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. 2013 Dec;11(12):1614-9.
doi: 10.1016/j.cgh.2013.03.007. Epub 2013 Mar 21.

Increased risk for irritable bowel syndrome after acute diverticulitis

Erica Cohen  1 , 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

Increased risk for irritable bowel syndrome after acute diverticulitis

Erica Cohen et al. Clin Gastroenterol Hepatol. 2013 Dec.

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.

Keywords: CI; CT; Colon; Functional Gastrointestinal Disease; HR; IBS; ICD-9; Inflammatory Disorder; International Classification of Diseases, 9th revision; Outcome; PDV-IBS; PI-IBS; VAGLAHS; Veterans Affairs Greater Los Angeles Healthcare System.; computed tomography; confidence interval; hazard ratio; irritable bowel syndrome; postdiverticulitis irritable bowel syndrome; postinfectious irritable bowel syndrome.

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Conflict of interest statement

Conflicts of interest

These authors disclose the following: Brennan Spiegel has served as an advisor for Ironwood Pharmaceuticals, Prometheus, and Takeda Pharmaceuticals, and has received research support from Amgen, Ironwood Pharmaceuticals, Ritter Pharmaceuticals, and Shire Pharmaceuticals; and Linnette Yen, Paul Hodgkins, M. Haim Erder are employed by Shire Pharmacueticals. The remaining authors disclose no conflicts.

The opinions and assertions contained herein are the sole views of the authors and are not to be construed as official or as reflecting the views of the Department of Veteran Affairs.

Figures

Figure 1
Figure 1
Incidence of new IBS diagnoses in diverticulitis cases vs matched controls.
Figure 2
Figure 2
Incidence of new functional bowel disorder diagnoses in diverticulitis cases vs matched controls.
Figure 3
Figure 3
Incidence of new depression and mood disorder diagnoses in diverticulitis cases vs matched controls.
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