Pathophysiology of Colonic diverticulosis

Risk Factors
increasing age (far more frequent in older
people, with only 25% of cases
occurring in those under 40 years of age)
Diet low in dietary fiber (The relative risk of
developing diverticular disease is 0.58 for men
with low alimentary fiber.)
High fat diet
Connective tissue disorders
Genetic predisposition

Theory: Colonic Wall Resistance / Structural

Theory: Colonic Motility

Theory: Dietary Factors

Areas of thinning due to
presumed focal microscopic
muscle atrophy
Some areas of the colonic
wall passing the circular
.muscle layer where vasa
recta penetrate become
relatively weak.

With progression, a clear-
cut defect occurs usually at
the site of penetration of a
vessel.
With increased age,
collagen fibrils demonstrate
increased cross-linking
Tissues become stiffer and
less resistant to stretching
Loss of colonic submucosal
compliance, the layer
responsible for tensile
strength
Submucosa more
susceptible to small tears
when subjected to the
higher intraluminal
pressures triggered by
segmentation
Numerous chemical
mediators of bowel motility
are found within colons
nerve cell bodies
Significantly higher levels of
vasoactive intestinal
polypeptide (VIP)
Intracolonic high pressure
Low fiber diet results to
slower colonic transit times,
smaller stool volumes and
less frequent bowel
movement
Other Risk Factors
Obesity
Smoking
Physical Inactivity
NSAIDs use


Colonic Diverticulosis
effectiveness in colonic
segmentation
intracolonic pressure far
from the
normal range during
colonic peristalsis
thickened circular muscle
layer, shortening of the
teniae, and luminal
narrowing.