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The Association between Family History and Diverticulitis Recurrence: A Population-Based Study.

BACKGROUND
After initial nonoperative management of diverticulitis, individuals with a family history of diverticulitis may have increased risk of recurrent disease.


OBJECTIVE
This study measured the association between family history and recurrent diverticulitis in a population-based cohort.


DESIGN
This is a retrospective, population-based cohort study.


SETTINGS
The cohort was identified from the Utah Population Database, a statewide resource linking hospital and genealogy records.


PATIENTS
Individuals evaluated in an emergency department or hospitalized 1998-2018 for nonoperatively managed diverticulitis were included.


INTERVENTION
The primary predictor was a positive family history of diverticulitis, defined as diverticulitis in a first-, second-, or third-degree relative.


MAIN OUTCOME MEASURES
This study measured the adjusted association between family history and the primary outcome of recurrent diverticulitis. A secondary outcome was elective surgery for diverticulitis. Additional analyses evaluated risk by degree of relation of the affected family member.


RESULTS
The cohort included 4426 individuals followed for a median of 71 months. Median age was 64 years and 45% were male. 17% had complicated disease, 11% had recurrence, and 15% underwent elective surgery. After adjustment, individuals with a family history of diverticulitis had a similar risk of recurrence when compared to those without a family history (HR 1.0 95% CI 0.8-1.2). However, individuals with a family history of diverticulitis were more likely to undergo elective surgery (HR 1.4 95% CI 1.1-1.6). This effect was most pronounced in those with an affected first-degree family member (HR 1.7 95% CI 1.4-2.2).


LIMITATIONS
The use of state-specific data may limit generalizability.


CONCLUSION
In this population-based analysis, individuals with a family history of diverticulitis were more likely to undergo elective surgery than those without a family history, despite similar risks of recurrence and complicated diverticulitis. Further work is necessary to understand the complex social, environmental, and genetic factors that influence diverticulitis treatment and outcomes. See Video Abstract at http://links.lww.com/DCR/B876.