title: Review article: the pathogenesis of diverticular disease--current perspectives on motility and neurotransmitters.
abstract: BACKGROUND
  Low-fibre diet, structural abnormalities and ageing are traditional aetiological factors implicated in the development of diverticular disease. More recently, motility disorders are implicated in its causation leading to speculation that neurotransmitters play a role in mediating these disturbances.
  
  
  OBJECTIVE
  To draw together studies on the role of neurotransmitters in the development of diverticular disease and its symptoms.
  
  
  METHODS
  Medline, GoogleScholar and Pubmed were searched for evidence on this subject using the terms neurotransmitters, motility, diverticular disease and pathogenesis. Articles relevant to the subject were cited and linked references were also reviewed.
  
  
  RESULTS
  Serotonin, which has been found to be an excitatory colonic neurotransmitter, has been found in early studies to be increased in colonic enterochromaffin cells. Acetylcholine, which is thought to be an excitatory neurotransmitter and cholinergic activity, has also seen to be increased in diverticular disease. These findings may suggest that an increase in excitatory neurotransmitters may result in the hypersegmentation thought to cause pulsion diverticula. Similarly, a decrease in nitric oxide which is inhibitory is found.
  
  
  CONCLUSIONS
  There is some evidence that neurotransmitters may play a role in the motility disturbances seen in diverticular disease; however, a clear role is yet to be ascertained.
authors.affiliation: Department of Colorectal Surgery, Kings College Hospital, Denmark Hill, London, UK. sanjeyarajah@doctors.net.uk
authors.forename: S
authors.initials: S
authors.lastname: Jeyarajah
authors.forename: S
authors.initials: S
authors.lastname: Papagrigoriadis
mesh_terms: D000109:Acetylcholine / Q000502:physiology; D000367:Age Factors; D002465:Cell Movement / Q000502:physiology; D004043:Dietary Fiber; D043963:Diverticulosis, Colonic / Q000503:physiopathology*; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D018377:Neurotransmitter Agents / Q000502:physiology*; D009569:Nitric Oxide / Q000502:physiology; D012701:Serotonin / Q000502:physiology
chemical_list: D004043:Dietary Fiber; D018377:Neurotransmitter Agents; D009569:Nitric Oxide; D012701:Serotonin; D000109:Acetylcholine