RT Journal
A1 Livingston EH, Fomby TB, Woodward WA, Haley RW
T1 EPidemiological similarities between appendicitis and diverticulitis suggesting a common underlying pathogenesis
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD March 1
VO 146
IS 3
SP 308
OP 314
DO 10.1001/archsurg.2011.2
UL http://dx.doi.org/10.1001/archsurg.2011.2
AB Background 
    Nonperforating appendicitis is primarily a disease of children, and nonperforating diverticulitis affects mostly older adults. Apart from these age differences, the diseases share many epidemiological features, such as association with better hygiene and low-fiber diets.Hypothesis 
    Nonperforating appendicitis and nonperforating diverticulitis are different manifestations of the same underlying colonic process and, if so, should be temporally related.Design 
    Data from the National Hospital Discharge Survey were analyzed to investigate the incidence of admissions for appendicitis in children and diverticulitis in adults between 1979 and 2006.Setting 
    Statistical sampling of all US hospitals.Patients 
    Children admitted for appendicitis and adults with diverticulitis.Main Outcome Measures 
    Time trends were assessed for stationarity using unit root analysis, and similarities between time trends were tested using cointegration analysis.Results 
    The incidence rates of nonperforating appendicitis and nonperforating diverticulitis exhibited U-shaped secular trends. The rates of perforating appendicitis and perforating diverticulitis rose slowly across all the study years. Cointegration analysis demonstrated that the rates of nonperforating and perforating diverticulitis did not cointegrate significantly over time. The rates of nonperforating and perforating appendicitis did not vary together. Nonperforating appendicitis and nonperforating diverticulitis rates were significantly cointegrated over time.Conclusions 
    Childhood appendicitis and adult diverticulitis seem to be similar diseases, suggesting a common underlying pathogenesis. Secular trends for their nonperforating and perforating forms are strikingly different. At least for appendicitis, perforating disease may not be an inevitable outcome from delayed treatment of nonperforating disease. If appendicitis represents the same pathophysiologic process as diverticulitis, it may be amenable to antibiotic rather than surgical treatment.