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Long-term Risk of Acute Diverticulitis Among Patients With Incidental Diverticulosis Found During Colonoscopy

  • Kamyar Shahedi
    Affiliations
    University of California Los Angeles/Veteran's Affairs Center for Outcomes Research and Education, Los Angeles, California
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  • Garth Fuller
    Affiliations
    University of California Los Angeles/Veteran's Affairs Center for Outcomes Research and Education, Los Angeles, California
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  • Roger Bolus
    Affiliations
    University of California Los Angeles/Veteran's Affairs Center for Outcomes Research and Education, Los Angeles, California

    Division of Digestive Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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  • Erica Cohen
    Affiliations
    University of California Los Angeles/Veteran's Affairs Center for Outcomes Research and Education, Los Angeles, California
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  • Michelle Vu
    Affiliations
    University of California Los Angeles/Veteran's Affairs Center for Outcomes Research and Education, Los Angeles, California
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  • Rena Shah
    Affiliations
    Division of Digestive Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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  • Nikhil Agarwal
    Affiliations
    University of California Los Angeles/Veteran's Affairs Center for Outcomes Research and Education, Los Angeles, California

    Division of Digestive Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California

    Department of Gastroenterology, Veteran's Affairs Greater Los Angeles Healthcare System, Los Angeles, California
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  • Marc Kaneshiro
    Affiliations
    Division of Digestive Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California

    Department of Gastroenterology, Veteran's Affairs Greater Los Angeles Healthcare System, Los Angeles, California
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  • Mary Atia
    Affiliations
    Department of Gastroenterology, Veteran's Affairs Greater Los Angeles Healthcare System, Los Angeles, California
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  • Victoria Sheen
    Affiliations
    Department of Gastroenterology, Veteran's Affairs Greater Los Angeles Healthcare System, Los Angeles, California
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  • Nicole Kurzbard
    Affiliations
    Division of Digestive Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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  • Martijn G.H. van Oijen
    Affiliations
    University of California Los Angeles/Veteran's Affairs Center for Outcomes Research and Education, Los Angeles, California

    Division of Digestive Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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  • Linnette Yen
    Affiliations
    Shire Development, LLC, Wayne, Pennsylvania
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  • Paul Hodgkins
    Affiliations
    Shire Development, LLC, Wayne, Pennsylvania
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  • M. Haim Erder
    Affiliations
    Shire Development, LLC, Wayne, Pennsylvania
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  • Brennan Spiegel
    Correspondence
    Reprint requests Address requests for reprints to: Brennan M. R. Spiegel, MD, MSHS, Associate Professor of Medicine, 11301 Wilshire Boulevard, Building 115, Room 215, Los Angeles, California 90073. fax: (310) 268-4510.
    Affiliations
    University of California Los Angeles/Veteran's Affairs Center for Outcomes Research and Education, Los Angeles, California

    Division of Digestive Diseases, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California

    Department of Gastroenterology, Veteran's Affairs Greater Los Angeles Healthcare System, Los Angeles, California

    Department of Health Services, University of California Los Angeles School of Public Health, Los Angeles, California
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      Background & Aims

      Colonic diverticulosis is the most common finding during routine colonoscopy, and patients often question the significance of these lesions. Guidelines state that these patients have a 10% to 25% lifetime risk of developing acute diverticulitis. However, this value was determined based on limited data, collected before population-based colonoscopy, so the true number of cases of diverticulosis was not known. We measured the long-term risk of acute diverticulitis among patients with confirmed diverticulosis discovered incidentally on colonoscopy.

      Methods

      We performed a retrospective study using administrative and clinical data from the Veterans Affairs Greater Los Angeles Healthcare System, collecting data on patients who underwent colonoscopies from January 1996 through January 2011. We identified patients diagnosed with diverticulosis, determined incidence rates per 1000 patient-years, and analyzed a subgroup of patients with rigorously defined events confirmed by imaging or surgery. We used a Cox proportional hazards model to identify factors associated with the development of diverticulitis.

      Results

      We identified 2222 patients with baseline diverticulosis. Over an 11-year follow-up period, 95 patients developed diverticulitis (4.3%; 6 per 1000 patient-years); of these, 23 met the rigorous definition of diverticulitis (1%; 1.5 per 1000 patient-years). The median time-to-event was 7.1 years. Each additional decade of age at time of diagnosis reduced the risk for diverticulitis by 24% (hazard ratio, 0.76; 95% confidence interval, 0.6–0.9).

      Conclusions

      Based on a study of the Veterans Affairs Greater Los Angeles Healthcare System, only about 4% of patients with diverticulosis develop acute diverticulitis, contradicting the common belief that diverticulosis has a high rate of progression. We also found that younger patients have a higher risk of diverticulitis, with risk increasing per year of life. These results can help inform patients with diverticulosis about their risk of developing acute diverticulitis.

      Keywords

      Abbreviations used in this paper:

      BMI (body mass index), CT (computed tomography), ICD-9 (International Classification of Diseases, 9th revision), VA (Veteran's Affairs), VAGLAHS (Veterans Affairs Greater Los Angeles Healthcare System)
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      Linked Article

      • Is There Really Anything New on Dietary Fiber in Colonic Diverticular Disease?
        Clinical Gastroenterology and HepatologyVol. 12Issue 7
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          The editors of Clinical Gastroenterology and Hepatology are to be complimented on gathering 3 articles on diverticular disease1–3 and publishing them with an excellent editorial by Burgell et al.4 In the first article, Shahedi et al1 reviewed 2222 patients with baseline colonic diverticulosis over an 11-year follow-up period from the Veterans Affairs Greater Los Angeles Healthcare System. The data showed that only about 4% of patients with diverticulosis developed acute diverticulitis, which contradicted the common belief that diverticulosis has a high rate of progression.
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