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Andrew T Chan - One of the best experts on this subject based on the ideXlab platform.
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intake of dietary fiber fruits and vegetables and risk of Diverticulitis
bioRxiv, 2018Co-Authors: Long H Nguyen, Mingyang Song, Lisa L Strate, Edward Giovannucci, Yin Cao, Manol Jovani, Pohong Liu, Idy Tam, Andrew T ChanAbstract:Background & Aims: Although low fiber intake has been considered a risk factor for Diverticulitis, prospective evidence is limited and conflicting, with little known about variation in the protective effects according to food sources. We assessed the associations of intakes of fiber and major food sources of fiber including fruits and vegetables with risk of Diverticulitis. Methods: We followed 50,019 women in the Nurses Health Study (1990-2014) and 48,292 men in the Health Professionals Follow-up Study (1986-2014) who were free of Diverticulitis, cancer, and inflammatory bowel disease at baseline. Incident Diverticulitis was identified through self-report with validity confirmed by review of medical records. Results: During a mean follow-up time of 22 years, we documented 4,343 incident cases of Diverticulitis in women and 1,142 cases in men. Compared to participants in the lowest quintile, the multivariable HRs (95% CIs) of Diverticulitis in the highest quintile of total fiber intake were 0.86 (0.78-0.95; P-trend=0.002) among women and 0.63 (0.51-0.79; P-trend
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western dietary pattern increases and prudent dietary pattern decreases risk of incident Diverticulitis in a prospective cohort study
Gastroenterology, 2017Co-Authors: Lisa L Strate, Edward Giovannucci, Andrew T Chan, Brieze R Keeley, Yin CaoAbstract:Background & Aims Dietary fiber is implicated as a risk factor for Diverticulitis. Analyses of dietary patterns may provide information on risk beyond those of individual foods or nutrients. We examined whether major dietary patterns are associated with risk of incident Diverticulitis. Methods We performed a prospective cohort study of 46,295 men who were free of Diverticulitis and known diverticulosis in 1986 (baseline) using data from the Health Professionals Follow-Up Study. Each study participant completed a detailed medical and dietary questionnaire at baseline. We sent supplemental questionnaires to men reporting incident Diverticulitis on biennial follow-up questionnaires. We assessed diet every 4 years using a validated food frequency questionnaire. Western (high in red meat, refined grains, and high-fat dairy) and prudent (high in fruits, vegetables, and whole grains) dietary patterns were identified using principal component analysis. Follow-up time accrued from the date of return of the baseline questionnaire in 1986 until a diagnosis of Diverticulitis, diverticulosis or diverticular bleeding; death; or December 31, 2012. The primary end point was incident Diverticulitis. Results During 894,468 person years of follow-up, we identified 1063 incident cases of Diverticulitis. After adjustment for other risk factors, men in the highest quintile of Western dietary pattern score had a multivariate hazard ratio of 1.55 (95% CI, 1.20−1.99) for Diverticulitis compared to men in the lowest quintile. High vs low prudent scores were associated with decreased risk of Diverticulitis (multivariate hazard ratio, 0.74; 95% CI, 0.60−0.91). The association between dietary patterns and Diverticulitis was predominantly attributable to intake of fiber and red meat. Conclusions In a prospective cohort study of 46,295 men, a Western dietary pattern was associated with increased risk of Diverticulitis, and a prudent pattern was associated with decreased risk. These data can guide dietary interventions for the prevention of Diverticulitis.
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association of geographic and seasonal variation with Diverticulitis admissions
JAMA Surgery, 2015Co-Authors: Lillias H Maguire, Mingyang Song, Lisa L Strate, Edward Giovannucci, Andrew T ChanAbstract:Importance The incidence of Diverticulitis has been associated with geographic and seasonal variation. Low levels of circulating vitamin D are associated with Diverticulitis. We investigated the association between UV light and Diverticulitis. Observations We identified nonelective Diverticulitis admissions in the Nationwide Inpatient Sample and linked hospital locations to UV data. We examined UV exposure in relation to risk of admission for Diverticulitis. We identified geographic and seasonal trends among 226 522 nonelective admissions for Diverticulitis. Compared with high-UV areas, low-UV areas had a higher rate of Diverticulitis (751.8 vs 668.1 per 100 000 admissions; P P P P P = .01). Conclusions and Relevance Low UV light exposure is associated with an increased rate of Diverticulitis admissions and greater seasonal variation. Because UV exposure largely determines vitamin D status, these findings support a role for vitamin D in the pathogenesis of Diverticulitis.
