title: Colonic wall changes in patients with diverticular disease - is there a predisposition for a complicated course?
abstract: BACKGROUND
  The aim of this study was to evaluate colonic wall changes and enteric neuropathy in patients with either uncomplicated (UDD) or complicated diverticular disease (CDD). Furthermore, we evaluated the presence of an anatomic sphincter at the rectosigmoid junction (RSJ).
  
  
  METHODS
  Samples of colonic tissue from fifteen patients with UDD, fifteen patients with CDD and fifteen patients as control were collected. Collagen quotient I/III was measured with the Sirius-red test, expression of MMP-1, MMP-13, innervation (S100), proliferation (Ki67) and apoptosis (TUNEL) in the colonic wall were investigated by immunohistochemical studies. Furthermore, measurements of the different layers were performed to investigate the RSJ.
  
  
  RESULTS
  Patients with either UDD or CDD had lower collagen I/III quotients compared to the control group, significant for CDD (p = 0.007). For MMP-1 and MMP-13 only a slight increase for patients with CDD was found. The percentage of proliferating (Ki67) and apoptotic (TUNEL) cells was significantly higher for patients with CDD than in the control group (p = 0.016; p = 0.037). Upon investigating the S100-expression a significant reduce in glial cells density was found in the myenteric and mucosal plexus for both groups (UDD and CDD) compared to the control group. Measurements of the different colon layers oral, aboral and at the RSJ revealed equal values.
  
  
  CONCLUSIONS
  This study has shown that colonic wall changes and enteric neuropathy seem to play a role in the pathogenesis of colonic diverticulosis. None of our results suggest a predisposition for a complicated diverticular disease. Furthermore, the presence of an anatomic sphincter at the rectosigmoid junction could not be detected.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany. Electronic address: fulmer@ukaachen.de.
authors.forename: T F
authors.initials: TF
authors.lastname: Ulmer
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Rosch
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Mossdorf
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Alizai
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Binnebösel
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, Aachen 52074, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Neumann
mesh_terms: D000368:Aged; D017209:Apoptosis / Q000502:physiology; D016022:Case-Control Studies; D003094:Collagen / Q000378:metabolism; D003106:Colon / Q000378:metabolism* / Q000473:pathology*; D004239:Diverticulitis, Colonic / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D020781:Matrix Metalloproteinase 1 / Q000378:metabolism; D053509:Matrix Metalloproteinase 13 / Q000378:metabolism; D008875:Middle Aged; D009457:Neuroglia / Q000378:metabolism / Q000473:pathology; D012007:Rectum / Q000378:metabolism / Q000473:pathology
chemical_list: D019394:Ki-67 Antigen; D003094:Collagen; D053509:Matrix Metalloproteinase 13; D020781:Matrix Metalloproteinase 1
keywords: Diverticular disease; Diverticulitis; Enteric neuropathy; Extracellular matrix; Matrix metalloproteinase; Sphincter