The latest critique from the ISFAR considers a study that links alcohol consumption to a rise in the risk of diverticulosis

The latest critique from the ISFAR considers a study that links alcohol consumption to a rise in the risk of diverticulosis

The etiology of diverticulosis of the colon is poorly understood. Many, but not all, studies suggest that low-fibre intake and obesity increase the risk; few studies have evaluated the relation of alcohol consumption and diverticulosis, with inconclusive results.

This paper tests the cross-sectional association of alcohol consumption with diverticulosis among 746 asymptomatic consecutive subjects undergoing screening colonoscopies in Lebanon.

One-half of the subjects in this study were abstainers. Most of the “drinkers” stated that they consumed alcohol occasionally or < 1 drink per day; only about 10% reported 1 or more drinks per day, and no data on type of beverage or pattern of drinking were available.

Nevertheless, from their analyses the authors conclude that alcohol consumption raises the risk of diverticulosis. 

Forum members considered that this cross-sectional analysis provides little support for a causative effect of alcohol on the risk of diverticulosis. Most larger observational studies have not shown such an effect.

In the present study, about 90% of subjects were either abstainers or consumed alcohol only occasionally or averaged < 1 drink per day. Further, the investigators did not evaluate the pattern of drinking (including binge drinking) and the results do not support an increase in risk with greater drinking (lack of a dose-response relation).

Mechanisms for such an effect are largely unknown. Thus, few of the Hill criteria for “causality” are met. 

The authors’ use of an inter-country comparison of per-capita alcohol intake and reported diverticulosis has no relevance: there are large cultural differences between nations with high and those with low per-capita alcohol intake, and alcohol use may well be just a marker for a western-type culture.

While the present study could be used to generate a hypothesis of a relation of alcohol intake to diverticulosis, attempts to validate such an association will require much additional research.

To read the full critique, click here.

These critiques are released with the permission of ISFAR.