Influence of Risk Factors on Incidence, Management, Recurrence, and Follow-up of Acute Diverticulitis.
Sharma, Prashant Vinay
Acute Diverticulitis is a significant problem, accounting for up to one third of acute surgical admissions. Despite significant and rapid advances in medical knowledge, it remains a poorly understood disease. Practice is influenced by historical studies which have significant flaws. Current practice may be a reflection of limitations of the past e.g. the lack of accurate Cross Sectional Imaging. Technology is advancing and historical practices such as routine colonoscopy after diverticulitis may not be required. Risk factors for acute diverticulitis and recurrent diverticulitis remain unclear. With western society changing, diseases such as obesity are increasing. These may have influence on acute diverticulitis, its course and recurrence. Similarly other poorly understood risk factors include use of Non-Steroidal and Steroid medications, and the influence of Diabetes and autoimmune diseases. This thesis is an attempt to clarify these questions. Chapter 1 addresses the historical research and evidence that formed the basis of current practice. In Chapter 2 we address the effect of BMI and other risk factors on acute diverticulitis, and found that obese patients may be at increased risk. In chapter 3 we addressed the role of colonoscopy and found that the risk of malignancy after a confirmed episode of uncomplicated diverticulitis is not significantly different to that of a screened asymptomatic population, while complicated diverticulitis still carries a significant risk. In chapter 4, we looked at recurrent diverticulitis, and found that uncomplicated disease at initial presentation, having an autoimmune disease and taking regular NSAIDS increased risk of recurrent disease.
Advisor: Frizelle, Francis Anthony; Eglinton, Timothy
Degree Name: Master of Medical Science
Degree Discipline: Department of Surgery, Christchurch Public Hospital
Publisher: University of Otago
Keywords: Diverticulitis; Colonoscopy; Recurrence; Obesity; Malignancy
Research Type: Thesis