Diverticular Disease Associated with Inflammatory Bowel Disease-Like Colitis: A Systematic Review

• Published in: Diseases of the colon & rectum Vol. 52; no. 6; pp. 1072 - 1079
• Main Authors: Mulhall, Aaron M, Mahid, Suhal S, Petras, Robert E, Galandiuk, Susan
• Format: Journal Article
• Language: English
• Published: Hagerstown, MDc The ASCRS 01.06.2009; Lippincott Williams & Wilkins
• Subjects: Age of Onset; Biological and medical sciences; Colitis - complications; Colitis - pathology; Colitis - therapy; Diverticulitis, Colonic - complications; Diverticulitis, Colonic - pathology; Diverticulitis, Colonic - therapy; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Medical sciences; Other diseases. Semiology; Recurrence; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Crohn's disease; Review; Inflammatory disease; Inflammatory bowel disease; Crohn disease; Diverticular colitis; Gastroenterology; Digestive diseases; Intestinal disease; Colitis; Crescenteric colitis; Bibliographic review; Ulcerative colitis; Segmental colitis
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/DCR.0b013e31819ef79a

PURPOSE:Diverticular-associated colitis significantly overlaps clinically with primary inflammatory bowel disease. However, the clinical and the pathologic features of diverticular-associated colitis suggest that it is a distinct clinical entity. METHODS:We performed a systematic review by use of multiple health care databases and gray literature, following predefined inclusion and exclusion criteria to determine the clinical, endoscopic, and pathologic features of diverticular-associated colitis, and recurrence rates following medical and surgical treatment. RESULTS:Two hundred twenty-seven participants were selected from 18 eligible studies, including our own patients (n = 13). The average age of disease onset was 64 years. The typical symptoms included tenesmus, hematochezia, and diarrhea. One hundred sixty-three of the 227 patients in these studies were classified as having diverticular-associated colitis, of which 142 were managed medically. Twenty-eight patients eventually required an operation. One-quarter (37 of 163) of the patients had recurrence of symptoms with an average follow-up time of three years. CONCLUSIONS:Diverticular-associated colitis is a distinct entity that presents with segmental colitis and a variety of clinical, endoscopic, and pathologic features. Diverticular-associated colitis should be considered in the presence of recurrent symptoms after resection for diverticulitis.