Diverticulitis in the Young Is Not More Aggressive Than in the Elderly, but It Tends to Recur More Often

Systematic Review and Meta-analysis

Lior H Katz; Daniel D Guy; Adi Lahat; Anat Gafter-Gvili; Simon Bar-Meir

Disclosures

J Gastroenterol Hepatol. 2013;28(8):1274-1281. 

In This Article

Abstract and Introduction

Abstract

Background and Aim For years, the natural course of diverticulitis in the young has been debatable in terms of its severity and recurrence rate, and no consensus has been reached regarding its treatment and timing of surgery. Thus, the study aims to evaluate by meta-analysis the natural course of acute diverticulitis in the young.

Methods Data were obtained from electronic databases and manual search of studies comparing the course of diverticulitis in young versus elderly patients. The age cut-off was selected to be 40–50 years, and only studies using computed tomography as the sole modality for diagnosis were included. Primary outcomes were surgery during hospitalization and disease recurrence. Relative risks (RRs) with 95% confidence intervals (CIs) are reported.

Results One thousand eighty publications were found, 12 of which were included. The total number of patients was 4982. Most young patients were males (RR 1.70, 95% CI 1.31–2.21), without tendency toward a more complicated disease at admission (RR 0.95, 95% CI 0.46–1.97). While there was no significant difference in the rate of surgery during hospitalization (RR 0.69, 95% CI 0.46–1.06), young patients underwent more elective surgeries (RR 2.39, 95% CI 1.82–3.15). No mortality was recorded among young patients. The disease recurrence rate was significantly higher than that of elderly patients (RR 1.70, 95% CI 1.31–2.21); however, no study specified the mean follow-up period for each group.

Conclusions The course of diverticulitis in the young is not more severe than that in elderly patients; however, the disease tends to recur more often. Therefore, while choosing a therapeutic regimen, factors other than age should also be considered.

Introduction

Diverticular disease of the colon is a common disorder in Western societies. The incidence of diverticular disease rises with age, and by the age of 85, about 65% of the population in the industrialized world will have diverticula.[1–3] The disease is much less frequent in the patients under the age of 50 years.[1–5]

While most patients will remain asymptomatic, a minority will suffer from complications, the most common of which is acute diverticulitis occurring in 10–25% of the patients.[3,4,6] In most patients, acute diverticulitis is mild, responds well to antibiotics, and usually does not recur. However, in up to 30% of patients, the disease may recur.[3,7] Up to 25% of the patients might suffer complications such as abscess formation, fistula, or free perforation.[8]

Data regarding the natural history of acute diverticulitis in young patients are conflicting. While some studies report a more severe course of disease and higher complications rate in young patients,[2,9–14] others find no difference from disease behavior in older age groups.[7,15] Unfortunately, most of these studies were undertaken before the computed tomography (CT) era and included only a small number of patients, making it difficult to establish standard of care.

We undertook a systematic review and meta-analysis of comparative studies in order to evaluate whether young patients indeed have more aggressive disease and a higher cumulative risk for dismal prognosis compared with elderly patients.

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