Edward Giovannucci - One of the best experts on this subject based on the ideXlab platform.
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intake of dietary fiber fruits and vegetables and risk of Diverticulitis
bioRxiv, 2018Co-Authors: Long H Nguyen, Mingyang Song, Lisa L Strate, Edward Giovannucci, Yin Cao, Manol Jovani, Pohong Liu, Idy Tam, Andrew T ChanAbstract:Background & Aims: Although low fiber intake has been considered a risk factor for Diverticulitis, prospective evidence is limited and conflicting, with little known about variation in the protective effects according to food sources. We assessed the associations of intakes of fiber and major food sources of fiber including fruits and vegetables with risk of Diverticulitis. Methods: We followed 50,019 women in the Nurses Health Study (1990-2014) and 48,292 men in the Health Professionals Follow-up Study (1986-2014) who were free of Diverticulitis, cancer, and inflammatory bowel disease at baseline. Incident Diverticulitis was identified through self-report with validity confirmed by review of medical records. Results: During a mean follow-up time of 22 years, we documented 4,343 incident cases of Diverticulitis in women and 1,142 cases in men. Compared to participants in the lowest quintile, the multivariable HRs (95% CIs) of Diverticulitis in the highest quintile of total fiber intake were 0.86 (0.78-0.95; P-trend=0.002) among women and 0.63 (0.51-0.79; P-trend
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western dietary pattern increases and prudent dietary pattern decreases risk of incident Diverticulitis in a prospective cohort study
Gastroenterology, 2017Co-Authors: Lisa L Strate, Edward Giovannucci, Andrew T Chan, Brieze R Keeley, Yin CaoAbstract:Background & Aims Dietary fiber is implicated as a risk factor for Diverticulitis. Analyses of dietary patterns may provide information on risk beyond those of individual foods or nutrients. We examined whether major dietary patterns are associated with risk of incident Diverticulitis. Methods We performed a prospective cohort study of 46,295 men who were free of Diverticulitis and known diverticulosis in 1986 (baseline) using data from the Health Professionals Follow-Up Study. Each study participant completed a detailed medical and dietary questionnaire at baseline. We sent supplemental questionnaires to men reporting incident Diverticulitis on biennial follow-up questionnaires. We assessed diet every 4 years using a validated food frequency questionnaire. Western (high in red meat, refined grains, and high-fat dairy) and prudent (high in fruits, vegetables, and whole grains) dietary patterns were identified using principal component analysis. Follow-up time accrued from the date of return of the baseline questionnaire in 1986 until a diagnosis of Diverticulitis, diverticulosis or diverticular bleeding; death; or December 31, 2012. The primary end point was incident Diverticulitis. Results During 894,468 person years of follow-up, we identified 1063 incident cases of Diverticulitis. After adjustment for other risk factors, men in the highest quintile of Western dietary pattern score had a multivariate hazard ratio of 1.55 (95% CI, 1.20−1.99) for Diverticulitis compared to men in the lowest quintile. High vs low prudent scores were associated with decreased risk of Diverticulitis (multivariate hazard ratio, 0.74; 95% CI, 0.60−0.91). The association between dietary patterns and Diverticulitis was predominantly attributable to intake of fiber and red meat. Conclusions In a prospective cohort study of 46,295 men, a Western dietary pattern was associated with increased risk of Diverticulitis, and a prudent pattern was associated with decreased risk. These data can guide dietary interventions for the prevention of Diverticulitis.
