Acute diverticulitis is the most common complication of diverticular disease, and its clinical presentation varies from mild local inflammation to full-blown perforation. After resolution of an acute episode, the best management strategy is as yet undefined, due to the risk of further episodes and the risk associated with elective surgical resection. Historically, surgical resection has been advocated after one episode of complicated diverticulitis (diverticulitis with perforation of the bowel wall, which manifests as intra-abdominal abscesses or peritonitis) and after one episode of uncomplicated disease (local inflammation) for patients younger than 50 years old. However, this aggressive strategy for younger patients has been questioned by several researchers.
A research article to be published on January 14, 2011 in the World Journal of Gastroenterology addresses this question. The authors did a retrospective study to compare the natural history and the course of acute diverticulitis in a younger age group with that of an older population.
In this study, the patients younger than 50 years at first presentation of diverticulitis had less severe disease but a higher recurrence rate (25.8% vs 11.1%). All the patients with recurrent disease were managed with conservative treatment and for the majority of patients, the most severe attack of diverticulitis was the first. On multivariate analysis, age was the only factor predictive of recurrence.
The results show that acute diverticulitis is a mild disease with a low complication rate. In younger patients, there is a male predominance and the disease tends to be less severe than in the older age group, in spite of the higher recurrence rate. The clinical course of uncomplicated acute diverticulitis is similar both in younger and older patients. Therefore the same guidelines should be used in the treatment of both groups of patients.
Reference: Faria GR, Almeida AB, Moreira H, Pinto-de-Sousa J, Correiada-Silva P, Pimenta AP. Acute diverticulitis in younger patients: Any rationale for a different approach? World J Gastroenterol 2011; 17(2): 207-212
http://www.wjgnet.com/1007-9327/full/v17/i2/207.htm
Correspondence to: Gil R Faria, MD, MSc, Department of General Surgery, Hospital de São João, Al. Prof. Hernâni Monteiro, HSJ, 4200-319 Porto, Portugal. [email protected]
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About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2009 IF: 2.092. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
