Pathophysiology of Diverticular Disease
Pathophysiology of Diverticular Disease
Colonic diverticular disease is a highly prevalent condition in Western populations. The
 prevalence increases age-dependently from 5% at 40 years to 65% by the age of 85 years (1-3).
 The majority remain asymptomatic. However, a significant proportion of the patient population
 develops complications, such as diverticulitis with or without symptoms (10-20%) (1, 4-10).
 Perforated diverticulitis is rare with an estimated incidence of 4 per 100.000 per year, but
 the associated mortality rate is 22% to 39% (9, 11, 12). In the United States, the
 complications related to diverticular disease account for 130.000 hospitalizations each year,
 resulting in substantial health care costs (13). In Europe, it is estimated that
 approximately 23.600 deaths per year can be attributed to complicated diverticular disease,
 and the mortality will probably increase in the future due to the aging population (15-17).
 Several case studies report an overall increase in the incidence of diverticulitis, based on
 the increase in hospitalizations (18). Kang et al, reported a 16% increased male admission
 rate and 12% female admission rate for diverticulitis, between 1989/1990 and 1999/2000 (19).
 Aging and the Western diet, low in fiber and high in fat, in combination with increased
 intraluminal pressure and alterations in colonic motility are considered important
 etiological factors. A disturbance in large bowel motility is suggested to be a common
 pathophysiological feature in IBS and diverticular disease (20, 21). Based on observations
 that IBD, subgroups of IBS and (symptomatic) diverticular disease share clinical symptoms,
 the hypothesis is derived that they might also share pathophysiological factors like low
 grade inflammation, changed microbiota composition and activity, and increased intestinal
 permeability. The identification of clinical and pathophysiological factors associated with
 an increased risk for complicated diverticular disease may help to identify patients with
 diverticular disease, prevent complications, develop strategies to improve quality of life
 and reduce the related health care costs. Therefore we aim to investigate the composition of
 luminal and mucosal intestinal microbiota and the intestinal permeability in the development
 of diverticular disease and complicated diverticular disease. We hypothesize that both the
 intestinal microbiota and intestinal permeability are altered in patients with (current- or
 previous history of complicated) diverticular disease.
Inclusion Criteria:

 -  Age ≥ 50 years and ≤ 75 years

 -  Scheduled for colonoscopy

 -  Written informed consent

 -  Patient group: The presence of diverticulosis, diagnosed during the scheduled
 colonoscopy

 -  Control group: During the scheduled colonoscopy, diverticulosis or other

 -  gastrointestinal and liver diseases are absent. In other words, the

 -  colonoscopy is qualified as a 'normal' colonoscopy.

 Exclusion Criteria:

 -  Age < 18 years

 -  Presence of gastrointestinal and liver diseases, such as inflammatory bowel disease.

 -  Use of NSAID's and proton pump inhibitors, during the 5-day time period prior to
 endoscopy.

 -  Alcohol intake above 14 consumptions per week for males and 7 consumption per week for
 females

 -  (Sub)total colectomy or hemicolectomy.

 -  Refusal to participate in this study