Diverticulitis Misunderstood: A Ticking Time Bomb in the Colon

Background: Historically, diverticulosis and its complications emerged with the industrial revolution and subsequent socioeconomic changes, including dietary, which went from an agrarian high-fiber to a low-fiber, processed food product. Corporeal body habitus basal metabolic index (BMI) increased exponentially, and colonic diverticulosis now involves 70% of the population at >80 years of age. The correlation of severity in diverticulosis was predictive of diverticulitis (DIV). Methods: In the individual patient, this is very difficult to predict, so we turned to a database of patients from a colorectal neoplasia database to compare parameters those who had experienced diverticulitis with those who had no documented diverticulitis. We were able to ascertain 28 patients and compare them to 2256 controls. We used an antibody (Adnab-9) that recognizes an epitope on the p87 molecule, a product of the innate immune system (InImS) and as a denominator of serum ferritin yield the FERAD ratio and directly evaluated the expression of p87 by immunohistochemistry (IHC) in six contiguous regions of the colon. Results: The FERAD ratio was significantly lower in the diverticulitis patients, 2567 versus 18,989. IHC showed significant lower p87 in the rectosigmoid regions (p < 0.01). Significant differences were also seen in blood platelets (p < 0.036); serum creatinine (p < 0.005); 65.6% DIV smokers versus 38% controls (p < 0.008). Surprisingly there were no differences in BMI, mortality, or age. Conclusions: The InImS appears not to be active in DIV patients as compared to controls, which may predispose to DIV. Smoking also appears to predispose to DIV. Platelets are lower and creatinine higher as has been described in the literature.