Colorectal visceral perception in diverticular disease

Abstract

Background and aims: The pathogenesis of asymptomatic diverticular disease (ADD) and symptomatic uncomplicated diverticular disease (SUDD) has not been elucidated. The aim of our study was to assess whether altered visceral perception or abnormal compliance of the colorectal wall play a role in these clinical entities.

Methods: Ten ADD patients, 11 SUDD patients, and nine healthy controls were studied. Using a dual barostat device, sensations were scored and compliance curves obtained using stepwise intermittent isobaric distensions of the rectum and sigmoid, before and after a liquid meal. In addition, the colonic response to eating was assessed by monitoring the volumes of both barostat bags at operating pressure before and after the meal.

Results: In the rectum, perception was increased in the SUDD group compared with controls (p = 0.010) and the ADD group (p = 0.030). Rectal compliance curves were not different between the groups. In the sigmoid colon, perception in the pre- and postprandial periods was increased in SUDD compared with controls (p = 0.018) but not when compared with ADD. Sigmoid volume-pressure curves had comparable slopes (compliance) in all groups but were shifted downwards in SUDD compared with ADD in the preprandial period (p = 0.026). The colonic response to eating (decrease in intrabag volume) was similar in all three groups, both in the rectum and sigmoid.

Conclusion: Symptomatic but not asymptomatic uncomplicated diverticular disease is associated with heightened perception of distension, not only in the diverticula bearing sigmoid, but also in the unaffected rectum. This hyperperception is not due to altered wall compliance.

Figure 1

Schematic representation of the study protocol. MDP, minimum distending pressure.

Figure 2

Perception (score 1 = no sensation, score 7 = maximal tolerable pain) on stepwise isobaric distensions of the rectum and sigmoid colon during the preprandial period and in the sigmoid colon during the postprandial period in healthy controls, asymptomatic diverticular disease (ADD) patients, and symptomatic uncomplicated diverticular disease (SUDD) patients. In the rectum, the SUDD group had increased perception scores compared with the control group (p = 0.010) and the ADD group (p = 0.030). In the sigmoid colon, in the pre- and postprandial periods, the SUDD group had increased perception scores compared with the control group (p = 0.018).

Figure 3

Volume-pressure curves in the rectum and sigmoid colon during the preprandial period and in the sigmoid colon in the postprandial period on isobaric distensions in healthy controls, asymptomatic diverticular disease (ADD) patients, and symptomatic uncomplicated diverticular disease (SUDD) patients. Preprandially, the SUDD curve was shifted downwards compared with the ADD curve (*p = 0.026).

Figure 4

Barostat volumes in the rectum before the meal (Preprandial), and in the first and second 10 minute postprandial periods. There were no significant differences between the groups (healthy controls, asymptomatic diverticular disease (ADD) patients, and symptomatic uncomplicated diverticular disease (SUDD) patients). In all three groups, rectal volume decreased significantly after the meal (controls p = 0.006; ADD p = 0.016; SUDD p = 0.003).

Figure 5

Barostat volumes in the sigmoid colon before the meal (Preprandial), and in the first and second 10 minute postprandial periods. Differences between the groups failed to reach statistical significance. In all three groups (healthy controls, asymptomatic diverticular disease (ADD) patients, and symptomatic uncomplicated diverticular disease (SUDD) patients) sigmoid volumes decreased significantly after the meal (controls p = 0.001; ADD p = 0.001; SUDD p = 0.004).