Diverticular disease is a common problem.
Although present in only 12-30% of people under 40 years of age in the UK, over 50% of the population aged over 50 years are affected. This rises to 70% by 80 years of age.*
The consequences can be devastating – but most people have never heard of it, and it remains something of a mystery even to those who have it – and their Doctors.
That’s why Bowel Research UK has awarded £30,000 to launch an international research project to better understand diverticular disease. The team have now recruited over 130 hospitals, covering every continent – just look at the map below!
* Statistics from https://www.londongeneralsurgeryclinic.co.uk/diverticulitis.php and https://www.sciencedirect.com/science/article/abs/pii/S0736467907001461 Accessed 07.10.25
The fear of the unknown was the hardest part, it was out of my hands and I had no control over the situation. A patient discusses the effects of diverticular disease at a DAMASCUS PPI event
DAMASCUS is an international, prospective study aiming to investigate the international variability in the presentation and index management of acute diverticulitis, and whether there is an association between index management and short and medium-term clinical outcomes including the readmission or re-intervention rates over the subsequent six months. DAMASCUS is a trainee-led study with local consultant support.
Data collection for DAMASCUS will start in October 2020. Your hospital can take part in this international project aiming to improve the management of diverticular disease. If you are a researcher and would like your hospital to join, please click the link below and fill in the REDCap registration.
You can also download the full protocol for Damascus here
Final Report Summary
Acute diverticulitis is an increasingly common condition that affects an increasingly younger population of patients. The ideal management of this condition remains unclear and despite multiple national and international guidelines there is a perception that the treatment and outcomes vary both within and between countries. The aim of the DAMASCUS (Diverticulitis Management : a Snapshot Collaborative Audit) was to look across the management of this condition over a six month period across the whole world to determine areas of variability in practice and outcomes.
The study was run by the Birmingham Centre for Observational and Prospective studies using an established online database tool (RedCap) which ensure all patient identities remained anonymous. The study collected data on all patients admitted to hospitals with acute diverticulitis between October 2020 and December 2021. Data on both patient and disease characteristics along with short-term outcomes at 30 days were collected. Subsequent studies were designed to collect follow up data at 6, 12 and 24 months however this summary specifically reports the 30-day outcomes.
6285 patients were recruited from 248 across 48 countries in total. Patients were segregated into uncomplicated or complicated disease after central review of CT reports or operative findings. Countries were separated into 5 distinct regions: UK, Europe, North America, Australasia and the rest of the world. Our analysis of the data revealed a number of key findings:
- The use of antibiotics in mild, uncomplicated disease (where the evidence would support no antibiotics) is extremely high across the whole world (92.7%-99.4%)
- The use of ambulatory care (i.e. not admitting patients to hospital) varied significantly across the world from 5% to 70%
- Patients in low-middle income countries were more likely to undergo emergency surgery without any scans prior to surgery
- The rate of permanent ostomy formation varied significantly but on the whole were very high (47% to 92%)
- The overall mortality rate at 30 days was higher in complicated patients (4.5%) and patients from low-middle income countries (6.2%)
The DAMASCUS study is the largest prospective study of patients with acute diverticulitis. It has confirmed that there is a large degree of variation in the management and outcomes of patients across the world. The overuse of antibiotics and hospital admission in patients with mild, uncomplicated disease is an area of concern particularly in an era of limited healthcare resources and antibiotic resistance. The reasons behind the variation in surgical treatment strategies is unclear and is requiring further investigation.
Further analysis of the data will continue to explore outcomes at 6, 12 and 24 months and determine if these are related to treatment undertaken on the initial admission.
Impact of Bowel Disease Research Foundation /Bowel Research UK funding
This project would not have been possible without Bowel Research UK, the vision to invest in an area of bowel disease that has received little attention has created a long-term impact that will benefit future generations of patients. Bowel Research UK funding has also brought about critical mentorship, promotion and moral support which is undoubtedly of huge benefit for researchers.