Epidemiological similarities between appendicitis and diverticulitis suggesting a common underlying pathogenesis

Abstract

Background: Nonperforating appendicitis is primarily a disease of children, and nonperforating diverticulitis affects mostly older adults. Apart from these age differences, the diseases share many epidemiological features, such as association with better hygiene and low-fiber diets.

Hypothesis: Nonperforating appendicitis and nonperforating diverticulitis are different manifestations of the same underlying colonic process and, if so, should be temporally related.

Design: Data from the National Hospital Discharge Survey were analyzed to investigate the incidence of admissions for appendicitis in children and diverticulitis in adults between 1979 and 2006.

Setting: Statistical sampling of all US hospitals.

Patients: Children admitted for appendicitis and adults with diverticulitis.

Main outcome measures: Time trends were assessed for stationarity using unit root analysis, and similarities between time trends were tested using cointegration analysis.

Results: The incidence rates of nonperforating appendicitis and nonperforating diverticulitis exhibited U-shaped secular trends. The rates of perforating appendicitis and perforating diverticulitis rose slowly across all the study years. Cointegration analysis demonstrated that the rates of nonperforating and perforating diverticulitis did not cointegrate significantly over time. The rates of nonperforating and perforating appendicitis did not vary together. Nonperforating appendicitis and nonperforating diverticulitis rates were significantly cointegrated over time.

Conclusions: Childhood appendicitis and adult diverticulitis seem to be similar diseases, suggesting a common underlying pathogenesis. Secular trends for their nonperforating and perforating forms are strikingly different. At least for appendicitis, perforating disease may not be an inevitable outcome from delayed treatment of nonperforating disease. If appendicitis represents the same pathophysiologic process as diverticulitis, it may be amenable to antibiotic rather than surgical treatment.