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Diverticulitis patients suffer long-term psychological and physical problems

The researchers note that their findings could lead to better disease management
The researchers note that their findings could lead to better disease management
Robin Wulffson, MD

A new UCLA study has found that long after their acute episode has passed, diverticulosis patients suffer from psychological and physical symptoms. The researchers note that their findings could lead to better disease management. The study was published this week in the journal Quality of Life Research.

A UCLA researcher team led by Dr. Brennan Spiegel interviewed patients in great detail regarding the symptoms that they experienced weeks, months, or even years after an acute diverticulitis attack. Their remarkable findings add to growing evidence that, for some patients, diverticulitis goes beyond isolated attacks and can lead to a chronic condition that is similar to irritable bowel syndrome (IBS).

Diverticulosis is a common condition that occurs with aging. The disorder is characterized by the formation of pouches in the lining of the colon. More than 50% of individuals over 60 years of age have the condition; however, the pouches usually do not cause any problems. However, the pouches sometimes become inflamed, resulting in a related disorder known as diverticulitis, which causes pain and infection in the abdomen. Physicians usually treat diverticulitis with antibiotics, or in more severe cases, surgery.

Diverticulitis has long been thought to be acute with periods of relative silence in between attacks; however, according to the UCLA researchers, that is not true for everyone. Some patients experience ongoing symptoms. In an earlier study, Dr. Spiegel and his colleagues found that people suffering from diverticulitis have a four-fold higher risk of developing IBS after their illness, a condition called post-diverticulitis irritable bowel syndrome; furthermore, the patients suffered from anxiety and depression long after the initial attack. That study was based on a database of more than 1,000 patients; thus, it did not obtain personal testimonials from people living with diverticulitis.

In the new study, patients described feelings of fear, anxiety, and depression; they reported that they had been stigmatized for having the condition. In addition, they noted that they live in constant fear of having another attack, are scared to travel, and feel socially isolated. In addition, many patients continue to experience troublesome physical symptoms such as bloating, watery stools, abdominal pain, incomplete evacuation, and nausea.

“We dug deeper into identifying the chronic physical, emotional and behavioral symptoms that can profoundly change people’s lives after an attack of diverticulitis,” explained Dr. Spiegel, a professor of medicine at the David Geffen School of Medicine at UCLA and the Fielding School of Public Health. He added, “Our findings reveal that many people suffer silently with severe quality-of-life problems long after an acute diverticulitis attack.” The researchers used those factors to develop a questionnaire to assist physicians better assess the long-term impact of diverticulitis, which ultimately could lead to better understanding and management of the disease. Dr. Spiegel explained, “Doctors often don’t know to ask about these ongoing symptoms. We hope that our findings and new tool will help physicians better tailor individual treatment and reassure patients that they aren’t alone.”

To help in the development of the new screening tool, the investigators reviewed medical literature on quality-of-life measures used to gauge diverticulitis and related gastrointestinal conditions; in addition, they interviewed experts and conducted focus groups with individuals who had suffered diverticulitis attacks. They then developed a framework for the tool based on the most commonly described physical, social, and psychological symptoms. They also generated a draft survey and tested it on 197 patients who had reported symptoms after an acute diverticulitis attack. Then, using feedback from those patients, the investigators refined the survey to create the final 24-question version.

“This new screening tool will help clinicians better define and manage diverticulitis,” explained study author Mark Reid, principal statistician at the UCLA/VA Center for Outcomes Research and Education. He added, “We can now screen patients for poor quality of life based on their condition and then actively manage their diverticulitis like other chronic gastrointestinal conditions.” Dr. Spiegel noted that more study is needed to help researchers understand how diverticulitis can trigger the longer-lasting symptoms.