A study of some factors involved in the aetiology of diverticular disease of the large intestine in Malta.

Abstract

Factors involved in the aetiology of diverticular disease in Malta have been studied and compared with those of other countries by reviewing the relevant literature. The incidence of diverticular disease was investigated by carrying out a retrospective radiological survey over an 8 year period (1967-1974), and a prospective necropsy survey, over a 2 year period. The age and sex incidence and the anatomical distributing of diverticula in both series were studied. The incidence was similar to that of western communities on a predominantly low residue diet. However certain peculiarities have been noted, namely a predominance in males and a high incidence of right-sided diverticula. The urban-rural distribution of patients diagnosed radiologically was investigated and a predominance of urban cases found. The natural history of the disease was studied by reviewing hospital records and by personally interviewing patients. A detailed dietary history revealed that most patients had been and were still on a relatively refined diet; a high residue diet had rarely been advised. Although rarely fatal, diverticular disease had a high morbidity rate. The characteristics of colonic carcinoma were also studied by reviewing the ‘Tumour Register’ records over the period 1969-1973. Certain similarities were found with diverticular disease in the sex and anatomical distribution, and in the clinical picture. The two conditions occasionally coexisted. Intestinal motility studies were carried out. In vitro perfusion studies were performed on a guinea-pig and human taeniae and differences noted in the motility exhibited by taniae of normal patients and those with diverticular disease. Transit times were carried out on patients undergoing gastro-intestinal radiological investigation on no prescribed diet, to obtain indirect information on the habitual amount of roughage ingested. Average daily stool weigh, moisture and ash contents were estimated. Fasting blood samples were obtained from the same patients and blood glucose and plasma cholesterol levels performed an interesting correlation was found between transit times and plasma cholesterol levels.