Findings on Colonoscopy after Diverticulitis: A Multicenter Review

2019 ◽  
Vol 85 (12) ◽  
pp. 1381-1385 ◽  
Author(s):  
Adam Studniarek ◽  
Kunal Kochar ◽  
Christina Warner ◽  
Saleh Eftaiha ◽  
Sandra Naffouj ◽  
...  
Keyword(s):  
Diverticular Disease ◽  
Acute Diverticulitis ◽  
Teaching Hospitals ◽  
Average Risk ◽  
Major Teaching ◽  
History Of ◽  
Advanced Adenomas ◽  
Current Guidelines ◽  
Villous Adenomas ◽  
Serrated Adenomas

Diverticular disease is a common problem where patients with diverticulosis have a 1–4 per cent risk of acute diverticulitis. Current guidelines recommend a colonoscopy after.the resolution of acute diverticulitis. The aim of this study was to evaluate the yield of significant findings on colonoscopy after an episode of diverticulitis. This is a retrospective analysis of patients who underwent colonoscopy after an episode of diverticulitis between November 2005 and August 2017 at three major teaching hospitals. Advanced adenomas were defined as adenomas ≥1 cm, serrated adenomas, and tubulovillous or villous adenomas. A total of 584 patients (298 males; 51%) underwent colonoscopy for a history of diverticulitis after resolution of acute symptoms. Colonoscopy was complete in 488 patients (84%). Among these 488 patients, 446 had diverticular disease, 31 had advanced adenomas, and four had adenocarcinomas. Colonoscopies were incomplete in 96 patients (16%). Forty-six of those patients underwent surgery. The overall incidence of advanced adenomas and adenocarcinomas was 32 (5.4%) and nine (1.5%), respectively. In our study, the prevalence of advanced adenomas and adenocarcinomas was relatively high compared with the average risk individuals. Our findings support that patients after an episode of diverticulitis should continue to get a colonoscopy.

scholarly journals The Prevalence of Adenomas, AAs, and CRCs in Colonoscopy Screening Among Average-Risk Individuals in China

2021 ◽  
Author(s):  
Yan Gong ◽  
Yansong Zheng ◽  
Rilige Wu ◽  
Miao Liu ◽  
Hong Li ◽  
...  
Keyword(s):  
Age Groups ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Number Of Patients ◽  
High Prevalence ◽  
Male Sex ◽  
Advanced Adenomas ◽  
Old Men ◽  
Number Of Individuals ◽  
Serrated Adenomas

Abstract Background: Screening colonoscopy has historically been recommended starting at the age of 50. However, the recommended age for beginning screening has recently been reduced to 45 independent of sex. However, studies on screening colonoscopies of average-risk individuals in China are sparse. This study aimed to determine and compare the prevalence of adenomas, advanced adenomas (AAs), and colorectal cancers (CRCs) and the number of individuals needing screening in an average-risk Chinese population of different ages and sexes.Methods: A total of 53,152 individuals undergoing colonoscopy were included from January 2013 to December 2019. We analysed and compared the prevalence of adenomas, AAs, and CRCs and the number of individuals needing screening in different age groups of men and women.Results: The average age of males was 48.80 years (SD, 8.47 years), that of females was 50.00 years (SD, 9.00 years), and the sex ratio was 66.28% (n=35,226) vs. 33.72% (n=17,926). The prevalence of adenomas, AAs, serrated adenomas and CRCs was 14.51% ([95% CI 14.21–14.81], n=7713), 3.04% ([95% CI 2.90–3.19], n=1617), 1.23% ([95% CI 1.01–1.32], n=653) and 0.59% ([95% CI 0.52–0.65], n=313), respectively. Male sex was significantly associated with a high prevalence of adenomas (17.14% [95% CI 16.74–17.53] vs 9.36% [95% CI 8.94–9.79], P<0.001), AAs (3.67% [95% CI 3.47–3.87] vs 1.81% [95% CI 1.61–2.00], P<0.001) and serrated adenomas (1.56% [95% CI 1.43–1.69] vs. 0.59% [95% CI 0.47–0.70], P<0.001). The prevalence of AAs in 45- to 49-year-old individuals was 3.17% (95% CI 2.80–3.55) in men and 1.49% (95% CI 1.12–1.86) in women. The number of men needing screening(NNS) was 31.55 (95% CI 28.17–35.71), while the number of women was 67.11 (95% CI 53.76–89.29). The prevalence and number of patients needing screening for AAs in men aged 45–49 years were close to those in women aged 65–69 years (31.55 [95% CI, 28.17–35.71] vs. 29.07 [95% CI, 21.05–46.73]).Conclusions: The prevalence of adenomas, AAs, and serrated adenomas increased with age. Males had a higher prevalence rate than females. The prevalence and NNS of AAs in 45- to 49-year-old men were close to those in 65- to 69-year-old women.

