Keck School of Medicine, Los Angeles, California.
Keck School of Medicine, Los Angeles, California.
J Surg Res. 2022 Dec;280:348-354. doi: 10.1016/j.jss.2022.07.021. Epub 2022 Aug 26.
The true prevalence and pathogenesis of diverticulosis is poorly understood. Risk factors for diverticulosis are presently unclear, with most clinicians attributing its development to years of chronic constipation. Previous studies have been limited by their failure to include young, ethnically diverse patient populations.
Patients who presented to the emergency department of our hospital from January-September 2019 and underwent abdominal computerized tomography (CT) scan for the evaluation of appendicitis were included. CT's were reviewed for the presence of diverticulosis. Risk factors for diverticulosis were determined for two age groups: >40 and ≤ 40.
A total of 359 patients were included in the study. The median age was 38.57.1% were male. 81.6% were Hispanic. 43.5% had colonic diverticulosis on CT. 198 patients (55.1%) were ≤ age 40. The rate of diverticulosis in this group was 35.3% (n = 70). Those with diverticulosis were not significantly older (median age 29 versus 27, P = 0.061) but had a higher median body mass index (BMI) (28.4 versus 25.3, P = 0.003) compared to those without diverticulosis. On multivariate analysis, no characteristics were associated with the presence of diverticulosis for this group. Over age 40, 53.4% of patients (n = 86) had diverticulosis. Patients with diverticulosis were more likely to be Hispanic (95.3% versus 73.3%, P ≤ 0.001), less likely to be Asian (2.4% versus 16.0%, P = 0.004), had a higher median BMI (28.7 versus 25.5, P ≤ 0.001), and were more likely to use alcohol (30.2% versus 14.7%, P = 0.024) than those without diverticulosis. On multivariate analysis, characteristics associated with the presence of diverticulosis were BMI >30 (odds ratio OR 2.22, 95% confidence interval CI 1.03-4.80), Hispanic ethnicity (OR 10.05, 95% CI 1.74-58.26), and alcohol use (OR 3.44, 95% CI 1.26-9.39).
There was a higher rate of asymptomatic diverticulosis in the <40 cohort than previously reported in the literature. Obesity, alcohol use, and Hispanic ethnicity were associated with the presence of diverticulosis in patients > age 40, but no risk factors for diverticulosis were identified for patients ≤ age 40, suggesting that diverticular pathogenesis may differ by age. Constipation was not a risk factor for diverticulosis in either age group. The data regarding the prevalence of diverticulosis in Hispanic patients is lacking and should be the focus of future inquiry.
憩室病的真实患病率和发病机制尚未得到充分了解。憩室病的危险因素目前尚不清楚，大多数临床医生将其发病归因于多年的慢性便秘。以前的研究因未能纳入年轻、种族多样化的患者群体而受到限制。
纳入 2019 年 1 月至 9 月期间因阑尾炎到我院急诊科就诊并接受腹部计算机断层扫描（CT）检查的患者。对 CT 进行评估以确定是否存在憩室病。为两个年龄组确定了憩室病的危险因素：>40 岁和≤40 岁。
共纳入 359 例患者。中位年龄为 38.5 岁，71.6%为男性，81.6%为西班牙裔，43.5%的患者 CT 上有结肠憩室病。198 例（55.1%）患者年龄≤40 岁，其中 35.3%（n=70）患有憩室病。憩室病患者年龄无显著差异（中位数 29 岁与 27 岁，P=0.061），但 BMI 中位数较高（28.4 与 25.3，P=0.003）。多变量分析显示，对于该组患者，无特征与憩室病的存在相关。40 岁以上患者中，53.4%（n=86）有憩室病。憩室病患者更可能是西班牙裔（95.3%比 73.3%，P≤0.001），亚洲裔的可能性较小（2.4%比 16.0%，P=0.004），BMI 中位数较高（28.7 比 25.5，P≤0.001），更可能使用酒精（30.2%比 14.7%，P=0.024）。多变量分析显示，与憩室病存在相关的特征包括 BMI>30（比值比 OR 2.22，95%置信区间 CI 1.03-4.80）、西班牙裔（OR 10.05，95%CI 1.74-58.26）和酒精使用（OR 3.44，95%CI 1.26-9.39）。
<40 岁患者中无症状憩室病的发生率高于文献报道。肥胖、饮酒和西班牙裔与 40 岁以上患者憩室病的发生相关，但未确定≤40 岁患者憩室病的危险因素，提示憩室病的发病机制可能因年龄而异。在两个年龄组中，便秘都不是憩室病的危险因素。关于西班牙裔患者憩室病患病率的数据尚缺乏，应成为未来研究的重点。
