Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California.
Clin Gastroenterol Hepatol. 2013 Dec;11(12):1614-9. doi: 10.1016/j.cgh.2013.03.007. Epub 2013 Mar 21.
BACKGROUND & AIMS: Individuals with diverticulosis frequently also have irritable bowel syndrome (IBS), but there are no longitudinal data to associate acute diverticulitis with subsequent IBS, functional bowel disorders, or related emotional distress. In patients with postinfectious IBS, gastrointestinal disorders cause long-term symptoms, so we investigated whether diverticulitis might lead to IBS. We compared the incidence of IBS and functional bowel and related affective disorders among patients with diverticulitis.
We performed a retrospective study of patients followed up for an average of 6.3 years at a Veteran's Administration medical center. Patients with diverticulitis were identified based on International Classification of Diseases, 9th revision codes, selected for the analysis based on chart review (cases, n = 1102), and matched with patients without diverticulosis (controls, n = 1102). We excluded patients with prior IBS, functional bowel, or mood disorders. We then identified patients who were diagnosed with IBS or functional bowel disorders after the diverticulitis attack, and controls who developed these disorders during the study period. We also collected information on mood disorders, analyzed survival times, and calculated adjusted hazard ratios.
Cases were 4.7-fold more likely to be diagnosed later with IBS (95% confidence interval [CI], 1.6-14.0; P = .006), 2.4-fold more likely to be diagnosed later with a functional bowel disorder (95% CI, 1.6-3.6; P < .001), and 2.2-fold more likely to develop a mood disorder (CI, 1.4-3.5; P < .001) than controls.
Patients with diverticulitis could be at risk for later development of IBS and functional bowel disorders. We propose calling this disorder postdiverticulitis IBS. Diverticulitis appears to predispose patients to long-term gastrointestinal and emotional symptoms after resolution of inflammation; in this way, postdiverticulitis IBS is similar to postinfectious IBS.
患有憩室病的个体经常也患有肠易激综合征（IBS），但没有纵向数据将急性憩室炎与随后的 IBS、功能性肠病或相关的情绪困扰联系起来。在感染后 IBS 患者中，胃肠道疾病会导致长期症状，因此我们研究了憩室炎是否会导致 IBS。我们比较了憩室炎患者中 IBS 和功能性肠病以及相关情感障碍的发生率。
我们对退伍军人管理局医疗中心平均随访 6.3 年的患者进行了回顾性研究。根据国际疾病分类，第 9 版代码，我们基于图表审查选择了憩室炎患者（病例，n=1102）进行分析，并与没有憩室病的患者（对照组，n=1102）相匹配。我们排除了有先前 IBS、功能性肠或情绪障碍的患者。然后，我们确定了在憩室炎发作后被诊断为 IBS 或功能性肠病的患者，以及在研究期间发生这些疾病的对照组患者。我们还收集了情绪障碍的信息，分析了生存时间，并计算了调整后的危险比。
病例组以后被诊断为 IBS 的可能性是对照组的 4.7 倍（95%置信区间 [CI]，1.6-14.0；P=0.006），以后被诊断为功能性肠病的可能性是对照组的 2.4 倍（95% CI，1.6-3.6；P<0.001），以后被诊断为情绪障碍的可能性是对照组的 2.2 倍（CI，1.4-3.5；P<0.001）。
憩室炎患者可能有以后发展为 IBS 和功能性肠病的风险。我们建议将这种疾病称为憩室炎后 IBS。憩室炎似乎使患者在炎症消退后容易发生长期的胃肠道和情绪症状；在这种方式下，憩室炎后 IBS 类似于感染后 IBS。
