The results of a new study suggest that the demographics of acute diverticulitis in the United States are changing. In acute diverticulitis, a common intestinal disease related to a low-fiber diet, increased pressure causes pouches, or diverticula, to bulge out in the wall of the intestines. Bacterial infections can develop and cause serious complications, such as perforations.

Even though most medical textbooks suggest that acute diverticulitis is primarily confined to elderly patients, radiologists in Baltimore report that the majority of cases treated recently at their institution’s emergency department occurred in patients age 50 or younger. Approximately one in five cases was diagnosed in patients younger than 40.

“I’ve been doing abdominal and pelvic CT scans for about 12 years, and during the last 5 years, I was seeing a lot more acute diverticulitis cases in young patients who were obese,” Dr. Barry Daly said in an interview with Reuters Health.

To confirm this observation, Daly and Dr. Eram Zaidi reviewed medical records of 104 adult patients treated at the University of Maryland Medical Center for acute diverticulitis between 1999 and 2003. Their findings appear in the American Journal of Roentgenology.

Patient age ranged from 22 to 88 years, and the authors observed that 53.8 percent were no older than 50 years and 21.1 percent were 40 or younger.

Daly and Zaidi measured abdominal obesity in 82 percent of subjects. Patients who were 50 years old or younger were more likely to be obese than older patients. The relationship between abdominal obesity and diverticulitis was the most pronounced when the analysis was limited to patients 40 years or younger and those older than 70 years.

Eighty-nine percent of patients required hospital admission, the investigators report. CT scans revealed complications in 36 percent of patients, including colon perforation, abscess or bowel obstruction. Surgery or abscess drainage was required in 26.9 percent of the cases.

The investigators emphasize the importance of CT imaging in determining or confirming the diagnosis of acute diverticulitis; staging of the inflammatory response accurately, identifying serious complications, and guiding treatment decisions for the patients.

Failure to diagnose acute diverticulitis in younger individuals early in the disease process increases the risk of major complications. Moreover, because of their longer remaining lifespan, “young adults are at risk for repeated episodes,” Daly added. “We’ve seen patients with up to five acute attacks, and we have patients who had three surgeries.”

“Acute diverticulitis is not a trivial disease,” he emphasized.

Acute diverticulitis can cause fever, malaise, elevated white cell count and other symptoms, characteristics that should guide physicians when considering referral for a CT scan.

Daly also pointed out that some patients develop mild, self-limiting diverticulitis involving inflammation of a single diverticulum. “But typically, those who present at the ED have extensive disease, and quite a few of them are going to develop complications,” he added.

In young adults with belly pain, he recommends that acute diverticulitis be included in the differential diagnosis, along with appendicitis, acute inflammation of the gall bladder, pancreatitis and colon.

SOURCE: American Journal of Roentgenology, September 2006.