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Diverticulosis, Symptoms and Colonic Inflammation

A Population-Based Colonoscopy Study

Järbrink-Sehgal, Maria Ellionore MD, PhD1,2; Rassam, Loui MD, MRChB, FRCPA3,4; Jasim, Aws MD, MRChB, FRCPA3,5; Walker, Marjorie M. MD, BMBS FRCPA3,4; Talley, Nicholas J. MD, PhD3,6; Agréus, Lars MD, PhD6; Andreasson, Anna PhD1,7,8,9; Schmidt, Peter T. MD, PhD1,9

American Journal of Gastroenterology: March 2019 - Volume 114 - Issue 3 - p 500–510
doi: 10.14309/ajg.0000000000000113

INTRODUCTION: Low-grade chronic inflammation has been suggested to play a role in uncomplicated asymptomatic and symptomatic diverticular disease. However, population-based studies are lacking. We investigated whether community participants with diverticulosis, with or without symptoms, would have colonic inflammation on histology and serology.

METHODS: In a nested case–control study of 254 participants from the population-based colonoscopy (PopCol) study, colonic histological inflammatory markers and serological C-reactive protein levels were analyzed in cases with diverticulosis and controls without diverticulosis. Statistical methods included logistic and linear regression models.

RESULTS: Background variables including age (P = 0.92), sex (P = 1.00), body mass index (P = 0.71), smoking (P = 0.34), and recent antibiotic exposure (P = 0.68) were similar between cases and controls. Cases reported more abdominal pain (P = 0.04) and diarrhea symptoms (mushy and high-frequency stools) than controls (P = 0.01 and P = 0.03, respectively) but were otherwise similar. The median C-reactive protein levels were similar among cases and controls [1.05 mg/L (0.3, 2.7) vs 0.8 (0.4, 2.2), P = 0.53]. There was a trend of increased numbers of cecal lymphoid aggregates in cases vs controls (P = 0.07), but no other associations between diverticulosis and inflammatory markers on histology were found. Similarly, no serological or mucosal inflammation was associated with symptomatic cases of diarrhea or abdominal pain vs asymptomatic controls.

CONCLUSIONS: In a general community sample, both asymptomatic and symptomatic diverticulosis are not associated with colonic mucosal inflammation. Other explanations for symptomatic colonic diverticulosis need to be identified.

1Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden;

2Department of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA;

3Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia;

4Inifinity Path, Brisbane, Queensland, Australia;

5Anatomical Pathology, PathWest, Fiona Stanley Hospital, Murdoch, Western Australia, Australia;

6Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden;

7Stress Research Institute, Stockholm University, Stockholm, Sweden;

8Department of Psychology, Macquarie University, North Ryde, NSW, Australia;

9Center for Digestive Diseases Karolinska University Hospital, Stockholm, Sweden.

Correspondence: Maria Ellionore Järbrink-Sehgal, MD. E-mail: or

SUPPLEMENTARY MATERIAL accompanies this paper at

Received July 17, 2018

Accepted November 29, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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