title: Diverticulitis in the young is not more aggressive than in the elderly, but it tends to recur more often: systematic review and meta-analysis.
abstract: OBJECTIVE
  For years, the natural course of diverticulitis in the young has been debatable in terms of its severity and recurrence rate, and no consensus has been reached regarding its treatment and timing of surgery. Thus, the study aims to evaluate by meta-analysis the natural course of acute diverticulitis in the young.
  
  
  METHODS
  Data were obtained from electronic databases and manual search of studies comparing the course of diverticulitis in young versus elderly patients. The age cut-off was selected to be 40-50 years, and only studies using computed tomography as the sole modality for diagnosis were included. Primary outcomes were surgery during hospitalization and disease recurrence. Relative risks (RRs) with 95% confidence intervals (CIs) are reported.
  
  
  RESULTS
  One thousand eighty publications were found, 12 of which were included. The total number of patients was 4982. Most young patients were males (RR 1.70, 95% CI 1.31-2.21), without tendency toward a more complicated disease at admission (RR 0.95, 95% CI 0.46-1.97). While there was no significant difference in the rate of surgery during hospitalization (RR 0.69, 95% CI 0.46-1.06), young patients underwent more elective surgeries (RR 2.39, 95% CI 1.82-3.15). No mortality was recorded among young patients. The disease recurrence rate was significantly higher than that of elderly patients (RR 1.70, 95% CI 1.31-2.21); however, no study specified the mean follow-up period for each group.
  
  
  CONCLUSIONS
  The course of diverticulitis in the young is not more severe than that in elderly patients; however, the disease tends to recur more often. Therefore, while choosing a therapeutic regimen, factors other than age should also be considered.
authors.affiliation: Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel. liorshlomit@yahoo.com
authors.forename: Lior H
authors.initials: LH
authors.lastname: Katz
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Guy
authors.forename: Adi
authors.initials: A
authors.lastname: Lahat
authors.forename: Anat
authors.initials: A
authors.lastname: Gafter-Gvili
authors.forename: Simon
authors.initials: S
authors.lastname: Bar-Meir
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D004238:Diverticulitis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D016239:MEDLINE; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012306:Risk; D012720:Severity of Illness Index; D012737:Sex Factors; D014057:Tomography, X-Ray Computed
keywords: diverticulitis; natural history; recurrence; surgery; young