Antonio Tursi1, Giovanni Brandimarte2, Francesco Di Mario3, Maria L Annunziata4, Mauro Bafutto5, Maria A Bianco6, Raffaele Colucci7, Rita Conigliaro8, Silvio Danese9, Rudi De Bastiani10, Walter Elisei11, Ricardo Escalante12, Roberto Faggiani13, Luciano Ferrini14, Giacomo Forti15, Giovanni Latella16, Maria G Graziani17, Enio C Oliveira18, Alfredo Papa19, Antonio Penna20, Piero Portincasa21, Kjetil Søreide22, Antonio Spadaccini23, Paolo Usai24, Stefanos Bonovas25, Carmelo Scarpignato26, Marcello Picchio27, Piera G Lecca2, Costantino Zampaletta13, Claudio Cassieri2, Alberto Damiani14, Kari F Desserud22, Serafina Fiorella23, Rosario Landi19, Elisabetta Goni3, Maria A Lai24, Flavia Pigò8, Gianluca Rotondano2, Giuseppe Schiaccianoce21. 1. Gastroenterology Service, Azienda Sanitaria Locale Barletta-Andria-Trani, Andria, Italy. 2. Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy. 3. Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy. 4. Division of Gastroenterology, Istituto di Rocovero e Cura a Carattere Scientifico San Donato, San Donato Milanese, Italy. 5. Instituto Goiano de Gastroenterologia e Endoscopia digestiva, Faculdade de Medicina da Universidade Federal de Goiás, Goiânia, Brasil. 6. Division of Gastroenterology, T. Maresca Hospital, Torre del Greco, Italy. 7. Digestive Endoscopy Unit, San Matteo degli Infermi Hospital, Spoleto, Italy. 8. Division of Digestive Endoscopy, Sant'Agostino Estense Hospital, Baggiovara, Italy. 9. Humanitas University, IBD Center, Humanitas Clinical and Research Hospital, Via Manzoni, Rozzano, Milan, Italy. 10. Service of Territorial Gastroenterology, Feltre, Italy. 11. Division of Gastroenterology, Azienda Sanitaria Locale Azienda Sanitaria Locale Roma H., Rome, Italy. 12. Loira Medical Center, Universidad Central de Venezuela, Caracas, Venezuela. 13. Division of Gastroenterology, Belcolle Hospital, Viterbo, Italy. 14. Service of Gastroenterology and Digestive Endoscopy, Villa dei Pini Home Care, Civitanova, Marche, Italy. 15. Division of Digestive Endoscopy, S. Maria Goretti Hospital, Latina, Italy. 16. Division of Gastroenterology, S. Salvatore Hospital, L'Aquila, Italy. 17. Service of Digestive Endoscopy, S. Camillo Hospital, Rome, Italy. 18. Department of Surgery, Federal University of Goiás, Goiânia, Brasil. 19. Division of Internal Medicine and Gastroenterology, C.I. Columbus Catholic University, Rome, Italy. 20. Division of Gastroenterology, S. Paolo Hospital, Bari, Italy. 21. Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy. 22. Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway. 23. Division of Gastroenterology and Digestive Endoscopy, Padre Pio Hospital, Vasto, Italy. 24. Division of Gastroenterology, Monserrato University Hospital, University of Cagliari, Cagliari, Italy. 25. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy. 26. Laboratory of Clinical Pharmacology, University of Parma, Parma, Italy. 27. Division of Surgery, P. Colombo Hospital, Rome, Italy.
Abstract
BACKGROUND: Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification has been recently developed for patients suffering from diverticulosis and diverticular disease. AIMS: We assessed retrospectively the predictive value of DICA in patients for whom endoscopic data and clinical follow-up were available. METHODS: For each patient, we recorded: age, severity of DICA, presence of abdominal pain, C-reactive protein and faecal calprotectin test (if available) at the time of diagnosis; months of follow-up; therapy taken during the follow-up to maintain remission (if any); occurrence/recurrence of diverticulitis; need of surgery. RESULTS: We enrolled 1651 patients (793 M, 858 F, mean age 66.6 ± 11.1 years): 939 (56.9%) patients were classified as DICA 1, 501 (30.3%) patients as DICA 2 and 211 (12.8%) patients as DICA 3. The median follow-up was 24 (9-38) months. Acute diverticulitis (AD) occurred/recurred in 263 (15.9%) patients; surgery was necessary in 57 (21.7%) cases. DICA was the only factor significantly associated to the occurrence/recurrence of diverticulitis and surgery either at univariate (χ(2 )= 405.029; p < 0.0001) or multivariate analysis (hazard ratio = 4.319, 95% confidence interval (CI) 3.639-5.126; p < 0.0001). Only in DICA 2 patients was therapy effective for prevention of AD occurrence/recurrence with a hazard ratio (95% CI) of 0.598 (0.391-0.914) (p = 0.006, log rank test). Mesalazine-based therapies reduced the risk of AD occurrence/recurrence and needs of surgery with a hazard ratio (95% CI) of 0.2103 (0.122-0.364) and 0.459 (0.258-0.818), respectively. CONCLUSIONS: DICA classification is a valid parameter to predict the risk of diverticulitis occurrence/recurrence in patients suffering from diverticular disease of the colon.
BACKGROUND: Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification has been recently developed for patients suffering from diverticulosis and diverticular disease. AIMS: We assessed retrospectively the predictive value of DICA in patients for whom endoscopic data and clinical follow-up were available. METHODS: For each patient, we recorded: age, severity of DICA, presence of abdominal pain, C-reactive protein and faecal calprotectin test (if available) at the time of diagnosis; months of follow-up; therapy taken during the follow-up to maintain remission (if any); occurrence/recurrence of diverticulitis; need of surgery. RESULTS: We enrolled 1651 patients (793 M, 858 F, mean age 66.6 ± 11.1 years): 939 (56.9%) patients were classified as DICA 1, 501 (30.3%) patients as DICA 2 and 211 (12.8%) patients as DICA 3. The median follow-up was 24 (9-38) months. Acute diverticulitis (AD) occurred/recurred in 263 (15.9%) patients; surgery was necessary in 57 (21.7%) cases. DICA was the only factor significantly associated to the occurrence/recurrence of diverticulitis and surgery either at univariate (χ(2 )= 405.029; p < 0.0001) or multivariate analysis (hazard ratio = 4.319, 95% confidence interval (CI) 3.639-5.126; p < 0.0001). Only in DICA 2 patients was therapy effective for prevention of AD occurrence/recurrence with a hazard ratio (95% CI) of 0.598 (0.391-0.914) (p = 0.006, log rank test). Mesalazine-based therapies reduced the risk of AD occurrence/recurrence and needs of surgery with a hazard ratio (95% CI) of 0.2103 (0.122-0.364) and 0.459 (0.258-0.818), respectively. CONCLUSIONS: DICA classification is a valid parameter to predict the risk of diverticulitis occurrence/recurrence in patients suffering from diverticular disease of the colon.
Entities:
Keywords:
Colonoscopy; colon; diverticular disease; endoscopic classification; outcome; surgery
Authors: Jason F Hall; Patricia L Roberts; Rocco Ricciardi; Thomas Read; Christopher Scheirey; Christoph Wald; Peter W Marcello; David J Schoetz Journal: Dis Colon Rectum Date: 2011-03 Impact factor: 4.585
Authors: Antonio Tursi; Walter Elisei; Marcello Picchio; Gabriella Nasi; Angela Maria Mastromatteo; Francesco Di Mario; Enrico Di Rosa; Maria Alessandra Brandimarte; Giovanni Brandimarte Journal: Ann Transl Med Date: 2017-08