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Movement of segmental constrictions in the human colon.

Changes in the segmental pattern of opaque contents in the transverse colon among patients with diverticulosis were observed by means of time-lapse cinefluorography after ingestion of barium sulphate suspension. In some of them the muscular constrictions separating the opaque masses of bowel contents were seen to relax and later to re-form in a different spatial relationship to fixed points on the bowel wall represented by the necks of diverticula. In other instances ring contractions moved progressively along the bowel wall, temporarily occluding the necks of any diverticula they passed. Bowel contents were seen to be transported ahead of the advancing constrictions at varying rates and in either direction.

Barium Sulfate↗

Mobilization of tissue kallikrein in inflammatory disease of the colon.

Colonic tissue was taken at operation from 10 patients with active ulcerative colitis and three patients with uncomplicated diverticular disease but with severe symptoms. Levels of kininogen, kallikrein, and kallikrein precursor were measured in blood-free tissue samples. In normal colon tissue a kininogen occurred in the muscle and none was detected in the mucosa. Kallikrein and its precursor were found in mucosa but not in muscle. In acutely inflamed tissue from ulcerative colitis patients relatively high levels of active kallikrein were detected in the underlying colonic muscle. There was little change in the level of kallikrein in inflamed mucosa or of kininogen in the muscle of these patients. No kallikrein was found in colonic muscle from patients with diverticular disease and the mucosal kallikrein level in these patients was unchanged. The findings suggest a mechanism for the formation of kinins in the wall of the colon which is present in ulcerative colitis but not in diverticular disease.

Biological Assay↗

Variation in the incidence of diverticular disease within the city of Edinburgh.

An estimate of the incidence of diverticular disease of the colon was based on all the barium enema examinations in Edinburgh over four years (12 335 cases); using the census data for 1971, incidence rates for the city by age, sex, and electoral ward were calculated. The overall annual incidence rate was 1-55/1000, the rate rising sharply with increasing age. The incidence of diverticular disease varies from ward to ward (range 0-92-2-04/1000), adjacent wards have similar incidence rates and the six wards with the lowest rates are clustered together in the South East of the city. Ward incidence rates have a significant negative association with the percentage of owner occupiers living in that area.

Adolescent↗

Does ispaghula husk stimulate the entire colon in diverticular disease?

The effect of ispaghula husk on colonic motility of the right and left side was examined in 10 patients with left sided diverticular disease using an untethered pressure sensitive radiotelemetry capsule. After treatment, ispaghula husk reduced mouth to rectum transit by a median of 8.8 hours and the time to midtransverse colon by five hours. In the right colon there was an increase in the median percentage activity of 7% and the median number of pressure waves greater than 5 mm Hg/hour rose by 35.3. Motility changes in the left colon were less pronounced. Five of the seven patients with abdominal pain and six of the nine patients with altered bowel habit responded to treatment. These results suggest that it is ispaghula husk's action on the right unaffected colon which alleviates the symptoms of left sided diverticular disease.

Aged↗

Cross linking of collagen is increased in colonic diverticulosis.

Development of colonic diverticulosis is a function of age and declining colonic wall mechanical strength. The latter is partly a consequence of changes in the collagen structure. Collagen from unaffected human colons (n = 20, age range 20-80 years) and those with colonic diverticulosis (n = 5, age range 67-80 years) were obtained at necropsy. The total collagen content was measured as the hydroxyproline content and cross linkage by collagen solubility in weak acid was studied. The colonic total collagen content was constant with age (mean (SD) 15.8 (0.3) mg/100 mg wet weight of tissue). The acid solubility of the collagen, however, increased after the age of 40 years: at over 60 years, colonic diverticulosis was associated with an increased acid solubility ratio compared with values in unaffected colons (15.3 (0.2); compared with 9.2 (0.2), p < 0.001). The cross linking of colonic collagen increases with age. These changes seem to be a factor in the aetiology of colonic diverticulosis.

Adult↗

INTRAMURAL GANGLIA IN DIVERTICULAR DISEASE OF THE COLON.

Intramural plexuses were studied in 30 colons, and a plethora of ganglionic tissue was observed in specimens with diverticula when compared with a control series. This alteration in the ganglionic pattern is considered real rather than apparent; the changes are confined to the region of the colon where muscular hypertrophy is present.

Diverticulitis↗

Paneth cells in diverticular disease of the colon.

Paneth cells were found in the mucosa of the sigmoid colon in 13 out of 27 cases of diverticulosis and diverticulitis. It is concluded that their appearance at this site is a non-specific reaction to injury.

Colon, Sigmoid↗

CT evaluation of the colon: inflammatory disease.

Computed tomography (CT) is valuable for detection and characterization of many inflammatory conditions of the colon. At CT, a dilated, thickened appendix is suggestive of appendicitis. A 1-4-cm, oval, fatty pericolic lesion with surrounding mesenteric inflammation is diagnostic of epiploic appendagitis. The key to distinguishing diverticulitis from other inflammatory conditions of the colon is the presence of diverticula in the involved segment. In typhlitis, CT demonstrates cecal distention and circumferential thickening of the cecal wall, which may have low attenuation secondary to edema. In radiation colitis, the clinical history is the key to suggesting the diagnosis because the CT findings can be nonspecific. The location of the involved segment and the extent and appearance of wall thickening may help distinguish Crohn disease and ulcerative colitis. In ischemic colitis, CT typically demonstrates circumferential, symmetric wall thickening with fold enlargement. CT findings of graft-versus-host disease include small bowel and colonic wall thickening, which may result in luminal narrowing and separation of bowel loops. In infectious colitis, the site and thickness of colon affected may suggest a specific organism. The amount of wall thickening in pseudomembranous colitis is typically greater than in any other inflammatory disease of the colon except Crohn disease.

Adolescent↗