Features of diverticular disease in patients with metabolic disorders

Objective — to identify the clinical features of uncomplicated diverticular disease (UDD) in the context of metabolic disorders (MD); to analyze the main representatives of the obligate and mucin-producing intestinal flora; and to evaluate endoscopic and morphological changes in the colonic mucosa in patients with isolated UDD and those with concomitant MD. Materials and methods. The study included 259 patients with UDD (101 men and 158 women; mean age 65.6±1.45 years). All participants underwent body mass index (BMI) assessment and total colonoscopy with evaluation of diverticular inflammation activity. In 172 patients, microbiome profiling was performed by qRT-PCR using 16S rRNA gene-specific primers. During colonoscopy, mucosal biopsies were taken from diverticular orifices for PAS staining, immunohistochemical analysis, and morphometric assessment of the functional state of the colonic mucosa. Results. Patients with UDD and concomitant MD demonstrated a significantly higher rate of recurrent diverticular inflammation—52 (24.1%) vs 3 (6.9%) (p=0.013). Symptomatic uncomplicated diverticular disease (SUDD) was more frequently diagnosed in patients with metabolic disorders—121 (56.0%) vs 13 (30.2%) (p=0.002). Microbiome analysis revealed a tendency toward decreased levels of the main representatives of the obligate flora and of butyrate-producing bacterial strains. The mean score of endoscopic activity of diverticular inflammation in patients with MD was higher than in the group with normal BMI and correlated with a higher intensity of inflammation according to morphological and morphometric analysis. Conclusions. Patients with metabolic disorders exhibit a significantly higher frequency of recurrent diverticular inflammation. This may be attributed to more intense mucosal inflammation and altered mucus production resulting from a marked reduction in butyrate-producing microbiota and the predominance of Bacteroidetes species.