Re: “The Prevalence and Management Outcomes of Diverticular Disease in a Tertiary Facility in Ghana”

Dear Editor, We have read with great interest the recent article entitled “The Prevalence and Management Outcomes of Diverticular Disease in a Tertiary Facility in Ghana” by Taah-Amoako et al. We would like to congratulate the authors for this well-designed study and excellent discussion of diverticular disease in West Africa. We would also like to highlight a couple notable elements of the study and humbly add a few comments of our own. Taah-Amoako et al. demonstrate an 8.91% rate of diverticular disease among patients undergoing colonoscopy or sigmoidoscopy at a tertiary care centre in Ghana. While this represents an increase in the prevalence in their population, they observe that it remains significantly less than the reported prevalences of diverticular disease in Western and Asian populations. Curiously, however, when examining the subset of Ghanaian patients requiring hospitalisation for diverticular disease complications, 94% were treated for diverticular bleeding while only five patients total (5.6%) were treated for diverticulitis. This depicts a completely different paradigm than that seen in the United States, where the percentage of diverticular disease hospitalisations attributed to bleeding represents a mere 25% of the total in white patients and a more evenly balanced 50% in black patients.[1] As we consider this trend in light of recent studies identifying distinct clinical features and risk factors for the two conditions, we propose that diverticular bleeding and diverticulitis be regarded as two different clinical entities.[2,3] In fact, when teased away from the diverticulitis data, it is patients of African ancestry who are found to have the highest risk for hospitalisation with diverticular bleeding in the United States.[1] Surely this, along with the characteristic pan-colonic pattern of distribution of diverticula found in previous studies on those of African heritage and again identified in the current study, would insist that Africans hold the key to understanding the unique genetic and environmental factors underpinning diverticular bleeding.[4] We therefore would like to again commend the authors for their work and encourage the continued study of diverticular disease in sub-Saharan Africa. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.