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association of geographic and seasonal variation with Diverticulitis admissions
JAMA Surgery, 2015Co-Authors: Lillias H Maguire, Mingyang Song, Lisa L Strate, Edward Giovannucci, Andrew T ChanAbstract:Importance The incidence of Diverticulitis has been associated with geographic and seasonal variation. Low levels of circulating vitamin D are associated with Diverticulitis. We investigated the association between UV light and Diverticulitis. Observations We identified nonelective Diverticulitis admissions in the Nationwide Inpatient Sample and linked hospital locations to UV data. We examined UV exposure in relation to risk of admission for Diverticulitis. We identified geographic and seasonal trends among 226 522 nonelective admissions for Diverticulitis. Compared with high-UV areas, low-UV areas had a higher rate of Diverticulitis (751.8 vs 668.1 per 100 000 admissions; P P P P P = .01). Conclusions and Relevance Low UV light exposure is associated with an increased rate of Diverticulitis admissions and greater seasonal variation. Because UV exposure largely determines vitamin D status, these findings support a role for vitamin D in the pathogenesis of Diverticulitis.
Philippe Morel - One of the best experts on this subject based on the ideXlab platform.
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long term follow up after first acute episode of sigmoid Diverticulitis is surgery mandatory a prospective study of 118 patients
Diseases of The Colon & Rectum, 2002Co-Authors: Roland Chautems, Patrick Ambrosetti, Alexandra Ludwig, Bernadette Mermillod, Philippe Morel, Claudio SoraviaAbstract:PURPOSE: This study was designed to evaluate the long-term natural history of sigmoid Diverticulitis in patients treated nonoperatively after a first acute episode and to assess the role of elective colectomy. METHODS: Between 1986 and 1991, 144 patients were admitted for acute Diverticulitis diagnosed by abdominal computed tomography and had a successful nonoperative treatment. Remote complications (persisting or recurring Diverticulitis) were also diagnosed by computed tomography. Patients had a poor outcome if they had one of these complications. Diverticulitis was graded mild or severe on computed tomography according to Ambrosetti’s criteria. We determined statistically whether young age (≤50 years old) and severe Diverticulitis were risk factors for a poor outcome. RESULTS: One hundred eighteen patients with a contributive computed tomographic scan at admission were followed up. Median age was 63 (range, 23–93) years, with a median follow-up of 9.5 (range, 0.2–13.8) years. Eighty patients had no complications, and 38 had remote complications. The incidence of remote complications was the highest (54 percent at 5 years) for young patients with severe Diverticulitis on computed tomography and the lowest (19 percent at 5 years) for older patients with mild disease. Young age and severe Diverticulitis taken separately were both statistically significant factors of poor outcome (P = 0.007 and P = 0.003, respectively), although age was no longer significant after stratification for disease severity on computed tomography (P = 0.07). Twenty-four patients died. The cause of death was unrelated to Diverticulitis in 21 cases and unknown in the remaining 3. CONCLUSIONS: We propose that after a first acute episode of Diverticulitis treated nonoperatively, elective colectomy should be offered to young patients (≤50 years old) with severe Diverticulitis on computed tomography.
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acute left colonic Diverticulitis compared performance of computed tomography and water soluble contrast enema prospective evaluation of 420 patients
Diseases of The Colon & Rectum, 2000Co-Authors: P Ambrosetti, Alexandra Jenny, C Becker, Francois Terrier, Philippe MorelAbstract:PURPOSE: The most valuable radiologic examination to be done initially when acute left colonic Diverticulitis is suspected is still a matter of controversy. This study compares the performance between water-soluble contrast enema and computed tomography. METHODS: From 1986 to 1997, all patients admitted in our emergency center with clinically suspected left-colonic Diverticulitis had a contrast enema and a computed tomography within 72 hours of their admission, unless clinical findings required immediate laparotomy. They were prospectively included in the study if one or both radiologic examinations showed signs of acute Diverticulitis or Diverticulitis was surgically removed and histologically proven or both. Diverticulitis was considered moderate when computed tomography showed localized thickening of the colonic wall (5 mm or more) and inflammation of pericolic fat and contrast enema showed segmental lumen narrowing and tethered mucosa; it was considered severe when abscess or extraluminal air or contrast or all three were observed on computed tomography and when one or both of the last two signs were seen on contrast enema. Of 542 patients, 420 who had both computed tomography and contrast enema entered the study. RESULTS: The performance of computed tomography was significantly superior to contrast enema in terms of sensitivity (98vs. 92 percent;P=0.01), which was calculated from patients who had their colon removed and whose Diverticulitis was histologically proven, and in the evaluation of the severity of the inflammation (26vs. 9 percent;P=0.02). Moreover, of 69 patients who had an associated abscess seen on computed tomography, only 20 (29 percent) had indirect signs of this complication on contrast enema. CONCLUSIONS: In the diagnostic evaluation of acute left-colonic Diverticulitis, computed tomography should be preferred to contrast enema as the initial radiologic examination because of its statistically significant superiority in sensitivity and for its significantly better performance in the detection of severe infection, especially when an abscess is associated with the disease.
