Aim: Growing evidence suggests that immune/inflammatory pathways play a crucial role in the persistence of symptoms in diverticular disease (DD). We hypothesize that chronic diverticulitis triggers a self-sustained inflammatory status which can be detected by measuring the levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). The aim of this study was to investigate the systemic levels of TNF-α and IL-6 before and after elective surgery in patients with DD, and their relationship with the gastrointestinal quality of life index (GIQLI) score.

Method: This prospective multicentric study enrolled patients from the Diverticular Disease Registry (DDR-Trial, NCT04907383). All adult patients diagnosed with symptomatic uncomplicated diverticular disease (SUDD), uncomplicated recurrent diverticulitis (URD) and smouldering diverticulitis (SmD) between 1st December 2022 and 31st December 2023 were included in this study. Exclusion criteria were as follows: no surgery, a concurrent chronic immunomodulated systemic disease, a SARS-CoV-2-positive test in the previous 12 months, a history of cancer in the previous 5 years, patients treated with immunomodulators, an American Society of Anesthesiologists category of class IV, and complicated acute diverticulitis.

Results: Seventy-two patients were included: 52 (72%) with URD, 11 (15%) with SUDD, and nine (13%) with SmD. The median postsurgery - presurgery (Δ)IL-6 and ΔTNF-α levels were -16.8 and -17.3 pg/mL, respectively (p < 0.001 for both; Wilcoxon test). Spearman correlation revealed a significant, negative association between the ΔGIQLI and the ΔIL-6, as well as the ΔTNF-α (p < 0.001 for both). Greater reduction in the levels of IL-6 and TNF-α following surgery are associated with higher GIQLI scores postoperatively.

Conclusion: Patients with chronic diverticulitis may experience persistent systemic inflammation driven by a colonic trigger. Surgical removal of this trigger appears to enhance GIQLI outcomes reducing IL-6 and TNF-α across surgery.

Keywords: IL‐6; TNF‐α; diverticulitis; quality of life; surgery.

© 2025 Association of Coloproctology of Great Britain and Ireland.

目的： 越来越多的证据表明，免疫/炎症途径在憩室病（DD）症状持续中起着关键作用。我们假设慢性憩室炎会触发一种自维持的炎症状态，可以通过测量肿瘤坏死因子-α (TNF-α) 和白细胞介素-6 (IL-6) 的水平来检测这种状态。本研究旨在调查患有 DD 患者在选择性手术前后 TNF-α 和 IL-6 的全身水平及其与胃肠生活质量指数（GIQLI）评分的关系。

方法： 这项前瞻性多中心研究纳入了来自憩室病注册处 (DDR-Trial, NCT04907383) 的患者。所有在 2022 年 12 月 1 日至 2023 年 12 月 31 日期间被诊断为症状性非复杂性憩室病 (SUDD)、非复杂复发性憩室炎 (URD) 和潜伏性憩室炎 (SmD) 的成年患者均纳入本研究。排除标准如下：无手术史，同时患有慢性免疫调节全身性疾病，最近 12 个月内 SARS-CoV-2 检测阳性，过去五年内有癌症病史，接受免疫调节剂治疗的患者，美国麻醉医师协会 IV 类别，以及复杂急性憩室炎。

结果： 共纳入了 72 名患者：52 名（72%）患有 URD，11 名（15%）患有 SUDD，9 名（13%）患有 SmD。术后与术前 (Δ)IL-6 和 ΔTNF-α 水平的中位数分别为 -16.8 pg/mL 和 -17.3 pg/mL （均 p

结论： 患有慢性憩室炎的患者可能会经历由结肠触发的持续性全身炎症。通过外科移除这种触发因素似乎可以提高手术后的 GIQLI 结果，并降低 IL-6 和 TNF-α 的水平。

关键词： IL‐6；TNF‐α；憩室炎；生活质量；手术。