Similarities between appendicitis and diverticulitis suggesting common pathogenesis

January 01, 0001

Similarities between appendicitis and diverticulitis suggesting common pathogenesis

Nonperforating appendicitis is primarily a disease of children, and nonperforating diverticulitis affects mostly older adults. Apart from these age differences, the diseases share many epidemiological features, such as association with better hygiene and low-fiber diets. The US authors hypothesized that nonperforating appendicitis and nonperforating diverticulitis are different manifestations of the same underlying colonic process and, if so, should be temporally related. They analyzed data from the National Hospital Discharge Survey to investigate the incidence of admissions for appendicitis in children and diverticulitis in adults between 1979 and 2006.

They found: "The incidence rates of nonperforating appendicitis and nonperforating diverticulitis exhibited U-shaped secular trends. The rates of perforating appendicitis and perforating diverticulitis rose slowly across all the study years. Cointegration analysis demonstrated that the rates of nonperforating and perforating diverticulitis did not cointegrate significantly over time. The rates of nonperforating and perforating appendicitis did not vary together. Nonperforating appendicitis and nonperforating diverticulitis rates were significantly cointegrated over time."

The authors concluded: "Childhood appendicitis and adult diverticulitis seem to be similar diseases, suggesting a common underlying pathogenesis. Secular trends for their nonperforating and perforating forms are strikingly different. At least for appendicitis, perforating disease may not be an inevitable outcome from delayed treatment of nonperforating disease. If appendicitis represents the same pathophysiologic process as diverticulitis, it may be amenable to antibiotic rather than surgical treatment."

Interesting concept, but no evidence yet to guide treatment decisions.

For the full abstract, click here.

Arch Surg 146(3):308-314, March 2011
© 2011 to the American Medical Association
Epidemiological Similarities Between Appendicitis and Diverticulitis Suggesting a Common Underlying Pathogenesis. Edward H. Livingston, Thomas B. Fomby, Wayne A. Woodward, Robert W. Haley. Correspondence to Dr. Livingston: [email protected]

Category: D. Digestive. Keywords: appendicitis, diverticulitis, children, adults, secondary analysis of database, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 19 April 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.