scholarly journals DICA endoscopic classification: 2-year analysis from an international, multicenter prospective study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Nasi ◽  
A Tursi ◽  
F Di Mario ◽  
W Elisei ◽  
M Picchio ◽  
...  
Keyword(s):  
Prospective Study ◽  
Diverticular Disease ◽  
Acute Diverticulitis ◽  
Women Patients ◽  
Chemical Abuse ◽  
Bowel Diseases ◽  
History Of ◽  
Endoscopic Classification ◽  
Inflammatory Bowel ◽  
Multicenter Prospective Study

Abstract Background Diverticulosis of the colon is the most frequent anatomical alteration detected during colonoscopy. The endoscopic classification “DICA”(Diverticular Inflammation and Complication Assessment) has been recently developed in order to have an objective endoscopic description of the colon harbouring diverticula. Aim of this multicentre, international, prospective study was to assess the predictive value of this classification in term of acute diverticulitis and surgery occurrence on a 2-year observational follow-up period. Methods 2215 prospective patients at the first diagnosis of diverticular disease were enrolled after exclusion of radiological signs of acute diverticulitis; inflammatory bowel diseases; ischemic colitis; prior colonic resection; patients with severe liver failure (Child-Pugh C) or severe kidney failure; pregnant women; patients who are currently using or who have received any laxative agents or mesalazine or probiotics or antibiotics &lt; 2 weeks prior to the enrollment; inability to comply with study protocol; patients with or history of cancer, of any origin, within 5 years before enrollment; history of alcohol, drug, or chemical abuse. Results 1377(62.15%) patients were classified as DICA 1, 599(27,04%) as DICA 2 and 239(10.80%) as DICA 3. The risk of acute diverticulitis occurrence/recurrence, as well as the risk of surgery, were significantly linked to the severity of DICA score at entry. Overall, acute diverticulitis occurred in 123 (5,5%) patients: it occurred in 32 (2,3%) DICA 1, 53 (8,9%) DICA 2 and 32 (16.4%) DICA 3 patients respectively (p &lt; 0,0001). Overall, surgery occurred in 35 (1,6%) patients: it occurred in 2 (0.1%) DICA1, 15 (2,5%) DICA 2 and 18 (7,6%) DICA 3 patients respectively (p &lt; 0,0001). Conclusions The 2-year results of this prospective study seems to confirm that DICA endoscopic classification has a significant prognostic role on the risk of acute diverticulitis occurrence/recurrence and surgery in these patients. Key messages DICA is the first endoscopic classification of diverticular disease. The risk of occurrence/recurrence of acute diverticulitis and the risk of surgery are strictly linked to the severity of DICA score.

scholarly journals Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1288
Author(s):  
Marilia Carabotti ◽  
Francesca Falangone ◽  
Rosario Cuomo ◽  
Bruno Annibale
Keyword(s):  
Systematic Review ◽  
Diverticular Disease ◽  
Dietary Habits ◽  
Acute Diverticulitis ◽  
High Quality ◽  
Eligibility Criteria ◽  
Diverticular Bleeding ◽  
Recurrent Diverticulitis ◽  
Increased Risk

Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the effect of dietary habits in the prevention of diverticula complications (i.e., acute diverticulitis and diverticula bleeding) in patients with diverticula disease. PubMed and Scopus databases were searched up to 19 January 2021, 330 records were identified, and 8 articles met the eligibility criteria and were subjected to data extraction. The quality of the studies was evaluated by the Newcastle-Ottawa quality assessment form. No study meets the criteria for being a high-quality study. A high intake of fiber was associated to a decreased risk of diverticulitis or hospitalization due to diverticular disease, with a protective effect for fruits and cereal fiber, but not for vegetable fiber; whereas, a high red meat consumption and a generally Western dietary pattern were associated with an increased risk of diverticulitis. Alcohol use seemed to be associated to diverticular bleeding, but not to recurrent diverticulitis or diverticular complications. Further high-quality studies are needed to better define these associations. It is mandatory to ascertain the role of dietary habits for the development of recurrent acute diverticulitis and diverticular bleeding.

Retrospective Review of Multitarget Stool DNA as a Screening Test for Colorectal Cancer

2021 ◽  
pp. 000313482110318
Author(s):  
Thomas K. Kleinschmidt ◽  
Austin Clements ◽  
Mark A. Parker ◽  
Steven D. Scarcliff
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Retrospective Review ◽  
Screening Test ◽  
Hyperplastic Polyps ◽  
Dna Testing ◽  
History Of ◽  
Stool Dna ◽  
Stool Dna Testing ◽  
Advanced Adenomas

Objectives To review the effectiveness of noninvasive multitarget stool DNA testing as a screening test for colorectal cancer. Methods We performed a retrospective review of patients referred to 2 high volume outpatient procedural centers for colonoscopy for positive Cologuard test. Positive findings for colorectal cancer based on pathologic findings and also advanced adenomas were recorded. Positive predictive value (PPV) was assessed. Results Of the 1585 patients evaluated and referred for colonoscopy from January 1, 2018 to November 1, 2019, for ICD-10 codes R19.5 (other fecal abnormalities) and K92.1 (melena), 84 were referred for a positive Cologuard test. Out of the 84, 6 were excluded based on family history of colon cancer in first degree relative or personal history of inflammatory bowel disease. Of the remaining 78 patients, 1 patient (1.3%) had colorectal cancer and 5 (6.4%) had advanced adenomas (>1 cm size, high grade dysplasia or villous). Postive predictive value for colorectal cancer was 1.3% and for precancerous lesions plus colorectal cancer was 7.7%. A total of 53 (68.0%) patients had either totally normal colonoscopy or hyperplastic polyps. Out of the 78 individuals in our study, 70 (89.7%) had normal findings, hyperplastic polyps, or non-advanced adenomas. Conclusions Multitarget stool DNA testing carries an unacceptably low PPV to be utilized as a screening test for colorectal cancer. The study fails to detect both adenomas and colon cancer at a higher rate than screening colonoscopy in selected studies. The advantage of being noninvasive has been noted to increase colorectal cancer screening in otherwise non-compliant Medicare patients.

scholarly journals Gut Microbiota and Acute Diverticulitis: Role of Probiotics in Management of This Delicate Pathophysiological Balance

2021 ◽  
Vol 11 (4) ◽  
pp. 298
Author(s):  
Andrea Piccioni ◽  
Laura Franza ◽  
Mattia Brigida ◽  
Christian Zanza ◽  
Enrico Torelli ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Diverticular Disease ◽  
Acute Diverticulitis ◽  
Bacterial Species ◽  
Mucosal Inflammation ◽  
Abdominal Symptoms ◽  
Pubmed Database ◽  
Anti Inflammatory ◽  
Key Terms

