Plain language summary
Diverticular disease (DD) is a disease of the colon that can be split into symptomatic uncomplicated diverticular disease (SUDD), asymptomatic complicated, and segmental colitis associated with diverticulosis (SCAD). They are all diseases of the colon that are poorly understood. It is thought that inflammation of the colon may play a part in their development, however levels of certain inflammatory biomarkers have shown contradicting relationships. This systematic review of 12 studies and meta-analysis of 6 of these aimed to determine the role of one inflammatory biomarker known as tumour necrosis factor-alpha (TNF-a) in DD. The results showed that mucosal TNF-a levels were unchanged in individuals with SUDD compared to healthy controls. They were also unchanged in SUDD vs asymptomatic DD. They were higher in individuals with DD and SCAD when compared to individuals with irritable bowel syndrome (IBS). It was concluded that TNF-a may be involved in the development of specific types of DD. This study could be used by healthcare professionals to understand that the management of inflammation in individuals with DD may be of benefit.
Abstract
Diverticular disease (DD) is the most frequent condition in the Western world that affects the colon. Although chronic mild inflammatory processes have recently been proposed as a central factor in DD, limited information is currently available regarding the role of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α). Therefore, we conducted a systematic review and meta-analysis aiming to assess the mucosal TNF-α levels in DD. We conducted a systematic literature search using PubMed, Embase, and Scopus to identify observational studies assessing the TNF-α levels in DD. Full-text articles that satisfied our inclusion and exclusion criteria were included, and a quality assessment was performed using the Newcastle-Ottawa Scale (NOS). The principal summary outcome was the mean difference (MD). The results were reported as MD (95% confidence interval (CI)). A total of 12 articles involving 883 subjects were included in the qualitative synthesis, out of which 6 studies were included in our quantitative synthesis. We did not observe statistical significance related to the mucosal TNF-α levels in symptomatic uncomplicated diverticular disease (SUDD) vs. the controls (0.517 (95% CI -1.148-2.182)), and symptomatic vs. asymptomatic DD patients (0.657 (95% CI -0.883-2.196)). However, the TNF-α levels were found to be significantly increased in DD compared to irritable bowel disease (IBS) patients (27.368 (95% CI 23.744-30.992)), and segmental colitis associated with diverticulosis (SCAD) vs. IBS patients (25.303 (95% CI 19.823-30.784)). Between SUDD and the controls, as well as symptomatic and asymptomatic DD, there were no significant differences in the mucosal TNF-α levels. However, the TNF-α levels were considerably higher in DD and SCAD patients than IBS patients. Our findings suggest that TNF-α may play a key role in the pathogenesis of DD in specific subgroups and could potentially be a target for future therapies.
Methodological quality
Jadad score
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Not applicable
Allocation concealment
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Not applicable
