title: Diverticulosis and colorectal polyps at younger age:  a possible link?
abstract: OBJECTIVE
  An association between diverticulosis and colorectal neoplasms may have implications for colonoscopic prevention of colorectal cancer. We aimed to examine the association between diverticulosis and colorectal polyps with special attention to the age at diagnosis, the anatomical location, and the histological subtype of colorectal polyps.
  
  
  METHODS
  We included all consecutive patients referred for routine colonoscopy between February 2008 and February 2009. We recorded the presence of diverticulosis (defined as at least two diverticula) and colorectal polyps (adenomas and serrated polyps).
  
  
  RESULTS
  We included 2310 patients (46.1% men, mean age 58.4 years), of which 37.0% had diverticulosis and 34.2% had one or more colorectal polyps. Multiple logistic regression analysis, including age, sex, and interaction terms with diverticulosis, showed that the association between diverticulosis and colorectal polyps was significantly influenced by age (P=0.009). In patients aged below 60 years, prevalence of colorectal polyps was significantly higher in those with diverticulosis compared with those without diverticulosis: 39.1% (79 of 202 patients) versus 19.6% (176 of 898 patients), adjusted odds ratio (OR) 1.87, 95% confidence interval (CI) 1.26-2.78, and P=0.002. This association was found for both proximal and distal polyps and for all histological subtypes, namely adenomas (adjusted OR 1.60, 95%CI 1.02-2.49, P=0.04), serrated polyps (adjusted OR 1.73, 95% CI 1.03-2.91, and P=0.04), and advanced neoplasms (adjusted OR 2.32, 95%CI 1.31-4.12, P=0.004).
  
  
  CONCLUSIONS
  Presence of diverticulosis in patients aged below 60 years may be considered a 'red flag' for synchronous adenomas, serrated polyps, and advanced neoplasms. Diverticulosis may represent an indication for earlier initiation of colorectal cancer prevention programs.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands. eveline.rondagh@maastrichtuniversity.nl
authors.forename: Eveline J A
authors.initials: EJ
authors.lastname: Rondagh
authors.forename: Silvia
authors.initials: S
authors.lastname: Sanduleanu
authors.forename: Chantal M C
authors.initials: CM
authors.lastname: le Clercq
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Ad A M
authors.initials: AA
authors.lastname: Masclee
mesh_terms: D000236:Adenoma / Q000209:etiology / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D003111:Colonic Polyps / Q000209:etiology* / Q000473:pathology; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000209:etiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D043963:Diverticulosis, Colonic / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors