Original article
Alimentary tract
Distribution and Characteristics of Colonic Diverticula in a United States Screening Population

https://doi.org/10.1016/j.cgh.2016.01.020Get rights and content

Background & Aims

Colonic diverticula are the most common finding from colonoscopy examinations. Little is known about the distribution of colonic diverticula, which are responsible for symptomatic and costly diverticular disease. We aimed to assess the number, location, and characteristics of colonic diverticula in a large US screening population.

Methods

We analyzed data from a prospective study of 624 patients (mean age, 54 years) undergoing screening colonoscopy at the University of North Carolina Hospital from 2013 through 2015. The examination included a detailed assessment of colonic diverticula. To assess the association between participant characteristics and diverticula, we used logistic regression to estimate odds ratios and 95% confidence intervals.

Results

Of our population, 260 patients (42%) had 1 or more diverticula (mean number, 14; range, 1–158). Participants with diverticula were more likely to be older, male, and have a higher body mass index than those without diverticula. The distribution of diverticula differed significantly by race. Among white persons, 75% of diverticula were in the sigmoid colon, 11% in the descending splenic flexure, 6% in the transverse colon, and 8% were in the ascending colon or hepatic flexure. In black persons 64% of diverticula were in the sigmoid colon, 8% in the descending colon or splenic flexure, 7% in the transverse colon, and 20% in the ascending colon or hepatic flexure (P = .0008). The proportion of patients with diverticula increased with age: 35% were 50 years or younger, 40% were 51–60 years, and 58% were older than 60 years. The proportion of patients with more than 10 diverticula increased with age: 8% were 50 years or younger, 15% were 51–60 years, and 30% were older than 60 years.

Conclusions

Older individuals not only have a higher prevalence of diverticula than younger individuals, but also a greater density, indicating that this is a progressive disease. Black persons have a greater percentage of their diverticula in the proximal colon and fewer in the distal colon compared with white persons. Understanding the distribution and determinants of diverticula is the first step in preventing diverticulosis and its complications.

Section snippets

Methods

The purpose of this study was to assess risk factors associated with colonic diverticula (National Institutes of Health, R01DK094738). In brief, the study recruited outpatients between 2013 and 2015 undergoing a first-time screening colonoscopy at the University of North Carolina Hospital in Chapel Hill, North Carolina. Eligible participants were 30 years and older, had a satisfactory preparation for colonoscopy, and a complete examination to the cecum. Exclusion criteria included any prior

Results

Our analysis included 624 participants. Of these, 260 (42%) had 1 or more diverticula on colonoscopy. Among those with diverticula, the mean number was 14 (range, 1–158). Participants with diverticula were more likely to be older, male, and have a higher body mass index and waist circumference than those without diverticula (Table 1).

Most diverticula were located in the sigmoid colon (Figure 1), although the distribution differed significantly by race. Among white persons, 75% of diverticula

Discussion

In the United States, many individuals older than 30 have sigmoid diverticula with the prevalence and density increasing with age suggesting this is a progressive disease. Although the sigmoid colon is disproportionately affected by diverticula compared with other locations, the distribution differs by race. Black persons have significantly more of their diverticula in the proximal colon and fewer in the distal colon compared with white persons. Peridiverticular muscular hypertrophy and

References (25)

  • D.O. Jacobs

    Clinical practice. Diverticulitis

    N Engl J Med

    (2007)
  • C.N. De Cecco et al.

    Prevalence and distribution of colonic diverticula assessed with CT colonography (CTC)

    Eur Radiol

    (2015)
  • Cited by (0)

    Conflicts of interest The authors disclose no conflicts.

    Funding This research was supported, in part, by grants from the National Institutes of Health (P30 DK034987, R01DK09473, T32DK07634) and by the National Center for Advancing Translational Sciences, National Institutes of Health (Grant KL2TR001109). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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