Case closed? Diverticulitis: Epidemiology and fiber
Case closed? Diverticulitis: Epidemiology and fiber
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DOI：
10.1097/01.mcg.0000225503.59923.6c
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发表时间：
2006-08-01
影响因子：
2.9
通讯作者：
Korzenik, Joshua R.
中科院分区：
文献类型：
--
作者：
Korzenik, Joshua R.
几十年前，随着纤维摄入量与憩室病发生之间的流行病学关联，对憩室病的认识取得了重大进展。在不发达国家，憩室病在采用低纤维的西式饮食之前几乎不为人知，对憩室病的出现进行的调查充分证明了这种联系。亚洲国家右侧憩室病的高发病率与西方国家不同。不溶性纤维的生理作用也已得到充分研究，增加了体积和减少了通过时间，缺乏有助于导致憩室疾病的生理学中涉及的高压。然而，最多有10%至25%的憩室病患者会发展为憩室炎。近年来，症状性憩室的风险因素越来越多地被描述，除了年龄之外，肥胖和红肉摄入量也特别重要。然而，已知的因素很难识别那些风险增加的人，而且诱发的病理生理学也不完全清楚。不溶性纤维，而不是可溶性纤维，已被视为西方饮食中缺乏的主要成分，并且是导致憩室疾病和憩室炎建立的罪魁祸首。可溶性纤维及其对肠道植物群的影响被认为对憩室炎的发展有重要影响。这种理解，如果得到证实，将有重要意义的一级和二级预防憩室炎。
A major advance in understanding diverticular disease occurred decades ago with the epidemiologic association between fiber intake and the development of diverticular disease. This association has been well documented with investigations into the emergence of diverticular disease in underdeveloped countries where the disease had been virtually unknown before the adoption of a westernized diet, low in fiber. The high frequency of right-sided diverticular disease in Asian countries diverges from what is seen in the West. The physiologic effects of insoluble fiber has been well examined as well, increasing bulk and decreasing transit time, with a deficiency contributing to the high pressures implicated in the physiology which leads to diverticular disease. However, at most, 10% to 25% of individuals with diverticular disease will develop diverticulitis. Risk factors for symptomatic diverticular have been increasingly described in recent years with obesity and red meat intake being of particular importance, in addition to age. However, the known factors poorly identify those at increased risk and the predisposing pathophysiology is incompletely understood as well. Insoluble fiber, but not soluble fiber, has been viewed as the principal component which has been deficient in western diets and is the culprit which leads to the establishment of diverticular disease and in turn, diverticulitis. Soluble fiber and its effect on the intestinal flora is proposed as having significant influence on the development of diverticulitis. This understanding, if demonstrated, would have important implications for the primary and secondary prevention of diverticulitis.