Pathological changes in the nerve ganglia of the colon in uncomplicated and complicated courses of diverticular disease

• Konyukova A.K.
• Mikhaleva L.M.
• Kozlova M.A.
• Areshidze D.A.
• Shapovaliants S.G.
• Mikhalev A.I.
• Bolikhov K.V.
• Shulaev A.V.
• Tikhonova K.O.

Abstract

Diverticular disease of the colon (DD), according to statistics from various countries, is one of the five most common diseases of the gastrointestinal tract throughout the world. It is known that 75% of diverticula carriers have asymptomatic disease. Up to 15% of cases life-threatening complications develop, leading to emergency surgery, and in the remaining 10% of patients the disease is continuously recurring. The question of finding predictors of the complicated course of DD is urgent for the healthcare system, for the timely identification of such patients, their optimal routing and treatment.

Our study is devoted to assessing the characteristics of the nervous system of the colon wall in patients with complicated and uncomplicated diverticular disease in order to clarify the pathogenesis of DD and identify morphological predictors of a complicated course.

Aim. Comparative analysis of clinical data and structural characteristics of the intermuscular nerve ganglia of the colon in patients with different course of DD and without colon diverticula to identify the morphological features of the complicated course of DD.

Material and methods. A retrospective comparative analysis of clinical data, pathomorphological and ultrastructural changes in the intermuscular nerve ganglia in surgical material from 68 patients who underwent left hemicolectomy was carried out.

Results. We comprehensively analyzed 68 clinical cases of patients who underwent left hemicolectomy for complicated DD (37), uncomplicated DD (19) and observation without colon diverticula (12). It was revealed that in men this disease occurs at a younger age than in women [Me age of men – 49 (39.5; 61) years, women – 66.5 (58; 81); U=178, p<0.001]. It was shown that the glial index in cases with DD is 1.25 times higher than in the comparison group (cases without colon diverticula) (p<0.05).

Conclusion. The study demonstrates the age and gender characteristics of DD, as well as significant differences in the values of the glial index in the groups of patients with DD and without colon diverticula, which shows the significance of nervous system pathology in the development of DD of various course variants.

Keywords: diverticular disease of the colon; complicated course; glial index; ganglia; morphological predictors

References

1.     Piscopo N., Ellul P. Diverticular disease: a review on pathophysiology and recent evidence. Ulster Med J. 2020; 89 (2): 83–8.

2.     Eckmann J.D., Shaukat A. Updates in the understanding and management of diverticular disease. Curr Opin Gastroenterol. 2022; 38 (1): 48–54. DOI: https://doi.org/10.1097/MOG.0000000000000791

3.     Vorontsov O.F., Tolochik V.V., Mikhin I.V., Kitaeva A.V., Grab K. Diverticular disease: from tradition to innovation. Vestnik VolgGMU [Bulletin of VolgSMI]. 2020; 4 (76): 92–5. (in Russian)

4.     Ardatskaya M.D., Podstavkina I.S., Mordasova V.I., Korotkikh N.N., Garush’yan G.V. Retrospective analysis of the prevalence, features of the course, treatment and outcomes of diverticular disease according to data of a multidifilinary hospital. Eksperimental’naya i klinicheskaya gastoenterologiya [Experimental and Clinical Gastroenterology]. 2020: 176 (4): 77–82. (in Russian)

5.     Lammert F., Jansen P.L., Lerch M.M. Weissbuch Gastroenterologie 2020/2021: Erkrankungen des Magen-Darm-Traktes, der Leber und der Bauchspeicheldrüse – Gegenwart und Zukunft. Berlin; Boston: De Gruyter, 2019. DOI: https://doi.org/10.1515/9783110642513

6.     Khalil H., Yoo J. Colorectal Emergencies: perforated diverticulitis (operative and nonoperative management. J Gastrointest Surg. 2014; 18 (4): 865–8.

7.     Humes D.J. Changing epidemiology: does it increase our understanding? Dig Dis. 2012; 30 (1): 6–11. DOI: https://doi.org/10.1159/000335692

8.     Levchuk A.L., Abdullaev E.G., Abdullaev A.E. Diagnosis of acute colon diverticulitis and its complications. Vestnik Natsional’nogo mediko-khirurgicheskogo Tsentra imeni N.I. Pirogova [Bulletin of the National Medical-Surgical Center named after N.I. Pirogov]. 2021; 16 (3): 25–32. (in Russian)

9.     Cameron R., Walker M.M., Thuresson M., et al. Mortality risk increased in colonic diverticular disease: a nationwide cohort study. Ann Epidemiol. 2022; 76: 39–49. DOI: https://doi.org/10.1016/j.annepidem.2022.10.006

10. Tursi A., Scarpignato C., Strate L.L., et al. Colonic diverticular disease. Nat Rev Dis Primers. 2020; 6 (1): 20. DOI: https://doi.org/10.1038/s41572-020-0153-5 Epub 2020 Mar 26.