How can the knowledge of probiotics and their mechanisms of action be translated into clinical practice when treating patients with diverticular disease and acute diverticulitis? Changes in microbiota composition have been observed in patients who were developing acute diverticulitis, with a reduction of taxa with anti-inflammatory activity, such as Clostridium cluster IV, Lactobacilli and Bacteroides. Recent observations supported that a dysbiosis characterised by decreased presence of anti-inflammatory bacterial species might be linked to mucosal inflammation, and a vicious cycle results from a mucosal inflammation driving dysbiosis at the same time. An alteration in gut microbiota can lead to an altered activation of nerve fibres, and subsequent neuronal and muscular dysfunction, thus favoring abdominal symptoms’ development. The possible role of dysbiosis and mucosal inflammation in leading to dysmotility is linked, in turn, to bacterial translocation from the lumen of the diverticulum to perivisceral area. There, a possible activation of Toll-like receptors has been described, with a subsequent inflammatory reaction at the level of the perivisceral tissues. Being aware that bacterial colonisation of diverticula is involved in the pathogenesis of acute diverticulitis, the rationale for the potential role of probiotics in the treatment of this disease becomes clearer. For this review, articles were identified using the electronic PubMed database through a comprehensive search conducted by combining key terms such as “gut microbiota”, “probiotics and gut disease”, “probiotics and acute diverticulitis”, “probiotics and diverticular disease”, “probiotics mechanism of action”. However, the amount of data present on this matter is not sufficient to draw robust conclusions on the efficacy of probiotics for symptoms’ management in diverticular disease.

scholarly journals Characterizations of Clinical Isolates of Clostridium difficile by Toxin Genotypes and by Susceptibility to 12 Antimicrobial Agents, Including Fidaxomicin (OPT-80) and Rifaximin: a Multicenter Study in Taiwan

2012 ◽  
Vol 56 (7) ◽  
pp. 3943-3949 ◽  
Author(s):  
Chun-Hsing Liao ◽  
Wen-Chien Ko ◽  
Jang-Jih Lu ◽  
Po-Ren Hsueh
Keyword(s):  
Clostridium Difficile ◽  
Care Setting ◽  
Antimicrobial Agents ◽  
Teaching Hospitals ◽  
Binary Toxin ◽  
Content Type ◽  
Vancomycin Mics ◽  
Major Teaching ◽  
Southern Taiwan

ABSTRACTA total of 403 nonduplicate isolates ofClostridium difficilewere collected at three major teaching hospitals representing northern, central, and southern Taiwan from January 2005 to December 2010. Of these 403 isolates, 170 (42.2%) were presumed to be nontoxigenic due to the absence of genes for toxins A or B or binary toxin. The remaining 233 (57.8%) isolates carried toxin A and B genes, and 39 (16.7%) of these also had binary toxin genes. The MIC90of all isolates for fidaxomicin and rifaximin was 0.5 μg/ml (range, ≤0.015 to 0.5 μg/ml) and >128 μg/ml (range, ≤0.015 to >128 μg/ml), respectively. All isolates were susceptible to metronidazole (MIC90of 0.5 μg/ml; range, ≤0.03 to 4 μg/ml). Two isolates had reduced susceptibility to vancomycin (MICs, 4 μg/ml). Only 13.6% of isolates were susceptible to clindamycin (MIC of ≤2 μg/ml). Nonsusceptibility to moxifloxacin (n= 81, 20.1%) was accompanied by single or multiple mutations ingyrAandgyrBgenes in all but eight moxifloxacin-nonsusceptible isolates. Two previously unreportedgyrBmutations might independently confer resistance (MIC, 16 μg/ml), Ser416 to Ala and Glu466 to Lys. Moxifloxacin-resistant isolates were cross-resistant to ciprofloxacin and levofloxacin, but some moxifloxacin-nonsusceptible isolates remained susceptible to gemifloxacin or nemonoxacin at 0.5 μg/ml. This study found the diversity of toxigenic and nontoxigenic strains ofC. difficilein the health care setting in Taiwan. All isolates tested were susceptible to metronidazole and vancomycin. Fidaxomicin exhibited potentin vitroactivity against all isolates tested, while the more than 10% of Taiwanese isolates with rifaximin MICs of ≥128 μg/ml raises concerns.

