The Clinical Factors for Predicting Severe Diverticulitis in Korea: A Comparison with Western Countries
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Background/Aims: It is unclear whether the risk factors associated with complicated diverticulitis in Asian and Western countries are the same. We evaluated the risk factors associated with severe diverticulitis (SD) in Korea and compared the clinical characteristics of diverticulitis according to location. Methods: A retrospective review of 190 patients hospitalized with acute diverticulitis from January 2005 to June 2010 was conducted. SD was defined as one of the following: perforation, abscess, obstruction, sepsis, or peritonitis that required an urgent operation. Results: Twenty-four patients (12.6%) were diagnosed with SD. SD was significantly associated with older age, a fever over 38oC, changes in bowel habits and a high visceral adipose tissue (VAT)/total adipose tissue (TAT) ratio. Multivariate analysis showed that the risk factors for developing SD were an age of 40 years or more (odds ratio [OR], 3.2; p=0.032), male gender (OR,4.0; p=0.021) and left-sided diverticulitis (OR, 6.2; p=0.017). Right-sided diverticulitis (n=175, 92.1%) was signifi cantly associated with younger ages, fewer changes in bowel habits,fewer comorbidities and non-SD. Conclusions: This study suggests that the risk factors for developing SD in Korea,where right-sided diverticulitis is predominant, are the male gender, an age of more than 40 years old, and left-sided diverticulitis. Given that there are different risk factors for developing SD in Western countries, different strategies for the treatment of diverticulitis in the Korean population seem to be needed.
Abstract
Background/Aims: It is unclear whether the risk factors associated with complicated diverticulitis in Asian and Western countries are the same. We evaluated the risk factors associated with severe diverticulitis (SD) in Korea and compared the clinical characteristics of diverticulitis according to location. Methods: A retrospective review of 190 patients hospitalized with acute diverticulitis from January 2005 to June 2010 was conducted. SD was defined as one of the following: perforation, abscess, obstruction, sepsis, or peritonitis that required an urgent operation. Results: Twenty-four patients (12.6%) were diagnosed with SD. SD was significantly associated with older age, a fever over 38oC, changes in bowel habits and a high visceral adipose tissue (VAT)/total adipose tissue (TAT) ratio. Multivariate analysis showed that the risk factors for developing SD were an age of 40 years or more (odds ratio [OR], 3.2; p=0.032), male gender (OR,4.0; p=0.021) and left-sided diverticulitis (OR, 6.2; p=0.017). Right-sided diverticulitis (n=175, 92.1%) was signifi cantly associated with younger ages, fewer changes in bowel habits,fewer comorbidities and non-SD. Conclusions: This study suggests that the risk factors for developing SD in Korea,where right-sided diverticulitis is predominant, are the male gender, an age of more than 40 years old, and left-sided diverticulitis. Given that there are different risk factors for developing SD in Western countries, different strategies for the treatment of diverticulitis in the Korean population seem to be needed.
참고문헌 (36)
- Hughes LE, "Postmortem survey of diverticular disease of the colon. I. Diverticulosis and diverticulitis", Gut, 10, pp.336~344 (1969)
- Hildebrand P, "Surgery for right-sided colonic diverticulitis: results of a 10-year-observation period", Langenbecks Arch Surg, 392, pp.143~147 (2007)
- Sugihara K, "Diverticular disease of the colon in Japan: a review of 615 cases", Dis Colon Rectum, 27, pp.531~537 (1984)
- Morris CR, "Epidemiology of perforated colonic diverticular disease", Postgrad Med J, 78, pp.654~658 (2002)
- Stollman NH, "Diagnosis and management of diverticular disease of the colon in adults: Ad Hoc Practice Parameters Committee of the American College of Gastroenterology", Am J Gastroenterol, 94, pp.3110~3121 (1999)
