137 Diverticular Paradox: Increasing Odds of Diverticulitis in Diverticular Disease With Younger Age

INTRODUCTION: Diverticula disease historically has been known to be a disease of the elderly with estimated prevalence greater than 50% in people ages 60 and above. The healthcare costs associated with impact of diverticular disease is estimated at $3 billion per year. Diverticular disease is one of the commonest reasons for gastroenterology visit yearly. Acute diverticulitis is one of the most feared morbidity conferring complications of diverticular disease. Recent studies have reported an increasing incidence of acute diverticulitis in hospitalized individual younger than the age of 50. However, not much is known about the age-specific odds of having acute diverticulitis in diverticular disease. METHODS: We performed a retrospective cohort study of 1197 patients with diverticular disease at Grady Memorial Hospital. We evaluated association between age and diverticulitis, while adjusting for gender, race, BMI, HIV, COPD, hemorrhoids, and hypertension. A multivariate logistic regression model was used to compare diverticulitis and diverticulosis. RESULTS: Of the 1197 patients, 732 were females and 465 males. The average age of this patient sample was 58.14, with frequency of diverticulitis and diverticulosis in age group 23–29 years: 5 and 13, 30–44 years: 45 and 98, 45–59 years: 246 and 265, 60–74 years: 243 and 146, >75 years: 98 and 36 respectively. Primary diagnosis was diverticulosis in 637 of the patients and diverticulitis in 558 of the patients. Age group 23–44 was strongly associated with diverticulitis. The odds of diverticulitis increased with reduced age: 23–29 years (OR, 7.08; 95% CI, 2.36 to 21.26), 30–44 years (OR, 5.93; 95% CI, 3.52 to 9.97), 45–59 years (OR, 2.93; 95% CI, 1.93 to 4.46), 60 – 74 years (OR, 1.64; 95% CI, 1.06 to 2.52). In the multivariate logistic regression, age group 23–44 was strongly associated with diverticulitis, while hypertension was only marginally statistically significant ( P -value = 0.05). In contrast BMI, HIV status, and COPD were not associated with diverticulitis, and neither was the interaction term: HIV, COPD, hypertension. CONCLUSION: Our study demonstrated that even though patients older than 45 had the highest number of diverticular disease cases, the odds of diverticulitis was highest in the younger age groups less that 45 years. More research should be done to evaluate this trend and clinicians should be aware of the high potential of diverticulitis in patients younger than 45 years old.