CLINICAL PATTERNS CAN DISTINGUISH DIVERTICULAR DISEASE FROM IRRITABLE BOWEL SYNDROME: A CASE-CASE MATCHING STUDY

Background and aim: Symptomatic diverticular disease (SDD) and irritable bowel syndrome (IBS) share similar symptom pattern. However, comparative symptom pattern studies are hampered by different age of onset of symptoms, being more prevalent in younger patients for IBS and older patients for DD. We aimed to verify the ability of some clinical parameters to distinguish SDD from IBS.Material and methods: Ninety SDD (46 males; age mean 51, 95%CI: 49-53) and 90 IBS (46; 51, 48-53) patients were recruited in 11 gastroenterology referral centres in Italy. Age and gender matched patients were recruited consecutively (SDD/IBS: 1/1). IBS was defined according to Rome III criteria while SDD was defined as the occurrence of symptoms in patients with DD. Data on demographic parameters (weight, height, BMI), voluptuary habits (smoking, coffee, alcohol), familial disease (DD, GI cancer) and symptoms over the previous 6 months (abdominal pain-AP < or > 24 hrs, bloating) were collected. The temporal association between AP > 24 hrs and clinical parameters (eg fever; antibiotic use) increasing probability of diverticulitis was also evaluated. Results: Sixty-seven SDD patients also had symptoms according to IBS criteria. Weight, height and BMI were no different between SDD and IBS. Higher intake ( > 1 cup/die) of coffee was detected in IBS as compared with SDD patients (55 vs 40; p=0.036); no differences were found in alcohol consumption and smoking habits between the two groups. SDD patients showed an increased familiarity for GI cancer (31 vs 18; p=0.044) and DD (29 vs 10; p < 0.0001). AP > 24 hrs appeared significantly present in patients suffering from SDD with respects to those affected by IBS (20 pts vs 6 pts; p=0.005). Abdominal pain duration < 24 hrs and bloating were found in both SDD and IBS patients without any significant difference. However, AP > 24 hrs and the use of antibiotics was significantly associated in SDD patients (SDD=12; IBS=0; p < 0.05) while fever was present only during AP > 24 hrs in SDD but did not reach statistical significance (SDD=5; IBS=0). Conclusions: A high proportion of SDD patients have symptoms that overlap IBS. Abdominal pain lasting for more than 24 hours seems to differentiate patients with DD from those with IBS