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Original article
Role of acute diverticulitis in the development of complicated colonic diverticular disease and 1-year mortality after diagnosis in the UK: population-based cohort study
  1. David J Humes1,
  2. Joe West1,2
  1. 1Nottingham Digestive Disease Centre and Biomedical Research Unit, Nottingham University Hospital NHS Trust, Nottingham, UK
  2. 2Division of Epidemiology and Public Health, Nottingham City Hospital, Nottingham, UK
  1. Correspondence to David J Humes, NIHR Clinical Lecturer in Surgery, NIHR Nottingham Digestive Disease Centre and Biomedical Research Unit, Department of Surgery, QMC Campus, E Floor, West Block, Nottingham University Hospital NHS Trust, Derby Road, Nottingham NG7 2UH, UK; david.humes{at}nottingham.ac.uk

Abstract

Objective To determine the risk of developing complicated colonic diverticular disease (CCDD) with prior episodes of acute diverticulitis and determine the mortality of the spectrum of CCDD.

Design Population-based cohort study.

Setting Computerised records from the General Practice Research Database linked to Hospital Episode Statistics data from the UK.

Participants Patients and controls registered in the General Practice Research Database from 1990 to 2007.

Main outcome measures Mortality was calculated and Cox regression modelling used to provide adjusted HRs and 95% CI. Logistic regression was used to model the effect of prior acute diverticulitis on the development of complications.

Results 2950 patients (1872 (63.5%) female) had a diagnosis of CCDD (8739 controls). A total of 1042 (35.3%) patients died compared with 2062 (23.6%) controls. Most excess deaths occurred in the first year after the complication. Patients with a perforation/abscess had a 4.5-fold increase in 1-year mortality (HR 4.55, 95% CI 3.74 to 5.52) compared with the general population, whereas those with a fistula or stricture had a 2.5-fold increase in mortality (fistula HR 2.60, 95% CI 1.47 to 4.62; stricture HR 2.41, 95% CI 1.86 to 3.11). Although most patients (2133 (72.3%)) had suffered no prior episodes of acute diverticulitis, increasing episodes of acute diverticulitis were associated with an increased risk of developing a fistula (two or more prior episodes, OR 1.54 95%, CI 1.08 to 2.19), but there was no clear relationship with stricture or perforation/abscess.

Conclusions Although most patients have experienced no prior episodes of acute diverticulitis, fistula formation is preceded by bouts of inflammation. Excess 1-year mortality across the spectrum of CCDD compared with the general population is substantial.

  • Diverticular disease
  • epidemiology

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Footnotes

  • Funding JW is funded by a UK National Institute of Health Research Clinician Scientist Fellowship. The dataset was acquired through the Medical Research Council scheme for academic use of GPRD data. The linked data and validation study was funded in part by the BUPA Foundation. The funders had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, and preparation, review or approval of the manuscript.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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