[Recurrent diverticulitis - risk factors]

Colonic diverticular disease is a common illness, especially in the elderly population. It may be asymptomatic and cause chronic intestinal problems, colonic diverticular bleeding or inflammatory complications with considerable morbidity and mortality. We have attempted at finding factors that would help us identify patients with a higher risk of diverticulitis recurrence as well as patients with a higher likelihood of perforated diverticulitis.

This retrospective study included all patients admitted to our surgical ward for inflammatory complications of diverticular disease between 2000 and 2012: 278 patients, 88 men and 190 women. We looked up the first attack of diverticulitis in our documentation as well as the relapses, if any, their number and course, and the time from the first attack to the relapse. We analyzed the influence of age, gender, comorbidities (diabetes mellitus, overweight, ischemic heart disease, chronic renal failure, gastroduodenal disease), nicotine abuse and medication (glucocorticoids and other immunosuppressive drugs, acetylsalicylic acid) on diverticulitis recurrence and its complicated course. We compared the results of conservative and surgical therapy. Statistical analysis was performed using Fishers exact test and Man-Whitney U tests.

We did not demonstrate any statistically significant dependence of diverticulitis recurrence on age or gender. Colectomy (both acute and elective surgery) clearly decreases the likelihood of recurrence (p=0.00007). Comorbidities, nicotine abuse and medication were not associated with an increased risk of recurrence. Steroid and immunosuppressive drugs use was significantly associated with higher perforation rates, without impacting on the likelihood of recurrence. Regular smoking of cigarettes had no impact on recurrence or on its severity.

We did not find any reliable indicator of recurrent diverticulitis. Age, gender, comorbidities, smoking and medication are not significant. Immunocompromised patients have a higher probability of perforation and a more serious course of the illness. The problem is, however, that complicated diverticulitis is often the initial clinical presentation of the disease. Surgical treatment is more effective than conservative therapy in the prophylaxis of recurrent diverticulitis, but, according to our as well as foreign data, the relapse of diverticulitis occurs in a minority of the patients (14% in our study) and the recurrence tends to have a relatively benign course. These findings should be taken into consideration when counselling patients regarding potential benefits of prophylactic colectomy.