Natural History of Ulcerative Colitis with Coexistent Colonic Diverticulosis

Abstract

Ulcerative colitis (UC) and colonic diverticulosis can co-exist in some patients. However, the natural history of UC associated with colonic diverticulosis is not well known. We here compared the disease characteristics and outcome of UC patients with and without concomitant colonic diverticulosis. Medical records of 347 UC patients were included in an observational, retrospective, nested-matched case-control study. Cases were 92 patients with UC and concomitant colonic diverticulosis, while controls were 255 UC patients without concomitant colonic diverticulosis. A propensity score matching (PSM) was used to homogenate cases (n = 92) and controls (n = 153) for age. UC patients with concomitant colonic diverticulosis were less likely to have an extensive disease (25/92, 27.1%) and to experience steroid dependence (8/92, 8.6%) compared to patients without concomitant colonic diverticulosis (70/153, 45.7% and 48/153, 31.3%, respectively; p < 0.001). The use of immunosuppressants (9/92, 9.7% vs. 37/153, 24.1%; p = 0.007) or biologics (3/92, 3.2% vs. 26/153, 16.9%, p < 0.001) was significantly lower in UC patients with concomitant diverticulosis compared to the control group. On multivariate analysis, steroid dependence and extensive colitis were significantly less frequent in UC patients with concomitant colonic diverticulosis compared to UC patients without diverticula. UC patients with coexisting colonic diverticulosis are less likely to have an extensive disease and to be steroid-dependent.

A Rare Presentation of Recurrent Diverticulitis in a Patient with Ulcerative Colitis

“…In our case, we managed a 47-year-old woman with a history of UC, presenting with haemorrhagic diverticulitis which was promptly resolved with supportive therapy. Only 0.3% of patients with either UC or diverticulitis have both conditions simultaneously [8] , significantly lower when compared to controls of the same age and gender. Although advancing age is a risk factor for diverticulosis, in UC patients diverticulosis frequently presents late and is associated with a less aggressive UC clinical course.…”

“…Although advancing age is a risk factor for diverticulosis, in UC patients diverticulosis frequently presents late and is associated with a less aggressive UC clinical course. Another possible confounding factor in our patient is the concomitant administration of mesalamine, given that some authors have described a possible inverse correlation between maintenance therapy for UC, for instance with 5-ASA compounds, and diverticula formation [5,8].…”