S3102 Diverticular Disease: A Nationwide Analysis

Abstract

INTRODUCTION: Diverticulosis of the colon is one of the most prevalent digestive disorders with half of all adults aged 60 and older expected to have diverticulosis. The condition is called diverticular disease (DD) when it becomes symptomatic due to bleeding or diverticulitis. Diverticulosis is considered an acquired multifactorial disorder. The pathogenesis of the disease is poorly understood, and low dietary fiber and constipation remain the most widely accepted causes, despite the low quality of supporting evidence. Other theories have reported a possible link between diverticulosis and altered tissue integrity and up to 35 genetic loci have been associated with diverticular disease. The microbiome, motility and inflammation are also reported contributing factors. The objectives of our study are to report the prevalence of DD and to identify risk factors in general to develop diverticular disease. METHODS: The Nationwide Inpatient Sample weighted discharges from 2003 to 2011 were used to assess for the prevalence of diverticular disease in the general population as well as in a subgroup of immunosuppressed patients. A multivariable direct logistic regression model was constructed to determine independent predictors of diverticular disease. RESULTS: The prevalence of diverticulosis in the general population of all ages was 2.3%, and the prevalence of diverticulosis increased with age (Figure 1). 35% of the patients with diverticulosis developed diverticulitis, for a prevalence of 0.8%. In patients with immunosuppression, the prevalence of diverticulitis was the same as the general population but the patients developed diverticulitis at an earlier age. However, the need for colonic surgery was less in the patients with immunosuppression (Table 1). 12% of the patients with diverticulosis developed diverticular bleeding for a prevalence of 0.27%. NSAID use, constipation and ADPKD had increased odds ratios for diverticulosis during multivariate analysis (Table2). CONCLUSION: The prevalence of diverticulosis was lower than what has been previously reported. However, the amount of patient with diverticulosis that develop diverticular disease is higher than what has been previously reported. Our results suggest that diverticulosis is significantly more common in patients with constipation. The fact that ADPKD is also a significant risk factor for diverticulosis, supports the theory that a structural underlying defect in the connective tissue makes these patients more prone to develop diverticular disease.Figure 1.: Prevalence of diverticulosis per age groups.Table 1.: Diverticulitis in patients with immunosuppression compared to the general populationTable 2.: Univariate and multivariate analysis of risk factor for diverticulosis