Increased Risk for Irritable Bowel Syndrome After Acute Diverticulitis

Overview

Journal Clin Gastroenterol Hepatol

Specialty Gastroenterology

Date 2013 Mar 26

PMID 23524129

Citations 40

Authors

Erica Cohen

Garth Fuller

Roger Bolus

Rusha Modi

Michelle Vu

Kamyar Shahedi

Rena Shah

Mary Atia

Nicole Kurzbard

Victoria Sheen

Nikhil Agarwal

Marc Kaneshiro

Linnette Yen

Paul Hodgkins

M Haim Erder

Brennan Spiegel

Affiliations

Soon will be listed here.

Abstract

Background & Aims: Individuals with diverticulosis frequently also have irritable bowel syndrome (IBS), but there are no longitudinal data to associate acute diverticulitis with subsequent IBS, functional bowel disorders, or related emotional distress. In patients with postinfectious IBS, gastrointestinal disorders cause long-term symptoms, so we investigated whether diverticulitis might lead to IBS. We compared the incidence of IBS and functional bowel and related affective disorders among patients with diverticulitis.

Methods: We performed a retrospective study of patients followed up for an average of 6.3 years at a Veteran's Administration medical center. Patients with diverticulitis were identified based on International Classification of Diseases, 9th revision codes, selected for the analysis based on chart review (cases, n = 1102), and matched with patients without diverticulosis (controls, n = 1102). We excluded patients with prior IBS, functional bowel, or mood disorders. We then identified patients who were diagnosed with IBS or functional bowel disorders after the diverticulitis attack, and controls who developed these disorders during the study period. We also collected information on mood disorders, analyzed survival times, and calculated adjusted hazard ratios.

Results: Cases were 4.7-fold more likely to be diagnosed later with IBS (95% confidence interval [CI], 1.6-14.0; P = .006), 2.4-fold more likely to be diagnosed later with a functional bowel disorder (95% CI, 1.6-3.6; P < .001), and 2.2-fold more likely to develop a mood disorder (CI, 1.4-3.5; P < .001) than controls.

Conclusions: Patients with diverticulitis could be at risk for later development of IBS and functional bowel disorders. We propose calling this disorder postdiverticulitis IBS. Diverticulitis appears to predispose patients to long-term gastrointestinal and emotional symptoms after resolution of inflammation; in this way, postdiverticulitis IBS is similar to postinfectious IBS.

Citing Articles

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Barbara G, Aziz I, Ballou S, Chang L, Ford A, Fukudo S Nat Rev Gastroenterol Hepatol. 2025; .

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Rifaximin in diverticulosis and diverticular disease: a national survey among Italian gastroenterologists and general practitioners.

Gatta L, Bellini M, Scarpignato C, Marrocco W, Chiriatti A, Grosso A Intern Emerg Med. 2024; 19(6):1675-1685.

PMID: 38850356 DOI: 10.1007/s11739-024-03669-6.

Site and duration of abdominal pain discriminate symptomatic uncomplicated diverticular disease from previous diverticulitis patients.

Carabotti M, Marasco G, Sbarigia C, Cuomo R, Barbara G, Pace F Intern Emerg Med. 2024; 19(5):1235-1245.

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Diverticular disease: update on pathophysiology, classification and management.

Williams S, Bjarnason I, Hayee B, Haji A Frontline Gastroenterol. 2024; 15(1):50-58.

