Diverticulitis is caused when outpouching in the colon (also known as the large intestine) becomes inflamed or infected. Inflammation is a reaction of the body to a place of injury and causes pain, swelling, and redness. Diverticulitis is a common problem affecting 2-3 million Americans each year. Even though it is common, doctors still have important questions about the best way to treat people who have recovered from an episode of diverticulitis.
Repeat episodes occur in about 1 in 4 people. Some people find that the risk of recurrence or worry about future episodes gets in the way of their quality of life. Other people are bothered by abdominal pain and symptoms that remain after they have recovered from an episode of diverticulitis. For patients grappling with recurrent and bothersome diverticulitis, the most important question remains to be answered: “Given my conditions, preferences, and interests, is surgery more effective than best medical management”?
Aim 1: Compare patient-reported outcomes such as quality of life in patients with quality of life limiting diverticulitis randomized to elective colectomy vs. best medical management.
Aim 2: Compare clinical outcomes such as number of subsequent episodes of diverticulitis between patients with quality of life limiting diverticulitis randomized to elective colectomy vs. best medical management.
Aim 3: Compare healthcare utilization between patients with quality of life limiting diverticulitis randomized to elective colectomy vs. best medical management.
Study participants will be randomized by a computer into two treatment options – either surgery or medical management. Surgery involves removal of the diseased part of the colon, an operation called “partial colectomy”, while medical management includes a combination of diet and lifestyle changes, supplements, and prescription medications.
During surgery, the part of the colon impacted by diverticulitis is removed and the remaining ends of the colon are reconnected. Most patients spend 3 to 5 days in the hospital to recover—during this time, doctors and nurses work with the patient to control pain levels and ensure that the patient is able to eat and drink before they are discharged.
Potential Risks & Benefits:
- As with any major surgical procedure, there are risks that can occur. The most serious problems may include infections or bleeding; leaking from the intestine where part of the colon was removed; a colostomy (where the colon is brought out to the skin to drain into a bag); damage to areas near the colon such as the tube that carries urine; and rarely, death.
- More common complications include infection where the skin was cut and a longer than expected time spent in the hospital for your bowels to recover their function.
- Despite the risk of complications, the surgery is considered safe and one of the accepted approaches to treating this condition.
Medical management may include:
- Exercise and a high fiber diet
- Supplements of medical grade fiber and probiotics
- Prescription medications, which include antibiotics or anti-inflammatory pills that specifically target the colon
We think of these as tools in a medical management toolbox.
Potential Risks & Benefits:
- All the tools in the toolbox have been shown to improve symptoms or to lower the chance of recurrent episodes of diverticulitis in some people.
- These treatments do not work in all patients. Randomized trials have been done with some showing they work and others showing no change.
- The doctor and healthcare team will work closely with the patient to decide which combination of medical management treatments to pursue.
- All of these treatments are safe and are accepted approaches to this condition, although some insurance companies may not pay for all of the treatments.
- The risks of medical management are small. A treatable form of diarrhea called C. diff can occur when antibiotics are used for medical management, but this is rare.
While medical management is very low-risk and may relieve symptoms, its impact on recurrence is unclear. Surgery is more likely to prevent recurrence but prevents more risk than medical management. What this study is trying to answer is which of these two treatments has the greater impact on quality of life and symptoms. A randomized trial is the best way to answer questions like these.