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Gene expression could inform diverticulitis treatment

OCTOBER 23, 2018
Clinical Congress Daily Highlights, Tuesday Second Edition

The cause of diverticulitis has long been pinned on nurture rather than nature, but genetics may play an underappreciated role. In gene expression profiles, patients with diverticulitis in two or more areas of the colon differ from those with a conventional presentation.

The findings suggest that it may be possible to find genetic markers in patients whose inherited susceptibility makes them more likely to have a second bout of diverticulitis in a different area of the colon. “The goal is to find a marker after the first episode,” said Bryan Kline, MD, Penn State Milton S. Hershey Medical Center, Hershey, PA.

Diverticulitis has long been considered a Western ailment, attributed to environmental factors such as lack of exercise, smoking and a low-fiber diet. But a growing body of research suggests that there’s genetic component to the condition as well, which can lead to life-threatening complications such as a perforated colon, abscess formation, or bowel obstruction.

Dr. Kline and his colleagues collected tissue from 11 patients with conventional diverticulitis and 10 patients with diverticulitis in two or more areas of the colon, a condition known as multifocal diverticulitis (MFD). Patients with MFD tend to be clinically different from other diverticulitis patients, Kline said. They have an earlier age of onset, increased likelihood of family history, and are more likely to have more episodes and require surgery.

The team isolated RNA from the samples to assess gene expression. Of the more than 17,000 genes evaluated, 69 were differentially expressed between groups. About 62 percent of these genes had dialed-down expression in MFD. Further analysis revealed that genes tasked with immune-response activities, such as T cell recruitment and white blood cell movement, were among the down-regulated group. This suggests that something in the immune system may go awry in patients with MFD that leads to a more aggressive form of the disease.

To view the study’s abstract, click here.

The Scientific Forum, Colon and Rectal Surgery II, was held October 23 at the 2018 Clinical Congress of the American College of Surgeons in Boston, MA. Program, webcast and audio information is available online at

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