- Wong WD, "Practice parameters for the treatment of sigmoid diverticulitis: supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons", Dis Colon Rectum, 43, pp.290~297 (2000)
- 이상길, "Relationship between disease location and age, obesity, and complications in Korean patients with acute diverticulitis: A comparison of clinical patterns with those of Western populations", Hepato-Gastroenterology, 55, pp.983~986, H G E UPDATE MEDICAL PUBLISHING S A
- 김석훈, "Comparative Study of the Clinical Features and Treatment for Right and Left Colonic Diverticulitis", Annals of Coloproctolgy, 26(6), pp.407~412 (2010), 대한대장항문학회
- 최귀숙, "대장 게실염: 임상 양상과 재발의 관점에서", Intestinal research, 6(1), pp.37~44 (2008), 대한장연구학회
- 이현철, "우측 대장 게실염과 좌측 대장 게실염의 임상양상 비교", 대한내과학회지, 75(5), pp.533~538 (2008), 대한내과학회
- Law WL, "Emergency surgery for colonic diverticulitis: differences between right-sided and left-sided lesions", Int J Colorectal Dis, 16, pp.280~284 (2001)
- 김광연, "대장 게실염의 수술적 치료에 대한 분석", 대한외과학회지, 73(1), pp.36~41 (2007), 대한외과학회
- Komuta K, "Toward therapeutic guidelines for patients with acute right colonic diverticulitis", Am J Surg, 187, pp.233~237 (2004)
- 김마루, "Treatment of Right Colonic Diverticulitis: The Role of Nonoperative Treatment", Annals of Coloproctolgy, 26(6), pp.402~406 (2010), 대한대장항문학회
- 김영호, "한국인에서 대장 게실염의 임상 양상", 대한소화기학회지, 42(5), pp.363~368 (2003), 대한소화기학회
- Commane DM, "Diet, ageing and genetic factors in the pathogenesis of diverticular disease", World J Gastroenterol, 15, pp.2479~2488 (2009)
- Wagner DE, "Diverticulitis of the cecum and ascending colon", Arch Surg, 83, pp.436~443 (1961)
- Chung HD, "Surgical treatment for diverticular disease of the colon", Korean Soc Coloproctol, 17, pp.243~250 (2001)
- Anderson L, "Acute diverticulitis of the cecum: study of 99 surgical cases", Surgery, 22, pp.479~488 (1947)
- Reisman Y, "Diverticulitis: the effect of age and location on the course of disease", Int J Colorectal Dis, 14, pp.250~254 (1999)
- Yang HR, "Management of right colon diverticulitis: a 10-year experience", World J Surg, 30, pp.1929~1934 (2006)
- Hall J, "New paradigms in the management of diverticular disease", Curr Probl Surg, 47, pp.680~735 (2010)
- Pautrat K, "Acute diverticulitis in very young patients: a frequent surgical management", Dis Colon Rectum, 50, pp.472~477 (2007)
- McConnell EJ, "Population-based incidence of complicated diverticular disease of the sigmoid colon based on gender and age", Dis Colon Rectum, 46, pp.1110~1114 (2003)
- Lo CY, "Acute diverticulitis of the right colon", Am J Surg, 171, pp.244~246 (1996)
- Strate LL, "Obesity increases the risks of diverticulitis and diverticular bleeding", Gastroenterology, 136, pp.115~122 (2009)
- Dobbins C, "The relationship of obesity to the complications of diverticular disease", Colorectal Dis, 8, pp.37~40 (2006)
- Zaidi E, "CT and clinical features of acute diverticulitis in an urban U.S. population: rising frequency in young, obese adults", AJR Am J Roentgenol, 187, pp.689~694 (2006)
- Sorser SA, "Obesity and complicated diverticular disease: is there an association?", South Med J, 102, pp.350~353 (2009)
- Fang JF, "Aggressive resection is indicated for cecal diverticulitis", Am J Surg, 185, pp.135~140 (2003)
- Oudenhoven LF, "Right colonic diverticulitis:US and CT findings--new insights about frequency and natural history", Radiology, 208, pp.611~618 (1998)
- Harada RN, "Surgical management of cecal diverticulitis", Am J Surg, 166, pp.666~669 (1993)
- Turunen P, "Smoking increases the incidence of complicated diverticular disease of the sigmoid colon", Scand J Surg, 99, pp.14~17 (2010)
- Korzenik JR, "Diverticulitis: new frontiers for an old country: risk factors and pathogenesis", J Clin Gastroenterol, 42, pp.1128~1129 (2008)
- Lorimer JW, "Comorbidity is a major determinant of severity in acute diverticulitis", Am J Surg, 193, pp.681~685 (2007)
- Yoo PS, "Medical comorbidities predict the need for colectomy for complicated and recurrent diverticulitis", Am J Surg, 196, pp.710~714 (2008)