Karin A. Herrmann - One of the best experts on this subject based on the ideXlab platform.
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magnetic resonance enterography enteroclysis in acquired small bowel Diverticulitis and small bowel diverticulosis
European Radiology, 2016Co-Authors: Bahar Mansoori, Conor P. Delaney, Raj M. Paspulati, Joseph Willis, Pablo R Ros, Christine Schmidtannwald, Karin A. HerrmannAbstract:Small bowel (SB) diverticulosis is a rare disorder that may entail serious complications, including SB Diverticulitis. Both are often missed in imaging. Magnetic resonance enterography/enteroclysis (MRE) is increasingly used to assess SB disease; awareness of the appearance of SB Diverticulitis is essential to ensure appropriate management. Our aim was to systematically describe imaging characteristics of SB diverticulosis and Diverticulitis in MRE. This retrospective, HIPAA-compliant study identified 186 patients with suspected SB diverticulosis/Diverticulitis in medical databases of two tertiary medical centres between 2005 and 2011. Patients with surgically confirmed diagnoses of SB diverticulosis/Diverticulitis were included. Two observers analyzed MR images for the presence, location, number, and size of diverticula, wall thickness, and mural and extramural patterns of inflammation. Seven patients were recruited. MRI analysis showed multiple diverticula in all (100 %). Diverticular size ranged from 0.5 to 6 cm. Prevalence of diverticula was higher in the proximal than the distal SB (jejunum 86 %, ileum 57 %, distal ileum43%). Diverticulitis occurred in 3/7 patients (43 %) showing asymmetric bowel wall thickening and focal mesenteric inflammation. SB Diverticulitis demonstrates characteristic MRE imaging features to distinguish this rare disorder from more common diseases. Asymmetric, focal mesenteric and mural inflammation and presence of multiple diverticula are keys to diagnosis. • Small bowel diverticulosis and Diverticulitis is rare and often missed in imaging • Acquired small bowel diverticula are variable in size and number • Small bowel Diverticulitis demonstrates characteristic features on MR enterography/enteroclysis • A focal or segmental asymmetric small bowel inflammation should prompt the search for diverticula
Frank A Frizelle - One of the best experts on this subject based on the ideXlab platform.
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elective surgery after acute Diverticulitis
British Journal of Surgery, 2005Co-Authors: Simon E J Janes, Alan P Meagher, Frank A FrizelleAbstract:Background: Diverticulitis is a common condition. Practice guidelines from many organizations recommend bowel resection after two attacks. The evidence for such a recommendation is reviewed. Methods: A Medline literature search was performed to locate English language articles on surgery for diverticular disease. Further articles were obtained from the references cited in the literature initially reviewed. Results: Most people with diverticulosis are asymptomatic. Diverticular disease occurs in over 25 per cent of the population, increasing with age. After one episode of Diverticulitis one-third of patients have recurrent symptoms; after a second episode a further third have a subsequent episode. Perforation is commonest during the first episode of acute Diverticulitis. After recovering from an episode of Diverticulitis the risk of an individual requiring an urgent Hartmann’s procedure is one in 2000 patient-years of follow-up. Surgery for diverticular disease has a high complication rate and 25 per cent of patients have ongoing symptoms after bowel resection. Conclusion: There is no evidence to support the idea that elective surgery should follow two attacks of Diverticulitis. Further prospective trials are required.