Impact of barium enema on acute diverticulitis recurrence: A retrospective cohort study of 349 patients

Aim Acute diverticulitis is becoming a health concern in western countries as its incidence is increasing. Currently, one of the accepted theories on possible causes of diverticular perforation is the impactation of faecal residuals into some diverticula. Our aim was to evaluate whether barium impactation might have a negative effect by promoting diverticular inflammation/rupture and thereby acute diverticulitis recurrence. Methods A retrospective cohort study (January 2005/December 2015) was conducted at the Reina Sofia University Hospital of Cordoba (Spain). A retrospective follow-up of patients with and without barium enema after their first episode of acute diverticulitis was conducted. Factors in relation to recurrence and severity of recurrence were analyzed by Chi square, Kaplan-Meier and Cox proportional hazards methods. Results A total of 349 patients were included (Barium enema group, n = 141) and Control group, n = 208). In the studied cohort, 72 (20.6%) patients suffered recurrence of acute diverticulitis which was almost twice as frequent in the barium enema group (27.7% vs. 15.9%, P=0.008). Patients who had undergone barium enema were more likely to demonstrate a higher Hinchey grade at recurrence than observed in the index presentation (30.8% vs. 9.1%, P=0.024). Age less than 50 years, female gender, absence of treatment with rifaximin and especially barium enema, showed a not statistically significant trend to a higher probability of acute diverticulitis recurrence along time (Kaplan-Meier and Cox models). Conclusions Patients who undergo barium enema may more likely present a higher Hinchey grade at recurrence than observed in the index presentation. Copyright © 2017 John Wiley & Sons, Ltd.