Patterns of pain in diverticular disease and the influence of acute diverticulitis.
BACKGROUND
While the association of recurrent bouts of abdominal pain with colonic diverticulosis is well recognized, the cause of this pain is obscure since in most cases it occurs without obvious diverticulitis or other potential causes.


OBJECTIVE
To define the patterns of pain in diverticular disease and the influence of acute diverticulitis.


METHODS
Two studies were undertaken to establish the relationship between bouts of prolonged abdominal pain (> 24 h) presumed to be due to inflammatory diverticulitis and recurrent short-lived pain. In Study 1, 261 patients with a barium enema showing diverticulosis completed a postal questionnaire concerning episodes of both prolonged and short-lived pain. In Study 2, 26 patients previously admitted to hospital with a firm diagnosis of diverticulitis were interviewed for details of their bowel habits since discharge.


RESULTS
Study 1: 94/261 patients experienced recurrent, short-lived pain on a median of five days a month, with a median duration of 3 h. In addition, 51/261 patients described episodes of prolonged pain with a median duration of three days. Of these, 31/51 (61%) experienced recurrent, short-lived pain compared with 63/210 (30%) who had not had an episode of prolonged pain. More specifically, 12/17 (71%) who received antibiotic treatment for presumed acute diverticulitis during their bout of prolonged pain experienced recurrent pain compared with 82/244 (34%) who did not experience such an episode. Study 2: 18/26 patients hospitalized for acute diverticulitis developed new, recurrent, short-lived abdominal pain following discharge, with a median duration of 4 h.


CONCLUSIONS
Episodes of prolonged, presumed inflammatory pain due to diverticulitis are frequently followed by recurrent, short-lived pain similar to that seen in irritable bowel syndrome.
Simpson
John
J
Division of Surgery, University of Nottingham, Nottingham, UK.
Neal
Keith R
KR
Scholefield
John H
JH
Spiller
Robin C
RC
D015746:Abdominal Pain / Q000209:etiology* / Q000503:physiopathology; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003672:Defecation; D004239:Diverticulitis, Colonic / Q000150:complications* / Q000188:drug therapy; D004241:Diverticulum, Colon / Q000150:complications*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D011795:Surveys and Questionnaires; D013997:Time Factors
D000900:Anti-Bacterial Agents