Rispo Antonio, Pasquale Luigi, Cozzolino Antonio, Di Girolamo Elena, De Palma Giovanni Domenico, Grassia Roberto, Compagna Alessandro, Chierchia Maria Rosaria, Castiglione Fabiana
Gastroenterology, University Federico II of Naples, Naples, Italy.
Dis Colon Rectum. 2007 Aug;50(8):1164-8. doi: 10.1007/s10350-007-0218-5.
Colonic diverticulosis is characterized by abnormal thickening of the bowel wall, associated with luminal overpressure and increase of sigmoid contractility. However, patients with ulcerative colitis show chronic inflammatory alterations determining a reduction of both bowel wall muscle tone and contractility. Thus, we could presume ulcerative colitis and colonic diverticulosis as two pathophysiologically and mutually excluding diseases. This study was designed to evaluate the prevalence of colonic diverticulosis in patients with ulcerative colitis compared with a control endoscopic population.
We prospectively analyzed the prevalence of colonic diverticulosis in 85 patients, older than aged 45 years, with known ulcerative colitis compared with that in 85 age/gender-matched patients without colitis. All patients underwent pancolonoscopy with ulcerative colitis and colonic diverticulosis diagnosis made by endoscopy and histopathology. The patients with ulcerative colitis also were divided in three subgroups according to the age at diagnosis (<30 years, 30-45 years, >45 years) and extension of disease (sigmoiditis, left colitis, extensive colitis).
Colonic diverticulosis was present in 7 of 85 patients with and in 24 patients without ulcerative colitis (8.2 vs. 28.2 percent; P < 0.001; relative risk, 3.4; 95 percent confidence interval, 1.56-7.52). All seven patients with both diseases were diagnosed with ulcerative colitis when older than age 45 years. No differences were found between the two groups in terms of extension of diverticula.
Patients with ulcerative colitis show a significantly lower prevalence of colonic diverticulosis, with this finding probably reflecting the motor alterations caused by chronic bowel wall inflammation. In the patients affected by ulcerative colitis with late onset of the disease, the reduced prevalence of colonic diverticulosis is not evident.
结肠憩室病的特征是肠壁异常增厚，与管腔内压力过高及乙状结肠收缩性增加有关。然而，溃疡性结肠炎患者表现出慢性炎症改变，导致肠壁肌张力和收缩性均降低。因此，我们可以假定溃疡性结肠炎和结肠憩室病是两种在病理生理上相互排斥的疾病。本研究旨在评估溃疡性结肠炎患者中结肠憩室病的患病率，并与对照内镜检查人群进行比较。
我们前瞻性分析了85例年龄大于45岁的已知溃疡性结肠炎患者中结肠憩室病的患病率，并与85例年龄和性别匹配的无结肠炎患者进行比较。所有患者均接受全结肠镜检查，溃疡性结肠炎和结肠憩室病通过内镜检查和组织病理学诊断。溃疡性结肠炎患者还根据诊断时的年龄（<30岁、30 - 45岁、>45岁）和疾病范围（乙状结肠炎、左半结肠炎、广泛性结肠炎）分为三个亚组。
85例溃疡性结肠炎患者中有7例存在结肠憩室病，85例无溃疡性结肠炎患者中有24例存在结肠憩室病（8.2%对28.2%；P < 0.001；相对风险，3.4；95%置信区间，1.56 - 7.52）。所有7例同时患有这两种疾病的患者在45岁以后被诊断为溃疡性结肠炎。两组在憩室范围方面未发现差异。
溃疡性结肠炎患者中结肠憩室病的患病率显著较低，这一发现可能反映了慢性肠壁炎症引起的运动改变。在疾病发病较晚的溃疡性结肠炎患者中，结肠憩室病患病率降低并不明显。
