The prevalence of symptomatic uncomplicated diverticular disease could be lower than expected: a single-center colonoscopy-based cohort study

Abstract

Aim The real prevalence of symptomatic uncomplicated diverticular disease (SUDD) is still unknown. The aim of this study was to assess the prevalence of SUDD, post-diverticulitis SUDD (PD-SUDD) and irritable bowel syndrome (IBS)-like symptoms in a real-life population. Methods A cohort of patients, submitted to colonoscopy from 1st January 2012 to 30th April 2018 was revised. Results A cohort of 5451 patients with diverticulosis was identified during the study period. Abdominal pain was recorded in 1141 patients (20.93%), diarrhea in 288 (5.28%) and constipation in 536 (9.83%) patients. SUDD was recorded in 371 patients (6.81% of the patients having diverticulosis and 32.51% of the patients experiencing abdominal pain), PD-SUDD was recorded in 103 patients (1.89% of the patients having diverticulosis and 9.03% of the patients experiencing abdominal pain) and IBS-like was recorded in 348 patients (6.38% of the patients having diverticulosis and 30.5% of the patients experiencing abdominal pain). Three hundred and nineteen patients were not part of any of the previous categories (5.85% of the patients having diverticulosis and 27.96% of the patients experiencing abdominal pain). SUDD and PD-SUDD were more frequent in older ages (>60 years), while IBS-like symptoms were more frequent in younger. Nonspecific abdominal pain was equally distributed in through the ages. Conclusion The prevalence of SUDD seems to be lower than expected, and most of patients with diverticulosis and abdominal symptoms may suffer from IBS-like or other causes.

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 ].…”

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

“…In an Italian case–control study including 5451 patients with colonic diverticula, Tursi et al found a prevalence of SUDD in 6.8% of patients. 23 Interestingly, abdominal pain was recorded in almost 21% of patients, diarrhea in 5.3%, and constipation in 9.8% among patients with colonic diverticulosis. 23 In a second Italian prospective observational multicenter cohort study (the REMAD Registry), Carabotti et al found that 6.3% of the 490 patients with baseline diverticulosis developed SUDD at one-year follow-up.…”

“… 23 Interestingly, abdominal pain was recorded in almost 21% of patients, diarrhea in 5.3%, and constipation in 9.8% among patients with colonic diverticulosis. 23 In a second Italian prospective observational multicenter cohort study (the REMAD Registry), Carabotti et al found that 6.3% of the 490 patients with baseline diverticulosis developed SUDD at one-year follow-up. 19 Differently, in a cohort of 310 participants during a mean follow-up time of 6.8 years at the University of North Carolina, Peery et al found that only 1% of participants with diverticulosis reported a protracted left lower quadrant abdominal pain associated with SUDD.…”

“…The prevalence of colonic diverticula increases with age, and it is primarily a life-long asymptomatic condition, with only 10–20% of patients that will develop diverticular disease. 23 , 24 Few studies explored SUDD prevalence, and the results are contrasting. In an Italian case–control study including 5451 patients with colonic diverticula, Tursi et al found a prevalence of SUDD in 6.8% of patients.…”

“…In addition, some clarifications are needed as SUDD might affect patients in differently. For example, a recent study showed that SUDD occurred after an acute diverticulitis episode as a different clinical condition named post-diverticulitis SUDD (PD-SUDD), 23 and found it associated with an unexpected abscess in almost half of the patients post asymptomatic uncomplicated diverticulitis and 63% with PD-SUDD. 22 Also, an overlapping preoperative diagnosis of IBS has been associated with postoperative recurrence of SUDD, analogously to diverticulitis.…”