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PROGRESSION RATE OF DIVERTICULAR DISEASE AND ASSOCIATED RISK FACTORS: RESULTS FROM PROSPECTIVE NATIONWIDE DIVERTICULAR DISEASE REGISTRY (REMAD)

Marilia Carabotti 1, Giuseppe Campagna 1, Camilla Ritieni 1, Rosario Cuomo 2, Fabio Pace 3, Caterina Sbarigia 1, Giovanni Barbara 4, Bruno Annibale 1

Affiliations

1 University Sapienza, Rome, Italy

2 AORN Sant'Anna e San Sebastiano, Caserta, Italy

3 Bolognini Hospital, Seriate, Italy

4 University of Bologna, Bologna, Italy

Summary

AI Generated

A five-year prospective multicenter cohort study of 1217 patients found that diverticular disease progression rates increase along the disease spectrum, with female gender being the only risk factor associated with progression to diverticulitis.

Among patients with baseline diverticulosis, 7.23% developed symptomatic uncomplicated diverticular disease and 1.13% developed diverticulitis over the study period.
Patients with previous diverticulitis had the highest recurrence rate at 21.70% (7.72 per 100 person-years), while 3.0% of symptomatic uncomplicated diverticular disease patients progressed to diverticulitis.
Female gender was associated with increased risk of developing diverticulitis in diverticulosis patients (HR 1.75, 95%CI 1.04-2.93) and recurrent diverticulitis (HR 2.73, 95%CI 1.42-5.25).
Other evaluated factors including age, BMI, family history, diet, smoking, alcohol, coffee use, physical activity, and medical treatments were not associated with disease progression.
This prospective data may help clinicians stratify progression risk and address clinical practice for patients with diverticular disease spectrum conditions.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Natural history of colonic diverticulosis and diverticular disease (DD) is poorly known, and available data come mostly from retrospective studies. Doubts exist about DD progression, rates, and associated risk factors.

Aims & Methods

We aimed to assess the progression rate of different spectrum of DD and associated risk factors. A five-years, prospective, observational, multicenter cohort-study, with follow-up assessment scheduled every six months (Diverticular Disease Registry, REMAD) was conducted. At baseline,1217 patients were categorized: i) Diverticulosis: presence of colonic diverticula in the absence of lower abdominal symptoms; ii) Symptomatic uncomplicated diverticular disease (SUDD): recurrent abdominal symptoms as pain and/or changes in bowel habits, attributed to diverticula in absence of overt inflammation; iii) Previous diverticulitis (PD): patients who have experienced at least one episode of diverticulitis in the past. We evaluated: i) risk of SUDD among patients with baseline diverticulosis; ii) risk of diverticulitis among patients with baseline diverticulosis; iii) risk of diverticulitis among patients with baseline SUDD; iv) risk of recurrent diverticulitis in patients with baseline PD.
Comparison of the continuous variables was performed by Generalized Linear Mixed Model, and the association with sex was evaluated by X2 test. Kaplan-Meier analysis and the Cox hazard model (backward model) were used to identify factors associated with DD progression [age, gender, body mass index (BMI), first-degree family history of DD or colonic cancer, diet rich in fiber, active smoking, alcohol and coffee use, physical activity, medical treatments].

Results

Table 1 presents patient’s baseline demographic characteristics and length of follow-up. Compared to diverticulosis, female gender was associated to SUDD (p<0.0001) and PD (p=0.003). PD patients were younger than diverticulosis and SUDD (p=0.002 vs diverticulosis; p=0.03 vs SUDD). Over the study period, 51 patients with baseline diverticulosis developed SUDD (7.23%; 2.42 per 100 person-year) and 8 developed diverticulitis (1.13%; 0.38 per 100 person-year). Nine patients with baseline SUDD developed diverticulitis (3.0%; 0.93 per 100 person-year). Forty-six patients with baseline PD develop a recurrent diverticulitis (21.70%; 7.72 per 100 person-year). Female gender is associated with increased risk of developing diverticulitis in patients with baseline diverticulosis [HR=1.75 (95%CI: 1.04 to 2.93), p=0.035] or having recurrent diverticulitis [HR=2.73 (95%CI: 1.42 to 5.25), p=0.003]. Other factors were not associated to DD progression.

	Diverticulosis [mean±SD; (n=705)]	SUDD [mean±SD; (n=300)]	Previous diverticulitis [mean±SD; (n=212)]	P value
Female gender (%)	277 (39.29)	176 (58.67)	109 (51.42)	<0.0001
Age (years)	66.68±9.43	66.26±9.55	63.71±12.29	0.003
BMI (kg/m2)	26.2±3.86	26.26±3.95	25.64±4.15	0.13
Follow-up (months)	39.72±20.36	41.35±20.53	38.64±22.18	0.51

Conclusion

This prospective observational study shows a progression rate of diverticular disease increasing along with DD spectrum (i.e. from diverticulosis, SUDD, up to patients with previous diverticulitis). We also found that the only risk factor associated with disease progression was the female gender. This should be kept in mind to better address clinical practice and to stratify progression disease risk.

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

There are always openings (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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