the clinical practice of young gastroenterologists. Methods: A web-based electronic survey was distributed to all participants of the National Meeting of the Italian Young Gastroenterologist and Endoscopist Association. Results: A total of 101 participants took part in the survey, with a majority (54.4%) being aged >30 years, 63.4% of whom were trainees in academic hospitals, and 69.3% of whom were involved in the clinical management of inflammatory bowel disease (IBD). While both non-dedicated and IBD physicians generally agreed on the appropriate dose of mesalazine for mild ulcerative colitis (UC), significant differences were observed between the two groups for moderate-severe ulcerative colitis (UC). Additionally, in IBD patients who were starting immuno-modulators and/or biologics, 80% of IBD-dedicated physicians continued to prescribe mesalazine, compared to 45.2% of non-dedicated physicians (p = 0.002). Indeed, 48.4% of non-dedicated IBD physicians did not acknowledge mesalazine for colorectal cancer chemoprevention. With regards to Crohn's disease, it is mainly used by 30.1% of IBD physicians for preventing postoperative recurrence of Crohn's disease. Finally, 57.4% used mesalazine for symptomatic uncomplicated diverticular disease, and 84.2% did not recommend its use for irritable bowel syndrome. Conclusions: This survey showed heterogeneous behaviors in the daily use of mesalazine, mainly in the management of IBD. Educational programs and novel studies are needed to clarify its use. [ABSTRACT FROM AUTHOR]

Factors associated with serious colonic diverticular bleeding (CDB) are unclear, although the incidence of CDB has increased. We carried out this study to clarify factors associated with serious CDB and rebleeding. Subjects included 329 consecutive patients hospitalized for confirmed or suspected CDB between 2004 and 2021. Patients were surveyed regarding backgrounds, treatment, and clinical course. Of 152 with confirmed CDB, 112 showed bleeding from the right colon, and 40 did from the left colon. Patients received red blood cell transfusions in 157 (47.7%), interventional radiology in 13 (4.0%), and surgery in 6 (1.8%) cases. Early rebleeding within one month occurred in 75 (22.8%) patients, and late rebleeding within one year occurred in 62 (18.8%). Factors associated with red blood cell transfusion included confirmed CDB, anticoagulants, and high shock index. The only factor related to interventional radiology or surgery was confirmed CDB, which was also associated with early rebleeding. Late rebleeding was associated with hypertension, chronic kidney disease and past CDB. Right CDB showed higher rates of transfusion and invasive treatment than left CDB. Confirmed CDB had high frequencies of transfusion, invasive treatment, and early rebleeding. Right CDB seemed to be a risk for serious disease. Factors related to late rebleeding were different from those related to early rebleeding of CDB. [ABSTRACT FROM AUTHOR]

Background: Asymptomatic patients at average risk of developing colorectal cancer are encouraged to undergo screening colonoscopy beginning at age 45 years. While ileal intubation is often considered the gold standard for a complete colonoscopy, the relatively low diagnostic yield has prevented widespread adoption. Small bowel cancers, including neuroendocrine tumors, may present incidentally as terminal ileitis on routine colonoscopy with terminal ileum intubation. Neuroendocrine tumors, the most common primary neoplasm of the small intestine, are often asymptomatic or present as nonspecific abdominal pain in the sixth or seventh decade of life. Case Report: A 51-year-old asymptomatic male with unremarkable physical examination underwent screening colonoscopy that revealed scattered ulcerations of the terminal ileum. Immunohistochemistry of the lesion was consistent with well-differentiated neuroendocrine tumor, World Health Organization Grade I. DOTATATE positron emission tomography/computed tomography demonstrated avid adjacent right mesenteric lymph node and avid focal pancreatic body lesion. Fine-needle biopsy and immunohistochemistry of the pancreatic lesion confirmed neuroendocrine tumor, while the mesenteric lymph node was found to be benign. The patient underwent robotic-assisted ileocolic resection and has ongoing surveillance of the pancreatic lesion. Conclusion: Terminal ileitis encompasses a host of pathologic processes, including inflammatory states, infectious disease, malignancy, and vasculitis. Importantly, small bowel cancer is an increasing cause of terminal ileitis. Screening colonoscopy with ileal intubation can be a valuable tool for early detection of these lesions. [ABSTRACT FROM AUTHOR]

