Multicentre observational study of the natural history of left‐sided acute diverticulitis ( Br J Surg 2012; 99: 276–285)
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We have read the invited Commentary of Dr Flum to our article (1). He is an authority in the field and we greatly appreciate his views. The sources of inaccuracy he raises including patients lost to follow up or uncertainty of the proportion of emergency operations, are indeed very real difficulties inherent in any study of this sort. We deal with these in the Discussion, but nevertheless we believe that the study has produced new data despite these limitations.
He mentions that only recurrences requiring admission to hospital were included. One of the most important aspects of the study was that all patients were diagnosed according to the most objective criteria possible in clinical practice. Thus we defined acute diverticulitis (AD) by clinical and radiological criteria and recurrence as a new episode of AD was diagnosed by the same definition and which occurred at least two months after complete resolution of the index episode. Patients with radiological evidence of acute diverticulitis were rarely treated as outpatients. Some patients treated with antibiotics for abdominal pain and fever in an outpatient setting without instrumental examination confirming the diagnosis of AD were simply classified as persistence or recurrence of symptoms. It is of course the case that a multicentre study of diverticular disease as presented in our study is extremely difficult to carry out. Confounding factors include the accuracy of data recording, uniformity of adherence to the protocol, variance in the clinical severity of the illness, length of follow up and many other variables. Any future study will always be faced with the same practical difficulties to a greater or lesser extent.
Despite these difficulties, we are, nevertheless, strongly of the view that the data presented are an advance on previous studies. Admittedly the results do not give a complete picture but they add to present knowledge beyond what was available before.
Gian Andrea Binda
Donato F. Altomare
Via Caffaro 14
1) Multicentre observational study of the natural history of left-sided acute diverticulitis.
Binda GA, Arezzo A, Serventi A, Bonelli L; on behalf of the Italian Study Group on Complicated Diverticulosis (GISDIC). Br J Surg. 2011 Nov 21.doi: 10.1002/bjs.7723. [Epub ahead of print] PubMed PMID: 22105809.
Gian Andrea Binda
- Galliera Hospital
- Date: Jan 22, 2012