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References

Kozak L, DeFrances C, Hall M . National hospital discharge survey: 2004 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13. 2006; (162):1-209. View

Korzenik J . Case closed? Diverticulitis: epidemiology and fiber. J Clin Gastroenterol. 2006; 40 Suppl 3:S112-6. DOI: 10.1097/01.mcg.0000225503.59923.6c. View

Shaheen N, Hansen R, Morgan D, Gangarosa L, Ringel Y, Thiny M . The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol. 2006; 101(9):2128-38. DOI: 10.1111/j.1572-0241.2006.00723.x. View

Lin H . Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. JAMA. 2004; 292(7):852-8. DOI: 10.1001/jama.292.7.852. View

Jung H, Choung R, Richard Locke 3rd G, Schleck C, Zinsmeister A, Talley N . Diarrhea-predominant irritable bowel syndrome is associated with diverticular disease: a population-based study. Am J Gastroenterol. 2009; 105(3):652-61. PMC: 2857983. DOI: 10.1038/ajg.2009.621. View

Simpson J, Scholefield J, Spiller R . Origin of symptoms in diverticular disease. Br J Surg. 2003; 90(8):899-908. DOI: 10.1002/bjs.4277. View

Spiller R, Campbell E . Post-infectious irritable bowel syndrome. Curr Opin Gastroenterol. 2005; 22(1):13-7. DOI: 10.1097/01.mog.0000194792.36466.5c. View

Humes D, Simpson J, Neal K, Scholefield J, Spiller R . Psychological and colonic factors in painful diverticulosis. Br J Surg. 2007; 95(2):195-8. DOI: 10.1002/bjs.5962. View

Brandt L, Chey W, Foxx-Orenstein A, Schiller L, Schoenfeld P, Spiegel B . An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009; 104 Suppl 1:S1-35. DOI: 10.1038/ajg.2008.122. View

10.

Trepsi E, Colla C, Panizza P, Polino M, Venturini A, Bottani G . [Therapeutic and prophylactic role of mesalazine (5-ASA) in symptomatic diverticular disease of the large intestine. 4 year follow-up results]. Minerva Gastroenterol Dietol. 2006; 45(4):245-52. View

11.

Pimentel M, Lembo A, Chey W, Zakko S, Ringel Y, Yu J . Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011; 364(1):22-32. DOI: 10.1056/NEJMoa1004409. View

12.

Simpson J, Neal K, Scholefield J, Spiller R . Patterns of pain in diverticular disease and the influence of acute diverticulitis. Eur J Gastroenterol Hepatol. 2003; 15(9):1005-10. DOI: 10.1097/00042737-200309000-00011. View

13.

Horgan A, McConnell E, Wolff B, The S, Paterson C . Atypical diverticular disease: surgical results. Dis Colon Rectum. 2001; 44(9):1315-8. DOI: 10.1007/BF02234790. View

14.

Barbara G, De Giorgio R, Stanghellini V, Cremon C, Corinaldesi R . A role for inflammation in irritable bowel syndrome?. Gut. 2002; 51 Suppl 1:i41-4. PMC: 1867730. DOI: 10.1136/gut.51.suppl_1.i41. View

15.

Mayer E, Collins S . Evolving pathophysiologic models of functional gastrointestinal disorders. Gastroenterology. 2002; 122(7):2032-48. DOI: 10.1053/gast.2002.33584. View

16.

Stollman N, Raskin J . Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 1999; 94(11):3110-21. DOI: 10.1111/j.1572-0241.1999.01501.x. View

17.

Deyo R, Cherkin D, Ciol M . Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992; 45(6):613-9. DOI: 10.1016/0895-4356(92)90133-8. View

18.

Brandimarte G, Tursi A . Rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease. Med Sci Monit. 2004; 10(5):PI70-3. View

19.

Comparato G, Fanigliulo L, Aragona G, Cavestro G, Cavallaro L, Leandro G . Quality of life in uncomplicated symptomatic diverticular disease: is it another good reason for treatment?. Dig Dis. 2007; 25(3):252-9. DOI: 10.1159/000103896. View

20.

Camilleri M, McKinzie S, Busciglio I, Low P, Sweetser S, Burton D . Prospective study of motor, sensory, psychologic, and autonomic functions in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2008; 6(7):772-81. PMC: 2495078. DOI: 10.1016/j.cgh.2008.02.060. View