TY - JOUR
T1 - Predictive value of the Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification on the outcome of diverticular disease of the colon: An international study
AU - Tursi, Antonio
AU - Brandimarte, Giovanni
AU - Di Mario, Francesco
AU - Annunziata, Maria L
AU - Bafutto, Mauro
AU - Bianco, Maria A
AU - Colucci, Raffaele
AU - Conigliaro, Rita
AU - Danese, Silvio
AU - De Bastiani, Rudi
AU - Elisei, Walter
AU - Escalante, Ricardo
AU - Faggiani, Roberto
AU - Ferrini, Luciano
AU - Forti, Giacomo
AU - Latella, Giovanni
AU - Graziani, Maria G
AU - Oliveira, Enio C
AU - Papa, Alfredo
AU - Penna, Antonio
AU - Portincasa, Piero
AU - Søreide, Kjetil
AU - Spadaccini, Antonio
AU - Usai, Paolo
AU - Bonovas, Stefanos
AU - