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Quality of Life and Persistent Symptoms After Uncomplicated Acute Diverticulitis

van Dijk, Stefan T., M.D.1; Daniels, Lidewine, M.D., Ph.D.1,2; de Korte, Niels, M.D., Ph.D.3; Stockmann, Hein B., M.D., Ph.D.3; Vrouenraets, Bart C., M.D., Ph.D.4; J. Consten, Esther C., M.D., Ph.D.5; B. van der Hoeven, Joost A., M.D., Ph.D.6; Faneyte, Ian F., M.D., Ph.D.7; W. Dijkgraaf, Marcel G., Ph.D.8; Boermeester, Marja A., M.D.1 for the Dutch Diverticular Disease (3D) Collaborative Study Group

Diseases of the Colon & Rectum: May 2019 - Volume 62 - Issue 5 - p 608–614
doi: 10.1097/DCR.0000000000001361
Original Contribution: Benign
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BACKGROUND: Although acute diverticulitis and its recurrence are well studied, little is known about the period after these attacks have passed. Many patients appear to be affected by persistent symptoms that impair quality of life. The few published studies on this topic are mostly limited by the lack of CT confirmation of the acute diverticulitis diagnosis, low numbers of patients, or cross-sectional design.

OBJECTIVE: This study longitudinally evaluated quality of life and symptoms after antibiotic or observational treatment of uncomplicated acute diverticulitis.

DESIGN: This was an observational study of randomized clinical trial data.

SETTINGS: This study was conducted at a single tertiary care center.

PATIENTS: Patients with CT-proven, primary, left-sided, uncomplicated acute diverticulitis were randomly assigned to observational or antibiotic treatment.

MAIN OUTCOME MEASURES: Quality of life was assessed using questionnaires (EuroQol 5D, Short Form-36, and Gastrointestinal Quality of Life Index) at baseline and 3, 6, 12, and 24 months after random assignment. Patients were considered to have persistent symptoms when specific quality-of-life scores at the 12- and 24-month follow-ups were among the lowest 16% of scores measured in a healthy reference group.

RESULTS: A total of 528 patients were included. No difference was detected between the observational and antibiotic groups in any quality-of-life score during follow-up. Overall, 32.2% to 38.2% of patients had persistent symptoms after 1 or 2 years, depending on which questionnaire (sub)score was assessed. Risk factors for persistent symptoms based on to the Gastrointestinal Quality of Life index GI symptoms score included a mean pain score ≥3.75 (OR = 2.77 (95% CI, 1.60–4.80)) during the first 10 days of disease and prolonged (≥28 d) time to recovery (OR = 2.25 (95% CI, 1.31–3.88)). Flatulence, rumblings, bloating, fullness, and many stools were the top 5 complaints at the 12- and 24-month follow-ups.

LIMITATIONS: The study was limited by possible selection bias of patients included in a randomized controlled trial.

CONCLUSIONS: More than one third of patients experience persistent symptoms after an episode of acute uncomplicated diverticulitis. Long-term quality of life is comparable after initial antibiotic or observational treatment. See Video Abstract at http://links.lww.com/DCR/A916.

1 Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands

2 Department of Surgery, Westfries Gasthuis, Hoorn, the Netherlands

3 Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands

4 Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands

5 Meander Medical Centre Amersfoort, the Netherlands

6 Albert Schweitzer Hospital, Dordrecht, the Netherlands

7 Ziekenhuisgroep Twente Hospital, Almelo, the Netherlands

8 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Funding/Support: The Diverticulitis: Antibiotics or Close Observation? trial was funded by the Netherlands Organization for Health Research and Development (ZonMw; 171002303) and the Digestive Diseases Foundation (Maag Lever Darm Stichting, MLDS WO08-54).

Financial Disclosure: None reported.

Correspondence: Marja A. Boermeester, M.D., Department of Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD, PO Box 22660, Amsterdam, the Netherlands. E-mail: m.a.boermeester@amc.nl

© 2019 The American Society of Colon and Rectal Surgeons