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Alcohol Consumption Is a Risk Factor for Colonic Diverticulosis

Sharara, Ala I. MD; El-Halabi, Mustapha M. MD; Mansour, Nabil M. MD; Malli, Ahmad MD; Ghaith, Ola A. MD; Hashash, Jana G. MD; Maasri, Karim MD; Soweid, Assaad MD; Barada, Kassem MD; Mourad, Fadi H. MD; El Zahabi, Lara MD

Journal of Clinical Gastroenterology: May/June 2013 - Volume 47 - Issue 5 - p 420–425
doi: 10.1097/MCG.0b013e31826be847
ALIMENTARY TRACT: Original Articles

Background and Aim: The exact factors predisposing to colonic diverticulosis other than age are unknown.

Methods: Cross-sectional study of asymptomatic subjects undergoing screening colonoscopy. A detailed dietary and social questionnaire was completed on all participants. A worldwide review of the literature was performed to further investigate any association between identified risk factors and diverticulosis.

Results: Seven hundred forty-six consecutive individuals were enrolled (mean age, 61.1±8.3 y; female: male=0.98). Overall, the prevalence of diverticulosis was 32.8% (95% CI, 29.5-36.2). Diverticula were left-sided, right-sided, or both in 71.5%, 5.8%, and 22.7% of affected subjects, respectively. On univariate analysis, age, sex, adenomatous polyps, advanced neoplasia (adenoma≥1 cm, villous histology, or cancer), aspirin, and alcohol use were significantly associated with diverticulosis. Diet, body mass index, physical activity, and bowel habits were not associated with the disease. On multivariate analysis, increasing age (P<0.001), advanced neoplasia (P=0.021), and alcohol consumption (P<0.001) were significantly associated with diverticulosis. The adjusted odds ratio for diverticulosis in alcohol users was 1.91 (1.36 to 2.69), with increasing prevalence with higher alcohol consumption (P-value for trend=0.001). When the prevalence of diverticulosis reported from 18 countries was analyzed against alcohol use, there was a strong correlation with national per-capita alcohol consumption rates (Pearson correlation coefficient r=0.68; P=0.002).

Conclusions: Alcohol use is a significant risk factor for colonic diverticulosis and may offer a partial explanation for the existing East-West paradox in disease prevalence and phenotype. Further studies are needed to investigate this association and its putative pathophysiological mechanisms.

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Department of Internal Medicine, Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon

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Presented in part at the annual ACG meeting, Washington, DC, October 30, 2011.

The authors declare that they have nothing to disclose.

Reprints: Ala I. Sharara, MD, FACG, AGAF, Department of Internal Medicine, Division of Gastroenterology, American University of Beirut Medical Center, P.O. Box 11-0236/16-B Beirut, Lebanon (e-mail:

Received February 27, 2012

Accepted July 26, 2012

© 2013 by Lippincott Williams & Wilkins