Chronic Diarrhea Compared to Chronic Constipation Results in More Colonic Diverticular Disease and GI Visits: A Community-Based Retrospective Cohort Study With >10-Year Follow-Up

Introduction: Colonic diverticula are generally thought to arise from increased intra-luminal pressures. Few cross-sectional studies have found mixed results regarding an association between diverticular disease and bowel habits. We assessed the association between objective documentation of diverticular disease among a community-based cohort of patients with chronic gastrointestinal (GI) symptoms. Methods: We conducted a retrospective population-based cohort study of non-deceased patients with chronic constipation and chronic diarrhea, defined as reporting symptoms on at least 2 separate Bowel Disease Questionnaires (BDQ) from 1988 to 2009. Outcomes included objective diverticulosis as documented in the medical record (EMR) via notes, endoscopy, radiography, or complications. Healthcare utilization was summarized as number of hospitalizations for diverticular diseases, Emergency Department (ED) visits for diverticular diseases, and any GI visits. Differences between groups were assessed using the Chi-squared test for categorical variables and ANOVA or Wilcoxon rank sum test for continuous variables. Logistic regression assessed the association between diverticular disease and chronic GI symptoms. Linear regression estimated the predictors of larger numbers of GI visits. Results: The demographics, prevalence of diverticulosis, diverticulitis, and healthcare utilization of 199 patients who had completed at least 2 BDQ at a single tertiary referral center are reported in Table 1. Seventy-eight patients reported chronic constipation and 121 had chronic diarrhea. Those with chronic diarrhea were more likely older and female. Those with chronic diarrhea were more likely to have evidence of diverticulosis (P=0.034), diverticulitis (P=0.049), and greater number of GI visits (P=0.001) compared to those with chronic constipation. There were no observed differences in rates of hospitalizations or ED visits between the groups. Predictive models showed that patients who were older (P=0.0437) and male (P=0.0279) had increased risk of having diverticulosis after adjustment for all other variables. Patients with chronic diarrhea (P=0.0179) and a diagnosis of irritable bowel syndrome (P=0.0099) had higher number of GI visits after adjustment for all other co-variates. Conclusion: Chronic diarrhea was more likely to be associated with future diverticular disease and with more GI visits, but there were no differences in hospitalizations or ED visits. Table 1. - Demographics of Participants That Met Case Definitions of Chronic Constipation and Chronic Diarrhea on Two Bowel Disease Questionnaires Administered at Different Times. *Data presented as mean (SD) or N (%) Chronic Constipation (N = 78) Chronic Diarrhea (N = 121) Total (N = 199) P-value Current Age (years) 76.0 (8.822) 79.0 (9.700) 77.8 (9.462) 0.0251 Female Sex 48 (61.5%) 56 (43.6%) 104 (52.3%) 0.0352 History of IBS Diagnosis 7 (9.0%) 23 (19.0%) 30 (15.1%) 0.0532 Current Use of Laxatives 14 (21.5%) 13 (13.5%) 27 (16.8%) 0.1832 Current Use of Anti-Diarrheals 0 (0.0%) 6 (6.2%) 6 (3.7%) 0.0382 Smoking Status 0.6142 Never 38 (59.4%) 54 (51.9%) 92 (54.8%) Former 23 (35.9%) 43 (41.3%) 66 (39.3%) Current 3 (4.7%) 7 (6.7%) 10 (6.0%) Alcohol Use 31 (57.4%) 41 (46.1%) 72 (50.3%) 0.1892 Presence of Diverticulosis 33 (44.0%) 72 (59.5%) 105 (53.6%) 0.0342 Any Episode of Diverticulitis 4 (5.2%) 17 (14.0%) 21 (10.6%) 0.0492 N of Related Hospitalizations 0.12 (0.734) 0.10 (0.494) 0.11 (0.597) 0.5833 N of Related ED Visits 0.04 (0.346) 0.10 (0.416) 0.08 (0.391) 0.0923 N of all GI Visits 1.29 (2.232) 2.86 (4.979) 2.25 (4.204) 0.0011 *Percentages represent proportion of those with non-missing data1Linear Model ANOVA2Pearson's Chi-squared test3Kruskal-Wallis rank sum testED, Emergency Department; GI, Division of Gastroenterology & Hepatology; IBS, irritable bowel syndrome; N, number; SD, standard deviation