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Our understanding of complicated diverticulitis is based on outdated literature.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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    • "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.
    Full-text · Article · May 2014 · International Journal of Colorectal Disease
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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.
    Full-text · Article · Nov 2013 · Therapeutic Advances in Chronic Disease
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    • "The present study also analyzed the relationship between diverticulitis severity and disease recurrence. While some reports suggest an increased risk of complications and a higher mortality rate in recurrent episodes,26-28 no link between recurrence and complicated diverticulitis was noted in newer studies.29-31 In this study, there were 17 patients (13.2%) with recurrent diverticulitis, and the OR for SD was 4.95. "
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    ABSTRACT: Acute complicated diverticulitis can be subdivided into moderate diverticulitis and severe diverticulitis. Although there have been numerous studies on the risk factors for complicated diverticulitis, little research has focused on severe diverticulitis. This study was designed to identify the risk factors for severe diverticulitis in an acute diverticulitis attack using the modified Hinchey classification. Patients were included if they had any evidence of acute diverticulitis detected by computed tomography. The patients were subdivided into severe diverticulitis (Hinchey class ≥Ib; abscesses or peritonitis) and moderate diverticulitis (Hinchey class Ia; pericolic inflammation) groups. Of the 128 patients, 25 exhibited severe diverticulitis, and 103 exhibited moderate diverticulitis. In a multivariate analysis, age >50 years (odds ratio [OR], 5.27; p=0.017), smoking (OR, 3.61; p=0.044), comorbidity (OR, 4.98; p=0.045), leukocytosis (OR, 7.70; p=0.003), recurrence (OR, 4.95; p=0.032), and left-sided diverticulitis (OR, 6.92; p=0.006) were significantly associated with severe diverticulitis. This study suggests that the risk factors for severe diverticulitis are age >50 years, smoking, comorbidity, leukocytosis, recurrent episodes, and left-sided diverticulitis.
    Full-text · Article · Jul 2013 · Gut and liver
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