Case Control Study on Risk Assessment of Colonic Diverticular Bleeding

Data regarding the natural history of acute diverticulitis in young patients is conflicting. We undertook a systematic review and meta-analysis in order to find whether there are true differences in disease behavior and recurrence rates according to the patients' age. Prospective and retrospective comparative cohort studies were included. The outcomes assessed were: operation rates during hospitalization; complicated disease at admission; recurrence rates; and overall mortality. The cut-off age for the comparisons was 50 years. Relative risks (RR) with 95% confidence intervals are reported. Nineteen studies (17 of them retrospective) were included. The total number of participants was 28526. Diverticulitis affected more males in the younger group, compared to the elders (RR 1.51, 1.26-1.81). Prior episode or symptoms were not significantly different according to patients' age (RR 1.16, 0.78-1.73). Complicated disease did not take place more in any age group (RR 1.04, 0.69-1.59), however, analysis of the prospective cohorts only did show tendency towards more complications in young patients (RR 1.55, 0.95-2.52). There was no difference in the rate of surgeries during hospitalization (RR 0.95, 0.79-1.15). Overall mortality was significantly lower in young patients (RR 0.08, 0.04-0.14), and the recurrence rate of diverticulitis was significantly higher in this group (RR 1.44, 1.23-1.86). Within a mean follow-up period between 19.7 to 120 months, the recurrence rate in the young patients was 20.7% compared to 14.6% in the elders. Diverticulitis in young patients seems to be of the same severity as in elders, with lower mortality rates and higher probability of recurrent attacks.