The treatment of a common bowel condition, diverticulitis varies widely across the world. In particular the use of antibiotics is 'alarmingly high' according to the biggest data analysis of the disease to date published in the Lancet's eClinicalMedicine journal this week.
The study, funded by Bowel Research UK and delivered through the University of Birmingham Centre for Observational and Prospective Studies (BiCOPS), showed that antibiotics were used to treat diverticulitis in between 93% and 99% of cases, with the lower rates seen in mainland Europe.
Clinical guidelines advise that only some cases of diverticulitis should be treated with antibiotics to reduce the risk of infections becoming resistant to the treatment, leaving no option but surgery. Many of these mild cases were treated with antibiotics despite these guidelines.
Diverticular disease occurs when pouches form in the bowel wall. It affects around half of people over the age of 50 in the UK. Diverticulitis is the most common complication arising from diverticular disease and happens when faecal matter gets caught up in these pouches and becomes inflamed or infected. Up to a quarter of people with diverticular disease go on to develop diverticulitis.
When it's caught early, diverticulitis may be treated with antibiotics but often only bowel rest and pain relief is needed. More severe cases may become infected and require antibiotic treatment, and occasionally surgery to remove some of the bowel. In some severe cases, the disease can be fatal. In patients undergoing surgery the study also showed very wide variation in the formation of a stoma and the reasons behind this need urgent further investigation.
Lead investigator, Mr Dale Vimalachandran, Consultant Colorectal Surgeon and clinical academic at the University of Liverpool said: "This is the first time the treatment of diverticulitis and outcomes of patients has been analysed globally, and the variation we've seen is concerning. It's crucial we see improved pathways to limit the use of antibiotics to those cases that can't be managed in other ways."
The study also found that, overall, 70% of patients with a form of the disease that was deemed uncomplicated were admitted to hospital for treatment, showing there needs to be more research and guidance for doctors to enable patients to manage their disease at home.
Patients from lower-middle income countries were more likely to be sicker, requiring emergency surgery, and were more likely to die from diverticulitis.
Lindsay Easton, Chief Executive of Bowel Research UK, said: "Diverticulitis is a relatively common disease, but many people have never heard of it. This landmark study takes us a big step forward in filling the information gap we have with diverticulitis - now we know how the disease is treated globally, we can use this knowledge to push for change so patients across the world receive the best possible treatments."
