Diverticulitis: A Progressive Disease?

Division of Colon & Rectal Surgery, Mayo Clinic and Mayo Foundation, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Annals of Surgery (Impact Factor: 8.33). 06/2006; 243(6):876-830; discussion 880-3. DOI: 10.1097/01.sla.0000219682.98158.11
Source: PubMed


Our understanding of complicated diverticulitis is based on outdated literature. Antecedent episodes of diverticulitis are felt to increase the risk of developing complicated diverticulitis, as well as its subsequent morbidity and mortality. Practice parameters recommend elective resection after 2 episodes of diverticulitis to reduce this morbidity and mortality.
A total of 150 patients with prior episodes of diverticulitis who were hospitalized with complicated diverticulitis were retrospectively analyzed. Statistical analysis was conducted using chi and Fisher exact test tests.
Patients were separated into 2 groups for analysis: group A = those with 1 or 2 prior diverticulitis episodes (n = 118) versus group B = patients with more than 2 prior episodes (n = 32). Characteristics of the groups were similar for age and preexistent comorbid conditions. The majority of patients presented with pericolonic abscess and inflammatory phlegmon. Perforated diverticulitis occurred more often in group A compared with patients with >2 episodes of diverticulitis. Because of the higher rate of perforation, patients in group A underwent surgical diversion more often than group B patients. No significant differences in operative complications, morbidity, or mortality rates were identified between the groups.
Patients with multiple (>2) episodes of diverticulitis are not at increased risk for poor outcomes if they develop complicated diverticulitis. Morbidity and mortality rates are not significantly different between patients with multiple episodes of diverticulitis compared with those with 1 or 2 prior attacks. Reevaluation of the practice of elective resection as a strategy for reducing the mortality and morbidity from complicated diverticulitis is needed.

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Available from: Dirk R Larson, Oct 06, 2015
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    • "A recurrence rate of 25–30 % is usually reported [30–32], which compares well with that of the present study, although rates as low as 6.1 % have been reported [33]. Different ways to indicate recurrence, whether as an absolute rate or as an estimated rate using Kaplan-Meier analysis, may explain some of the reported differences. "
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    ABSTRACT: Hospitalization for acute colonic diverticulitis has become more and more frequent. We studied the changes in the rate of admission and incidence of the disease during the last 25 years. We performed a retrospective analysis of all cases treated for acute diverticulitis during 1988-2012 at one hospital serving a defined population in Mid-Norway. The study made a distinction between admission rates and incidence rates. The admission rates defined the total number of cases admitted, while the incidence rates defined the number of new patients hospitalized for acute diverticulitis (first admission). Poisson regression was used to analyse factors associated with diverticulitis incidence rates. A total of 851 admissions in 650 different patients were identified, with an overall admission rate of 38.5 (CI 35.9 to 41.1) per 100,000 person-years. The admission rate increased from 17.9 (CI 14.1 to 22.3)/100,000 during 1988-1992 to 51.1 (CI 44.8 to 58.0)/100,000 during 2008-2012. Poisson regression analysis showed a significant increase in admission rates with a factor of 2.8 (C.I. 2.2 to 3.5) during 25 years. The overall incidence rate (IRR) of new patients was 29.4 (CI 27.1 to 31.7)/100,000 person-years. IRR increased significantly with a factor of 2.6 (CI 1.96 to 3.34) during 25 years, while IRR for perforations increased even more, by a factor of 3.3 (CI 1.24 to 8.58). The hospital admission rates as well as incidence rates for acute colonic diverticulitis increased significantly during the 25-year time span.
    International Journal of Colorectal Disease 05/2014; 29(8). DOI:10.1007/s00384-014-1888-9 · 2.45 Impact Factor
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    • "The overall mortality rate for patients with a prior history of diverticulitis was 2.5%, comparing favorably with a mortality rate of 10% for patients with a first presentation of complicated diverticulitis [Chautems et al. 2002]. In addition, 78% of patients with perforated diverticulitis had no prior history of diverticulitis [Chapman et al. 2006]. Elective sigmoid resection for diverticulitis is associated with risks of mortality and colostomy as high as 2.3% and 14.2% respectively [Hart et al. 2002; Richards and Hammitt, 2002; Salem et al. 2004]. "
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    ABSTRACT: Acute diverticulitis of the colon represents a significant burden for national health systems, in terms of direct and indirect costs. Past guidelines claimed that recurrent episodes (two or more) of diverticulitis need surgery, but revised guidelines recommend an individualized approach to patients after an attack of acute diverticulitis. For these reasons, conservative treatment has become the preferred choice after an episode of diverticulitis. Thus, significant efforts are now being focused to identify the correct therapeutic approach to prevent diverticulitis relapses. Nonabsorbable antibiotics, 5-aminosalicylic acid and probiotics are currently being investigated in this way. The effectiveness and the future perspectives of these treatments are discussed herein.
    Therapeutic Advances in Chronic Disease 11/2013; 4(6):277-86. DOI:10.1177/2040622313498809
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    • "In our study, ≤3 attacks was associated with a significantly higher rate of pre-operative abscesses and fistulas. In a study on 150 patients, Chapman et al. also found that those with ≤2 attacks had a higher fistula rate (21 vs 9%), although the difference was not significant [19]. Cole et al. reported that, although a history of abscess increases the rate for conversion, it does not result in a longer operative time or increased length of stay and complication rates [6]. "
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    ABSTRACT: We aimed to investigate the relationship between the number of prior episodes of diverticulitis and outcomes of sigmoid colectomy. After institutional review board approval, a retrospective review was undertaken based on records of patients who underwent sigmoid resection with anastomosis for diverticulitis between 4 May 2007 and 29 February 2012. Patients were divided into two groups: 0-3 attacks (group 1) and ≥4 attacks (group 2). Statistical analyses were performed to determine whether the groups differed on demographic, intra-operative and postoperative variables. We identified 247 patients who underwent sigmoid colectomy for diverticulitis (45 open, 202 laparoscopic). The two groups did not differ significantly in age, gender, American Society of Anesthesiologists score, past surgical history, body mass index, length of stay, use of a stoma or number of prior hospitalizations for diverticulitis. Group 1 had a higher rate of abscesses (30.6 vs 6.8%, P < 0.001) and fistulas (19.4 vs 0.9%, P < 0.001); a longer operative time (190.1 vs 166.3 min, P = 0.0024); and higher rates of postoperative complications (45.8 vs 23.3%, P < 0.001) and conversion (17.1 vs 4.4%, P = 0.0091). The most common surgical complications in groups 1 and 2 were wound infection (35 vs 10) and ileus (20 vs 8). Based on multivariate regression analysis, ≥4 attacks were independently correlated with a lower complication rate (odds ratio = 0.512, 95% confidence interval = 0.266-0.987, P = 0.046). Patients who had ≥4 previous attacks of diverticulitis had fewer postoperative complications.
    07/2013; 1(1):64-9. DOI:10.1093/gastro/got017
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