scholarly journals The Natural History of Incidental Colonic Diverticulosis on Screening Colonoscopy

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Ala I. Sharara ◽  
Nathalie Ziade ◽  
Rani H. Shayto ◽  
Luma Basma O. Rustom ◽  
Hamed Chehab ◽  
...  
Keyword(s):  
Natural History ◽  
Acute Diverticulitis ◽  
Screening Colonoscopy ◽  
Colonic Diverticulosis ◽  
Diverticular Bleeding ◽  
Cross Sectional ◽  
Acute Case ◽  
Probable Case ◽  
History Of ◽  
Study Population

Background. The natural history of colonic diverticulosis is unclear.Methods. Patients with incidental diverticulosis identified in a previous prospective cross-sectional screening colonoscopy study were evaluated retrospectively for clinic or hospital visit(s) for diverticular disease (DD= acute diverticulitis or diverticular bleeding) using review of electronic health records and patient phone interview.Results. 826 patients were included in the screening colonoscopy study. Three were excluded for prior DD. In all, 224 patients (27.2%; mean age 62.3 ± 8.2) had incidental diverticulosis distributed in the left colon (67.4%), right colon (5.8%), or both (22.8%). Up-to-date information was available on 194 patients. Of those, 144 (74.2%) could be reached for detailed interview and constituted the study population. Over a mean follow-up of 7.0 ± 1.7 years, DD developed in 6 out of 144 patients (4.2%) (4 acute cases of diverticulitis, 1 probable case of diverticular bleeding, and 1 acute case of diverticulitis and diverticular bleeding). Two patients were hospitalized, and none required surgery. The time to event was 5.1 ± 1.6 years and the incidence rate was 5.9 per 1000 patient-years. On multivariate analysis, none of the variables collected at baseline colonoscopy including age, gender, obesity, exercise, fiber intake, alcohol use, constipation, or use of NSAIDs were associated with DD.Conclusion. The natural history of incidental diverticulosis on screening colonoscopy was highly favorable in this well-defined prospectively identified cohort. The common scenario of incidental diverticulosis at screening colonoscopy makes this information clinically relevant and valuable to physicians and patients alike.

scholarly journals From the “ancestar” of turtles to the turtle-mouse: when Greek words are used for turtle taxon names

2015 ◽  
Author(s):  
Evangelos Vlachos
Keyword(s):  
Zoological Nomenclature ◽  
Alternative Systems ◽  
Proper Name ◽  
History Of ◽  
Greek Alphabet ◽  
Scientific Results ◽  
The Times ◽  
Animal Size ◽  
Current Guidelines ◽  
Phylogenetic Nomenclature

Background. Regardless using a rank-based or a phylogenetic nomenclature code, the use of Latinized binomens to describe the extant and extinct species has been essential. Ever since the times of Linnaeus, the use of Latinized Greek names has been a common practice both for neontologists and paleontologists. Methods. I critically analyzed the most common Greek words used as taxa names in the chelonian literature to establish their etymology and check whether the transliteration process has been done correctly. I also compared the current guidelines for the latinisation of Greek words recommended by the International Code of Zoological Nomenclature, with other alternative systems for the transformation of names formed in the Greek alphabet into Latin-based languages. Results. The preliminary results show that some Greek words (e.g. Chelone, Emys) dominate the chelonian nomenclature, but the history of the application of many of those names is intriguing. The use of Greek words is quite common in turtle taxa names when the name describes physical properties of the animal (size, shape, colour). However, several unfortunate examples exist, as some quite successful and famous names contain misspellings or poor choice of words that resulted in meanings opposite from the ones intended by the authors. Discussion. Naming species is an integral part of the research of both neontologists and palaeontologists, but the application of Greek words to life sciences is even far more extensive, applied to numerous terminologies as well. Forming a proper name for a taxon could aid significantly to the communication and interpretation of the scientific results. Publishing a new name requires a sense of responsibility as well, as the formation of a taxon name is a unique linguistic procedure. But in the end, to add a taxonomic side to the old shakespearean question, is not the name that is important, but the information it conveys. That which we call a turtle by any other name would be as unique.

