# Trends and Outcomes in Acute Colonic Diverticulitis: A Single-Center Three-Year Retrospective Cohort Study From Greece

## TL;DR

This study examines acute colonic diverticulitis trends in Greece, finding rising cases among younger, overweight individuals and highlighting lifestyle factors linked to recurrence.

## Contribution

The study provides novel regional insights into ACD epidemiology and recurrence risk factors in Greece, emphasizing lifestyle associations.

## Key findings

- 68.3% of ACD patients were under 65 years old, with 81.6% being overweight or obese.
- Recurrence was strongly associated with smoking, lack of physical activity, and poor dietary adherence.
- Conservative management was effective in 90% of cases, but 53.3% experienced recurrence within 21 months on average.

## Abstract

Background: Acute colonic diverticulitis (ACD) is an increasingly common condition with shifting epidemiological trends, particularly among younger adults in Western countries. The incidence appears to be rising in Greece; however, regional data are scarce. This three-year monocentric cohort study aims to shed light on the epidemiology and clinical outcomes of ACD in a Greek hospital.

Methods: This retrospective cohort study evaluated 60 patients with computed tomography (CT)-confirmed ACD managed between 2022 and 2024, stratified by age in two groups (<65 vs. ≥65 years). Data encompassed demographics, body mass index (BMI), comorbidities, clinical presentation, Hinchey classification, therapeutic interventions, and recurrence rates, with statistical analyses assessing associations between recurrence and patient characteristics.​

Results: Of the 60 patients, 68.3% were under 65 years, and 81.6% were overweight or obese. The study found a strong inverse correlation between BMI and age of presentation (r = -0.28, p = 0.028), indicating that patients with greater BMI developed diverticulitis at a younger age. Most presented with Hinchey 0-1a disease (83.33%) and responded well to conservative management (90%). Surgical intervention was required in 10% of our cases, with four being urgent and two occurring during hospitalization due to persistent inflammation despite conservative treatment. During the period of the study, elective sigmoidectomy was performed in six patients (10%), mainly in patients with ≥4 episodes. Recurrence occurred in 53.3%, with a median time to recurrence of 21 months. Specifically, 26.6% of recurrences were recorded after hospitalization in our department. Recurrence was strongly associated with modifiable lifestyle factors such as smoking (OR = 3.40, p = 0.037), lack of physical activity (OR = 5.73, p = 0.002), and poor dietary adherence (OR = 0.26, p = 0.019). Higher recurrence rates were noted in patients with elevated BMI (mean: 31.1 kg/m²); however, there was no statistically significant association between recurrence and BMI or age (p = 0.13 and p = 0.40, respectively), although there was a tendency among younger and obese individuals. Patients with higher Hinchey stages had shorter recurrence intervals (χ² = 6.9, p = 0.009). Close monitoring and planned post-discharge care are essential for high-risk individuals with recurrent disease, as 40.62% did not have a follow-up colonoscopy.

Conclusions: This study highlights a growing burden of ACD among younger, overweight individuals in Greece. Conservative management is effective in most cases, but recurrence is frequent and associated with modifiable lifestyle factors. Targeted follow-up, patient education, and structured prevention strategies are essential to mitigate disease recurrence, particularly in high-risk populations.