The natural history of symptomatic uncomplicated diverticular disease: a long-term follow-up study

Abstract

Background Symptomatic uncomplicated diverticular disease (SUDD) affects about 20% of patients who have diverticulosis. However, the natural history of SUDD is not yet completely understood. Our aim was to assess the outcomes of a cohort of SUDD patients during a long-term follow up. Methods One hundred eighty-five patients suffering from SUDD were identified from a large electronic database. Symptoms assessed were abdominal pain, bloating, bowel movement/day, each of which was scored using a visual analogic scale (VAS); the symptom score was calculated by considering the value of the worst symptom present during assessment. Another VAS was used to assess patients’ quality of life (QoL). Patients were treated at the physician’s discretion (with rifaximin, mesalazine, probiotics, spasmolytics) only when symptoms occurred during the follow up. Follow-up visit was performed every year or whenever patients consider it necessary. Results During the follow up (156 months, interquartile range 9-171), 47 patients were lost to follow up. Among these, 9 died from causes not related to SUDD. Acute diverticulitis occurred in 14 patients (7.6% of the overall population): 6 patients (3.2% of the overall population) underwent surgery, and 2 patients (1.1% of the overall population) died because of peritonitis. Both the symptom score and the QoL score were substantially unmodified during the study period. Conclusions SUDD is an important disease able to affect patients significantly in the long term. Acute diverticulitis may sometimes occur in these patients, often leading to surgery with possible severe complications.

Symptomatic Uncomplicated Diverticular Disease (SUDD): Practical Guidance and Challenges for Clinical Management

“… 19 Moreover, Tursi et al reported that among 185 patients with SUDD, acute diverticulitis occurred in 7.6% and surgery was required in 3.2% after a median follow-up time of 13 years. 10 The difference in acute diverticulitis rate between the studies is consistent with the more rigorous inclusion criteria to define SUDD used by Tursi et al and with different follow-up periods. Importantly, all three studies demonstrated that SUDD is a chronic and distinct clinical entity.…”

“…SUDD’s natural history has been explored by three studies with a follow-up period of at least 5 years after diagnosis. 10 , 18 , 19 As reported by Salem et al, among 163 patients with SUDD, acute diverticulitis occurred in 1.7%, and surgery was required in 0.9% after a mean follow-up time of 5 years. 18 While the REMAD Registry reports among 300 patients with SUDD, a 1.6% incidence of acute diverticulitis after only 1 year of follow-up.…”

“…Still, only 8.6% achieved symptom resolution after SUDD diagnosis. 10 Also, previous studies found lower QoL scores in patients with SUDD with associated negative psychological, social, and physical symptoms, both during and after acute attacks. 8 , 9 To assess QoL properly in patients with SUDD, a specific disease-targeted health-related QoL questionnaire, the DV-QOL, has been developed and validated.…”

Microbiota Composition in Diverticular Disease: Implications for Therapy

“…Only a minority will develop acute diverticulitis (AD), characterized by acute inflammation of the diverticula [ 1 ]. Although the prevalence of SUDD and AD are lower than expected [ 2 , 3 , 4 ], we do not yet know why some patients with diverticulosis develop symptoms while others do not. There are data in the recent literature pointing out the possible role of gut microbiota (GM) as a critical factor in the pathogenesis of several gastrointestinal (GI) and extraintestinal (EI) diseases, improving the understanding of the highly complex interaction between GM and innate and adaptive immunity in regulating inflammation [ 5 ].…”

Microbiota and Probiotics: The Role of Limosilactobacillus Reuteri in Diverticulitis

“…Rifaximin has been used to treat Symptomatic Uncomplicated Diverticular Disease in a clinical trial and results were encouraging, in terms of symptom control. Interestingly, the changes in clinical presentation, also corresponded to changes in faecal microbiota composition, with a reduction of Roseburia, Veillonella, Streptococcus and Haemophilus [ 69 ]. In another study, also Akkermansia resulted reduced [ 70 ].…”