Diverticular disease hospital admissions are increasing, with poor outcomes in the elderly and emergency admissions

Jeyarajah, Santhini; Faiz, Omar; Bottle, Alex; Aylin, Paul; Bjarnason, Ingvar; Tekkis, Paris; Papagrigoriadis, Savvas

doi:10.1111/j.1365-2036.2009.04098.x

Cited by 90 publications

(73 citation statements)

References 28 publications

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“…In a recent national population study, 30-day mortality following diverticular disease hospital admission was 5.1% and 1-year mortality was 14.5%. 25 Increasing age, comorbidity and emergency admission as for diverticular bleeding were independent predictors of mortality. 25 For instance, it has been proven that mortality increases significantly when patients receive more than 10 units of blood, 22 or when patients require emergency total colectomy for nonlocalized colonic diverticular bleeding by a nonspecialized surgeon.…”

Section: Patient Demographicsmentioning

confidence: 96%

“…25 Increasing age, comorbidity and emergency admission as for diverticular bleeding were independent predictors of mortality. 25 For instance, it has been proven that mortality increases significantly when patients receive more than 10 units of blood, 22 or when patients require emergency total colectomy for nonlocalized colonic diverticular bleeding by a nonspecialized surgeon. In a collected series of patients with surgery for bleeding diverticulosis, reviewed by Bender et al, 26 there was a cumulative mortality rate of 22.6% in all series from 1972 to 1990.…”

Section: Patient Demographicsmentioning

confidence: 96%

See 1 more Smart Citation

Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients

Poncet

Héluwaert

Voirin

et al. 2010

Aliment Pharmacol Ther

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Section: Patient Demographicsmentioning

confidence: 96%

Section: Patient Demographicsmentioning

confidence: 96%

Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients

Poncet

Héluwaert

Voirin

et al. 2010

Aliment Pharmacol Ther

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“…Furthermore, the incidence of this disease has been growing in both Europe and the USA (29,30). Eighty per cent of individuals affected with diverticulosis are asymptomatic but up to 15% will develop CDB, which may be severe and also occur as repeated episodes.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for severity and recurrence of colonic diverticular bleeding

Joaquim¹,

Caldeira²,

Antunes³

et al. 2016

Rev Esp Enferm Dig

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Background: Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Risk factors related to severity and repeated bleeding episodes are not completely clearly defined.Objective: To characterize a Portuguese population hospitalized due to colonic diverticular bleeding and to identify the clinical predictors related to bleeding severity and rebleeding.Methods: Retrospective analysis of all hospitalized patients diagnosed with colonic diverticular bleeding from January 2008 to December 2013 at our institution. The main outcomes evaluated were bleeding severity, defined as any transfusion support requirements and/or signs of hemodynamic shock, and 1-year recurrence rate.Results: Seventy-four patients were included, with a mean age of 75.7 ± 9.5 years; the majority were male (62.2%). Thirty-six patients (48.6%) met the criteria for severe bleeding; four independent risk factors for severe diverticular bleeding were identified: low hemoglobin level at admission (≤ 11 g/dL; OR 18.8), older age (≥ 75 years; OR 4.7), bilateral diverticular location (OR 14.2) and chronic kidney disease (OR 5.6). The 1-year recurrence rate was 12.9%. We did not identify any independent risk factor for bleeding recurrence in this population.Conclusion: In this series, nearly half of the patients hospitalized with diverticular bleeding presented with severe bleeding. Patients with low hemoglobin levels, older age, bilateral diverticular location and chronic kidney disease had a significantly increased risk for severe diverticular bleeding. In addition, a small number of patients rebled within the first year after the index episode, although we could not identify independent risk factors associated with the recurrence of diverticular bleeding.

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“…5 These increases in admissions have been mirrored by increasing rates of hospitalisation in the UK as reported from Hospital Episode Statics data, although these studies are limited by coding and cannot report overall rates of admission for acute diverticulitis. 6,7 It would appear, therefore, that the rates of admission are increasing. Although changes in coding and the use of diagnostic tests such as computed tomography may contribute to these changing patterns, this is unlikely given the differing patterns in admission occurring across age groups.…”

Section: Epidemiology and Pathogenesismentioning

confidence: 99%

Review article: the pathogenesis and management of acute colonic diverticulitis

Humes

Spiller

2014

Aliment Pharmacol Ther

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SummaryBackgroundAcute diverticulitis, defined as acute inflammation associated with a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians. There have been advances in both the medical and the surgical treatments offered to patients in recent years.AimTo review the current understanding of the aetiology and treatment of acute diverticulitis.MethodsA search of PubMed and Medline databases was performed to identify articles relevant to the aetiology, pathogenesis and management of acute diverticulitis.ResultsThere are 75 hospital admissions per year for acute diverticulitis per 100 000 of the population in the United States. Recent reports suggest a 26% increase in admissions over a 7‐year period. Factors predisposing to the development of acute diverticulitis include obesity, smoking, diet, lack of physical activity and medication use such as aspirin and nonsteroidal anti‐inflammatory drugs. The condition is associated with a low mortality of about 1% following medical therapy, rising to 4% in‐hospital mortality in those requiring surgery. There is limited evidence on the efficacy of individual antibiotic regimens, and antibiotic treatment may not be required in all patients. The rates of recurrence reported for patients with acute diverticulitis following medical management vary from 13% to 36%. The surgical management of those patients who fail medical treatment has moved towards a laparoscopic nonresectional approach; however, the evidence supporting this is limited.ConclusionsFurther high‐quality randomised controlled trials are required of both medical and surgical treatments in patients with acute diverticulitis, if management is to be evidence‐based.

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Diverticular disease hospital admissions are increasing, with poor outcomes in the elderly and emergency admissions

Abstract: SUMMARYBackground Diverticular disease has a changing disease pattern with limited epidemiological data.

Cited by 90 publications

References 28 publications

Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients

Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients

Risk factors for severity and recurrence of colonic diverticular bleeding

Review article: the pathogenesis and management of acute colonic diverticulitis

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