Jejunal diverticula are rare medical conditions with an incidence of 0.3%–2.5%, mostly discovered perioperatively. Our patient, 60 years old female, presented in an emergency with complaints of constipation, vomiting, abdominal pain, and distension. On examination, her abdomen was markedly distended with generalized tenderness. An erect abdominal X‐ray revealed multiple air‐fluid levels, which suggests small bowel obstruction. A diagnosis of jejunal diverticula was made on exploratory laparotomy. No evidence of granuloma or malignancy was seen on histopathological examination. Segmental resection of the affected jejunum was carried out, followed by end‐to‐end primary anastomosis. The patient was discharged on postoperative Day 6 with complete recovery at 2 weeks follow‐up visit. Jejunal diverticulosis can cause abdominal pain, but the association with intestinal obstruction is less commonly reported. This case report highlights the need for healthcare providers to be aware of this rare association and to consider the possibility of jejunal diverticulosis in the differential diagnosis of patients with symptoms of intestinal obstruction. [ABSTRACT FROM AUTHOR]

A 6-yr-old captive-bred male black pine snake (Pituophis melanoleucus lodingi) weighing 0.49 kg with a snout-to-vent length of 127 cm was presented for evaluation of a caudal coelomic swelling that had been present for 3 days. Survey radiographs showed focal distention of the body wall with a mass of soft tissue and mineral opacity. Anti-inflammatory and empiric antibiotic treatments were initiated, with no significant improvement. Coelomic ultrasound showed effusion and intestinal changes consistent with an intussusception. On exploratory celiotomy, the mass was found to be a 10-cm-long colonic diverticulum. A colotomy was performed and inspissated fecal material was removed from the lumen of the diverticulum prior to its resection and closing of the bowel defect. Histological examination of the excised tissue was consistent with an intestinal diverticulum and complete absence of the smooth muscle layers, indicating nonperforating rupture of the bowel wall. The snake recovered uneventfully and began eating 5 days after surgery. On physical and ultrasound examinations 8 months after surgery, the snake's body condition had improved and there was no recurrence of clinical signs, with the snake remaining normal 30 months postsurgery at home. [ABSTRACT FROM AUTHOR]

Various environmental factors affecting the human microbiota may lead to gut microbial imbalance and to the development of pathologies. Alterations of gut microbiota have been firmly implicated in digestive diseases such as hepatic encephalopathy, irritable bowel syndrome and diverticular disease. However, while these three conditions may all be related to dysfunction of the gut-liver-brain axis, the precise pathophysiology appears to differ somewhat for each. Herein, current knowledge on the pathophysiology of hepatic encephalopathy, irritable bowel syndrome, and diverticular disease are reviewed, with a special focus on the gut microbiota modulation associated with these disorders during therapy with rifaximin. In general, the evidence for the efficacy of rifaximin in hepatic encephalopathy appears to be well consolidated, although it is less supported for irritable bowel syndrome and diverticular disease. We reviewed current clinical practice for the management of these clinical conditions and underlined the desirability of more real-world studies to fully understand the potential of rifaximin in these clinical situations and obtain even more precise indications for the use of the drug. [ABSTRACT FROM AUTHOR]

There have been considerable advances in the treatment of diverticular disease in recent years. Antibiotics are frequently used to treat symptoms and prevent complications. Rifaximin, a non-absorbable antibiotic, is a common therapeutic choice for symptomatic diverticular disease in various countries, including Italy. Because of its low systemic absorption and high concentration in stools, it is an excellent medicine for targeting the gastrointestinal tract, where it has a beneficial effect in addition to its antibacterial properties. Current evidence shows that cyclical rifaximin usage in conjunction with a high-fiber diet is safe and effective for treating symptomatic uncomplicated diverticular disease, while the cost-effectiveness of long-term treatment is unknown. The use of rifaximin to prevent recurrent diverticulitis is promising, but further studies are needed to confirm its therapeutic benefit. Unfortunately, there is no available evidence on the efficacy of rifaximin treatment for acute uncomplicated diverticulitis. [ABSTRACT FROM AUTHOR]