Perforationsrisiko und Patientenalter

Holmer, Christoph; Lehmann, Kai S.; Gröne, Jörn; Hj, Buhr; Ritz, Jörg‐Peter

doi:10.1007/s00104-010-1961-z

Cited by 8 publications

(6 citation statements)

References 32 publications

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“…Although elective resection is often recommended after single episodes of complicated acute diverticulits that were resolved with conservative treatment, such an invasive procedure following a favorable response to noninvasive methods has serious implications and should be made on an individual basis [52-55]. …”

Section: Introductionmentioning

confidence: 99%

2013 WSES guidelines for management of intra-abdominal infections

Sartelli

Viale

Catena³

et al. 2013

World J Emerg Surg

271

267

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Section: Introductionmentioning

confidence: 99%

2013 WSES guidelines for management of intra-abdominal infections

Sartelli

Viale

Catena³

et al. 2013

World J Emerg Surg

271

267

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“…The third study reported a slightly increased odds ratio (OR) for every 10-year increase of age (adjusted OR 1.16; 95% CI 1.01-1.33) [38]. The fourth study found comparable risks for both groups (adjusted OR 1.01; 95% CI 0.65-1.57) [28].…”

Section: Severity Of Diverticulitis At Presentationmentioning

confidence: 95%

“…Whereas most studies applied no explicit in-or exclusion criteria, five studies [16][17][18][19][20] that mainly focussed on the risk of recurrent diverticulitis only included a subgroup of patients such as only uncomplicated diverticulitis or only patients without colonic resection in the initial diverticulitis episode. The stage of acute diverticulitis at presentation was reported by 21 studies , rates of emergency surgery during the initial episode by 11 studies [18,24,[27][28][29]32,34,37,39,41,42], rates of percutaneous abscess drainage during the initial episode by two studies [29,32] and rates of recurrent diverticulitis by 12 studies [16][17][18][19][20]24,25,27,33,34,36,41].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Neither of these variables could explain this heterogeneity; type of age cut-off (50 years versus 40 years; coefficient 0.134, P = 0.601), study design (prospective versus retrospective; coefficient 0.130, P = 0.569), history of diverticulitis (only primary diverticulitis versus mixed with history of diverticulitis; coefficient 0.204, P = 0.360) and location of diverticulitis (100% left-sided diverticulitis versus partially left-sided diverticulitis or not reported; coefficient −0.116, P = 0.618). Four studies [28,36,38,39] reported results from multivariable logistic regression analyses. Two of these four studies did not report crude results but only reported that age below 40 was not a risk factor for free perforation or complicated diverticulitis [36,39].…”

Section: Severity Of Diverticulitis At Presentationmentioning

confidence: 99%

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A systematic review and meta-analysis of disease severity and risk of recurrence in young versus elderly patients with left-sided acute diverticulitis

Dijk

Abdulrahman

Draaisma

et al. 2020

European Journal of Gastroenterology &Amp; Hepatology

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Young patients are thought to have a more severe disease course and a higher rate of recurrent diverticulitis. However, these understandings are mainly based on studies with important limitations. This review aimed to clarify the true natural history of acute diverticulitis in young patients compared to elderly patients. PubMed and MEDLINE were searched for studies reporting outcomes on disease severity or recurrences in young and elderly patients with a computed tomography-proven diagnosis of acute diverticulitis. Twenty-seven studies were included. The proportion of complicated diverticulitis at presentation (21 studies) was not different for young patients (age cut-off 40–50 years) compared to elderly patients [risk ratio (RR) 1.19; 95% confidence interval 0.94–1.50]. The need for emergency surgery (11 studies) or percutaneous abscess drainage (two studies) yielded comparable results for both groups with a RR of 0.93 (95% confidence interval 0.70–1.24) and 1.65 (95% confidence interval 0.60–4.57), respectively. Crude data on recurrent diverticulitis rates (12 studies) demonstrated a significantly higher RR of 1.47 (95% confidence interval 1.20–1.80) for young patients. Notably, no association between age and recurrent diverticulitis was found in the studies that used survival analyses, taking length of follow-up per age group into account. In conclusion, young patients do not have a more severe course of acute diverticulitis. Published data on the risk of recurrent diverticulitis in young patients are conflicting, but those with the most robust design do not demonstrate an increased risk. Therefore, young patients should not be treated more aggressively nor have a lower threshold for elective surgery just because of their age.

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“…This confirmation is essential to prevent that patients suffering from different diseases but with comparable symptoms, such as inflammatory bowel disease or irritable bowel syndrome, enter the study group. Studies that only include computed tomography-proven acute diverticulitis patients have found comparable proportions of complicated diverticulitis at presentation and comparable rates of emergency surgery in young (using cut-offs at 40 or 50 years) and elderly patients [ 17 – 20 ]. Nevertheless, these CT-based studies have found slightly higher rates of recurrent diverticulitis.…”

Section: Patient Subgroupsmentioning

confidence: 99%

Conservative Treatment of Acute Colonic Diverticulitis

Dijk

Rottier

Geloven

et al. 2017

Curr Infect Dis Rep

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Purpose of ReviewSince the treatment of acute diverticulitis has become more conservative over the last years, knowledge of conservative treatment strategies is increasingly important.Recent FindingsSeveral treatment strategies that previously have been imposed as routine treatment are now obsolete. Uncomplicated diverticulitis patients can be treated without antibiotics, without bed rest, and without dietary restrictions; and a selected group of patients can be treated as outpatients. Also, patients with isolated pericolic extraluminal air can be treated conservatively as well. Whereas some patient subgroups have been suggested to suffer from a more virulent disease course or higher recurrence rates, current evidence does not support all traditional understandings. Patients on immunosuppression or non-steroidal anti-inflammatory drugs seem to have a higher risk of complicated diverticulitis, but young patients do not. Data on the risk of recurrent diverticulitis in young patients is conflicting but the risk seems comparable to elderly patients. Besides the traditional treatments, several new treatment strategies have emerged but have failed thus far. Mesalazine does not have any beneficial effect on preventing recurrent diverticulitis based on current literature. Rifaximin and probiotics have been studied insufficiently in acute diverticulitis patients to conclude on their efficacy.SummaryThis review provides an overview of recent developments in conservative treatment strategies of acute diverticulitis and discusses the latest evidence on patient subgroups that have been suggested to suffer from an aberrant disease course.

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Perforationsrisiko und Patientenalter

Abstract: First episodes of SD were more frequent in younger patients (≤40) and did not involve a higher risk of perforation. The indication for treatment of acute SD should not be based on age but on the severity of inflammation and the individual situation of patients.

Cited by 8 publications

References 32 publications

2013 WSES guidelines for management of intra-abdominal infections

2013 WSES guidelines for management of intra-abdominal infections

A systematic review and meta-analysis of disease severity and risk of recurrence in young versus elderly patients with left-sided acute diverticulitis

Conservative Treatment of Acute Colonic Diverticulitis

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