LAUSR

We have read with great interest the original work by Patel et al., who, using the US Nationwide Readmissions Database, assessed both clinical outcomes and recurrence of diverticulitis after bariatric surgery [1]. The authors included patients with acute diverticulitis who were hospitalized between the years 2010 and 2014, divided into two groups: those with severe obesity and those with prior bariatric surgery. Clinical outcome between the two groups was considered on the basis of mortality, surgical events, and recurrent admissions due to diverticulitis. A large number of admissions for diverticulitis were found (52,274), of which 91.2% in patients with severe obesity and 8.8% in those who had undergone bariatric surgery. Very important, patients with severe obesity compared to those with prior bariatric surgery had higher odds of mortality (adjusted odds ratio [OR] 10.55; 95% confidence interval [CI] 1.45, 76.45), of emergency surgery (OR 1.71; 95% CI 1.25, 2.34), need for surgery (OR 1.45; 95% CI 1.26, 1.68), and surgical complications (OR 1.45, 1.09, 1.92). Similarly, length of hospital stay and rate of recurrent diverticulitis (readmissions within 30 days and 6 months) were higher in patients with severe obesity compared to those with prior bariatric surgery. The authors concluded that bariatric surgery that mitigates obesity improves clinical outcomes and reduces mortality rates for acute diverticulitis [1]. Obesity prevalence is increasing globally [2] and is associated with acute diverticulitis episodes and worse clinical outcomes as described previously [3] and highlighted as well in the current work by Patel et al. This is a crucial topic, considering an additional benefit that can be obtained with weight loss. Scarce data regarding the association between overweight and obesity and diverticulitis rate are available in the clinical setting. Recently, in a multicentre study including 529 patients with diverticulosis, we have shown that patients with BMI above the normal range had a higher OR of diverticulitis as compared with those with normal BMI (OR 3.10, 95% CI 2.00, 4.73, P < 0.001). Obesity was associated with a higher OR of diverticulitis as compared with patients who had normal BMI (OR 4.50, 95% CI 2.84–7.12, P < 0.001). Patients with overweight had a higher OR of diverticulitis than those in the normal BMI group (OR 1.85, 95% CI 1.14, 3.00, P = 0.01) [4]. Thus, both overweight and obesity were associated with an increased risk of diverticulitis. Pathophysiological mechanisms that may link obesity or overweight with the development of diverticulitis include the release of cytokines that promote inflammation in subcutaneous abdominal fat, alterations in gut microbiota, and probably dietary and lifestyle factors that may be associated with diverticulitis, e.g., low consumption of dietary fiber and sedentary life style [5-6]. In conclusion, the study by Patel et al. reinforces and further strengthens our findings. Thus, one more reason, in addition to the well-known ones on metabolism improvement, to pursue weight loss, must be the prevention of diverticulitis and its sequelae.