11. Swanson S.M., Strate L.L. Acute colonic diverticulitis. Ann Intern Med. 2018; 168 (9): ITC65–80.

12. Coakley K.M., Davis B.R., Kasten K.R. Complicated diverticular disease. Clin Colon Rectal Surg. 2021; 34 (2): 96–103. DOI: https://doi.org/10.1055/s-0040-1716701

13. Hallam S., Mothe B.S., Tirumulaju R. Hartmann’s procedure, reversal and rate of stoma-free survival. Ann R Coll Surg Engl. 2018; 100 (4): 301–7.

14. Fialho A., Fialho A., Shuja A. Analysis of the epidemiological trends on inpatient diverticulosis admissions in the US: a longitudinal analysis from 1997–2018. Cureus. 2023; 15 (2): e34493. DOI: https://doi.org/10.7759/cureus.34493 Epub 2023 Feb 1.

15. Peery A.F., Shaukat A., Strate L.L. AGA clinical practice update on medical management of colonic diverticulitis: expert review. Gastroenterology. 2021; 160 (3): 906–11.e1. DOI: https://doi.org/10.1053/j.gastro.2020.09.059

16. Hadji Ismail I.A., Vorobey A.V., Lagodich N.A., Dybov O.G., Starostin A.M., Baturin I.K. Diverticular disease of the colon: pathogenesis, classification and complications. Meditsinskie novosti [Medical News]. 2020; (6): 25–9. (in Russian)

17. Balkanov A.S., Rozanov I.D., Golanov A.V., Gaganov L.E., Chernikov V.P. Endothelium changes of peritumoral zone capillaries after brain glioblastoma adjuvant radiation therapy. Klinicheskaya i eksperimental’naya morfologiya [Clinical and Experimental Morphology]. 2021; 10 (1): 33–40. DOI: https://doi.org/10.31088/CEM2021.10.1.33-40  (in Russian)

18. Reynolds E.S. The use of lead citrate at high pH as an electron-opaque stain in electron microscopy. J Cell Biol. 1963; 17 (1): 208-12. DOI: https://doi.org/10.1083/jcb.17.1.208

19. Wedel T., Büsing V., Heinrichs G., Nohroudi K., Bruch H.-P., Roblick U.J., et al. Diverticular disease is associated with an enteric neuropathy as revealed by morphometric analysis. Neurogastroenterol Motil. 2010; 22: 407–14. DOI: https://doi.org/10.1111/j.1365-2982.2009.01445.x

20. Peery A.F., Keil A., Jicha K., Galanko J.A., Sandler R.S. Association of obesity with colonic diverticulosis in women. Clin Gastroenterol Hepatol. 2020; 18 (1): 107–14.e1. DOI: https://doi.org/10.1016/j.cgh.2019.04.058

21. Schultz J.K., Azhar N., Binda G.A., et al. European Society of Coloproctology: Guidelines for the management of diverticular disease of the colon. Colorectal Dis. 2020; 22 (suppl 2): 5–28. DOI: https://doi.org/10.1111/codi.15140

22. Alaburda P., Lukosiene J.I., Pauza A.G., Rysevaite-Kyguoliene K., Kupcinskas J., Saladzinskas, Z., Tamelis A., et al. Ultrastructural changes of the human enteric nervous system and interstitial cells of Cajal in diverticular disease. Histol Histopathol. 2020; 35 (2): 147–57. DOI: https://doi.org/10.14670/HH-18-136

23. Barbaro M.R., Cremon C., Fuschi D., et al. Nerve fiber overgrowth in patients with symptomatic diverticular disease. Neurogastroenterol Motil. 2019; 31 (9): e13575. DOI: https://doi.org/10.1111/nmo.13575

24. Kupcinskas J., Strate L.L., Bassotti G., et al. Pathogenesis of diverticulosis and diverticular disease. J Gastrointest Liver Dis. 2019; 28 (suppl 4): 7–10. DOI: https://doi.org/10.15403/jgld-551 Epub 2019 Dec 19.

25. Mikhaleva L., Konyukova A., Gutyirchik N. Fibrosis of the muscular layer of the colon as a predictor of the complicated course of diverticulosis. Virchows Arch. 2022; 481 (suppl 1): S1–364. DOI: https://doi.org/10.1007/s00428-022-03379-4

26. Konyukova A.K., Shapoval’yants S.G., Mikhalev A.I., Bolikhov K.V., Shulaev A.V., Gutyrchik N.A., et al. Morphological and genetic predictors of the complicated course of colon diverticulosis. Klinicheskaya i eksperimental’naya morfologiya [Clinical and Experimental Morphology]. 2022; 11 (3): 5–14. DOI: https://doi.org/10.31088/CEM2022.11.3.5-14 (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)