Bernoulli's principle and flat (depressed) adenoma in the large intestine

 
2016, Nov/15 

Yoshiharu Uno, MD, PhD

One picture tells more than 10,000 words of papers.

There is a possibility that contradiction may be hidden in the theory which cannot be presented to the figure.

＜Epidemiological background＞

Until the Second World War, there was not any custom in Japan to drink milk. The Japanese began to consume milk after 1945.  Daily intake of Japanese dairy products and milk increased to 20g in the 1950s, 60g in the 1960's and 130g in the 1990's.

Diverticular disease detection rate by barium enema examination was several percent by 1940.

It rose to the 20% level in the 1980s, and it rose to 30% in the 1990s.

Flat adenoma began to get discovered since the 1980s in Japan.

In the United States, the UK and Australia, there are many pedunculated adenomas, which are frequent in the left colon.

Even in Japan, that tendency exists.

Flat (depressed) adenomas which are a high incidence in Japan are mainly occurring at the right colon.

 

The distribution of flat adenoma in Japan is the same as the distribution of colon diverticulum disease.

The right-side colon diverticular disease in Japan is related to lactose intolerance.

When over fermentation occurs in the right colon, Bernoulli's principle is applied.
 

 
The pressure of the right-side colon (including cecum) rises, and the flow increases in the left-side colon.
 

The form of adenoma might be determined by physical laws.

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  https://www.ncbi.nlm.nih.gov/pubmed/15690665

Dis Colon Rectum. 2005 Jan;48(1):101-7.

Flat-type early colorectal cancer preferentially develops in right-sided colon in older patients.

RESULTS:

Out of 227 early cancers, 44 were flat type and 183 were polypoid. Flat-type early cancer was more frequently located in the right colon (57 percent, 25/44) than polypoid-type cancer (19 percent, 35/183; P < 0.001).

Early cancers of colorectal cancer in Japan have many protuberant polyps, but flat type early cancers are common in the right colon.

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In countries with less lactose intolerance, Bernoulli's principle is adapted by the difference in the anatomical luminal size, although not as pronounced as in Japan.



 

Evidence 1.

Research in Australia

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924432/

United European Gastroenterol J. 2016 Jun;4(3):438-48. doi: 10.1177/2050640615610266. Epub 2015 Oct 13.

Distribution, size and shape of colorectal adenomas as determined by a colonoscopist with a high lesion detection rate: Influence of age, sex and colonoscopy indication.

 

Small flat adenomas less than 7 mm are common in the right colon.
However, protruding adenomas of 8 mm or more are on the left side.

The difference in this distribution can be explained by the physical law.

Evidence 2.

 Research in Germany

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498525/table/Tab2/

BMC Gastroenterol. 2015 Jul 10;15:82. doi: 10.1186/s12876-015-0312-4.

Frequent co-occurrence of high-grade dysplasia in large flat colonic polyps (>20 mm) and synchronous polyps.

A large flat colonic polyp larger than 20 mm was more frequent in the proximal colon than in the distal colon.

However, adenocarcinoma was more frequent in the distal colon.

 

Flat polyp of the proximal colon was not correlated with malignancy.

This contradiction can conclude that the form of adenoma of the proximal colon is not a tissue vulnerability due to cancer but another cause.

Evidence 3.

Bhurwal A¹, Bartel MJ¹, Heckman MG², Diehl NN², Raimondo M¹, Wallace MB¹, Woodward TA¹

¹Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA.

²Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA.

Endoscopic mucosal resection: learning curve for large nonpolypoid colorectal neoplasia

Gastrointest Endosc. 2016 Apr 22. pii: S0016-5107(16)30066-9. doi: 10.1016/j.gie.2016.04.020. [Epub ahead of print]

A study of the United States: in 2016: 578 people

Distribution of large nonpolypoid colorectal neoplasia of 20 mm or more

80% occur in the proximal colon.

 

 
My comment: Secondary lactose intolerance may be increasing in the United States.