scholarly journals Non-invasive colorectal cancer screening

2016 ◽  
Vol 85 (2) ◽  
pp. 29-31
Author(s):  
Melissa Holdren ◽  
Brittany Deller ◽  
Kevin Braden
Keyword(s):  
Colorectal Cancer ◽  
Developmental Process ◽  
Population Based ◽  
Adenomatous Polyps ◽  
Morbidity And Mortality ◽  
Screening Tests ◽  
Average Risk ◽  
Screening Programs ◽  
Asymptomatic Patients ◽  
Advanced Adenomas

Colorectal cancer (CRC) is a major cause of morbidity and mortality throughout the world and is the second most common cause of Canadian cancer-related deaths in men and the third most common in women. Most CRC appears to arise from the gradual development and advancement of colonic adenomatous polyps to cancerous tissue. This developmental process of CRC is the rationale for screening programs which aim to reduce CRC-related morbidity and mortality by early detection and removal of adenomatous polyps, specifically advanced adenomas. Although both the gFOBT and FIT function to detect occult bleeding in asymptomatic patients at average risk for CRC development, the mechanisms of these screening tests are distinct. gFOBT works by detecting the peroxidase activity of heme whereas FIT selectively detects human hemoglobin. The sensitivity in detecting CRC is higher for the FIT, with sensitivity of 0.79 compared to gFOBT with sensitivity of 0.36, they have similar specificities of 0.94 and 0.96, respectively. Currently, both the gFOBT and FIT are strongly recommended across Canada, with all provinces using the FIT, apart from Ontario and Manitoba which currently use the gFOBT to screen asymptomatic patients for CRC. A newer test, the sDNA test, identifies mutations in DNA that are shed by both adenomatous polyps and CRC cells. The sDNA test is more sensitive (0.92 95% CI 0.83-0.98) than both the gFOBT and FIT, however, is less specific and more expensive. Further data surrounding the sDNA test will be required prior to its implementation and recommendation for population based CRC screening in Canada. 

scholarly journals Expanding the search for germline pathogenic variants for breast cancer. How far should we go and how high should we jump? The missed opportunity!

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Hikmat Abdel-Razeq
Keyword(s):  
Breast Cancer ◽  
Brca1 And Brca2 ◽  
Healthy Women ◽  
Panel Testing ◽  
Pathogenic Variants ◽  
Gene Panel Testing ◽  
History Of ◽  
Risk Reducing ◽  
Current Guidelines ◽  
Missed Opportunity

Since the identification of BRCA1 and BRCA2 genes 3 decades ago, genetic testing and genetic counseling have become an integral part of routine clinical practice. The risk of breast cancer among carriers of germline pathogenic variants, like BRCA1 and BRCA2, is well established. Risk-reducing interventions, including bilateral mastectomies and salpingo-oophorectomies are both effective and have become more acceptable. Many researchers and professional societies view current guidelines as restrictive and may miss many at-risk women, and are calling to expand testing to include all patients with breast cancer, regardless of their personal or family history of cancer, while others are calling for wider adoption to even include all healthy women at age 30 or older. This review will address expanding testing in two directions; horizontally to include more patients, and even healthy women, and vertically to include more genes using next-generation sequencing-based multi-gene panel testing.

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