Does having Irritable Bowel Syndrome (IBS) increase the chances of recurring diverticulitis?

IBS and Recurrent Diverticulitis: Risk Assessment

Having IBS is associated with an increased risk of recurrent diverticulitis, particularly in patients with long-standing disease. 1

Relationship Between IBS and Diverticulitis

IBS and symptomatic diverticular disease share several overlapping features but have important distinctions:

• Shared characteristics:

  • Recurrent abdominal pain episodes
  • Erratic bowel habits (diarrhea, constipation, or alternating patterns)
  • Visceral hypersensitivity may be present in both conditions 2

• Key differences:

  • Diverticulitis patients tend to be older
  • Diverticulitis lacks the female predominance seen in IBS
  • Diverticulitis may present with fever and prolonged pain episodes 2

Evidence for Increased Recurrence Risk

Multivariate analysis from a 2022 study identified several factors associated with recurrent diverticulitis after elective surgery:

• Preoperative diagnosis of IBS was significantly associated with diverticulitis recurrence (p=0.04) 1
• Other risk factors included:
  • Diverticulitis involving both sigmoid and descending colon (p=0.04)
  • Long-standing diverticular disease (>5 years) (p=0.03) 1

Recurrence Patterns and Risk Factors

The 2021 AGA clinical practice guidelines highlight important patterns in diverticulitis recurrence:

• Approximately 20% of patients experience recurrent episodes within 10 years of initial diverticulitis 3

• Recurrence risk increases with each subsequent episode:

  • 8% recurrence within 1 year after first episode
  • 18% recurrence within 1 year after second episode
  • 55% recurrence within 10 years after second episode 3

• Complicated diverticulitis (with abscess) has higher recurrence rates:

  • 25% recurrence within 5 years after non-surgical management 3

Management Implications

For patients with both IBS and diverticulitis:

• Dietary recommendations:

  • High-fiber diet is suggested for patients with history of diverticulitis 3
  • A prudent dietary pattern (high in fruits, vegetables, whole grains, legumes; low in red meat and sweets) is associated with decreased diverticulitis risk 3

• Medication considerations:

  • Avoid regular use of NSAIDs, particularly non-aspirin NSAIDs, which increase diverticulitis risk 3
  • No evidence supports using 5-aminosalicylic acid, probiotics, or rifaximin to prevent recurrent diverticulitis 3

• Surgical decision-making:

  • Elective segmental resection should not be based solely on number of episodes 3, 4
  • IBS diagnosis should be considered when evaluating surgical candidates, as it may influence recurrence risk 1
  • Surgery reduces but does not eliminate diverticulitis risk (15% recurrence at 5 years post-surgery vs. 61% with non-operative management) 4

Clinical Pearls and Pitfalls

• Important distinction: Complicated diverticulitis most commonly occurs during the first episode, not during recurrences 3
• Common misconception: Younger age has been debated as a risk factor for recurrence, with some studies showing increased risk in patients under 40 years 5
• Post-surgical expectations: 22-25% of patients experience persistent abdominal pain even after surgery 4, which may be difficult to distinguish from IBS symptoms

The overlap between IBS and diverticular disease requires careful assessment to determine whether symptoms are due to ongoing IBS, recurrent diverticulitis, or post-inflammatory IBS-like symptoms following diverticulitis episodes 6.