Multicentre observational study of the natural history of left-sided acute diverticulitis

Binda, Gian Andrea; Arezzo, Alberto; Serventi, A.; Bonelli, Luigina

doi:10.1002/bjs.7723

Cited by 81 publications

(54 citation statements)

References 53 publications

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“…The time interval claimed necessary to distinguish between the two episodes varies among authors, ranging between 1 [1], 2 [2,3] and 3 months [4]. …”

Section: Definitionmentioning

confidence: 99%

“…In order to gather information on the natural history of complicated colonic diverticular disease, a joint study group, the Italian Study Group on Complicated Diverticulosis (GISDIC) was formed in 1997 [3]. All consecutive patients with left-sided AD diagnosed clinically (abdominal pain, associated with leukocytosis (>11 × 10 9 ) and/or fever >38°C) and confirmed by imaging (CT scan, ultrasonography, water-soluble contrast enema) either alone or in combination and/or by operative findings, entered the study.…”

Section: Our Studymentioning

confidence: 99%

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Clinical Presentation and Risks

Binda

Amato

Serventi

et al. 2012

Dig Dis

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Background: A recurrent episode of diverticulitis is a new distinct episode of acute inflammation after a period of complete remission of symptoms. Outdated literature suggested a high recurrence rate (>40%) and a worse clinical presentation with less chance of conservative treatment. More recent studies showed a more benign course with no need toward an aggressive policy of treatment. Methods: We report data from revised literature and from our study: a 4-year multicenter retrospective and prospective database analysis of 743 patients hospitalized for acute diverticulitis (AD) treated medically or surgically and then followed for a minimum of 9 years. Results: The literature showed a recurrence rate of 25–35% at 5 years of follow-up, with a reduced risk of severe complications (i.e. perforations), a risk of subsequent emergency surgery of 2–14% and a risk of stoma and related death of 0–2.7%. Several risk factors of recurrence have been advocated: family history, abscess, severe CT stage, comorbidities (renal failure, collagen vascular disease) and nonsteroidal anti-inflammatory drugs. Young age is still a matter of debate. These studies have different limitations: retrospective, lack of definition of AD, small number of patients, long recruiting time, short follow-up, study population or hospital-system based. In our study of 320 followed-up, medically treated patients, 61% were asymptomatic and 22% complained of chronic symptoms: the 12-year actuarial risk of recurrence, emergency surgery, stoma and death was 21.2, 8.3, 1 and 0%, respectively. Recurrence was related to very young age (<40 years) and more than 3 previous episodes of AD. Conclusion: This study confirms the benign course of diverticulitis treated conservatively, with a low long-term risk of serious complications and death, and does not support an aggressive surgical policy to prevent them.

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“…The time interval claimed necessary to distinguish between the two episodes varies among authors, ranging between 1 [1], 2 [2,3] and 3 months [4]. …”

Section: Definitionmentioning

confidence: 99%

Section: Our Studymentioning

confidence: 99%

Clinical Presentation and Risks

Binda

Amato

Serventi

et al. 2012

Dig Dis

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“…134 These data were confirmed in a large multi centre study, in which the recurrence rate for conser vatively treated patients was 17.2% versus 5.8% in surgi cally treated patients, with the need for emergency surgery in 6.9% versus 1.3%, respectively. 135 Recurrence rates per year in conservatively treated patients were, however, only 1.8% and 2.1% in two large studies. 135,136 Hence, patient age and comorbidities might strongly influence the decision for elective surgery.…”

Section: Interventional Therapy and Surgerymentioning

confidence: 95%

“…135 Recurrence rates per year in conservatively treated patients were, however, only 1.8% and 2.1% in two large studies. 135,136 Hence, patient age and comorbidities might strongly influence the decision for elective surgery.…”

Section: Interventional Therapy and Surgerymentioning

confidence: 95%

Management of diverticular disease

Pfützer

Kruis

2015

Nat Rev Gastroenterol Hepatol

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Diverticular disease is a common condition in Western countries and the incidence and prevalence of the disease is increasing. The pathogenetic factors involved include structural changes in the gut that increase with age, a diet low in fibre and rich in meat, changes in intestinal motility, the concept of enteric neuropathy and an underlying genetic background. Current treatment strategies are hampered by insufficient options to stratify patients according to individual risk. One of the main reasons is the lack of an all-encompassing classification system of diverticular disease. In response, the German Society for Gastroenterology and Digestive Diseases (DGVS) has proposed a classification system as part of its new guideline for the diagnosis and management of diverticular disease. The classification system includes five main types of disease: asymptomatic diverticulosis, acute uncomplicated and complicated diverticulitis, as well as chronic diverticular disease and diverticular bleeding. Here, we review prevention and treatment strategies stratified by these five main types of disease, from prevention of the first attack of diverticulitis to the management of chronic complications and diverticular bleeding.

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“…Several large, long-term studies involving patients initially admitted to hospital for acute diverticulitis have reported that the 5-year recurrence rate is up to 20%. [16][17][18] Several aspects of management after an acute episode (i.e., diet, antibiotic therapy and surgery) are discussed below.…”

Section: How Is Diverticulitis Currently Managed After An Acute Episode?mentioning

confidence: 99%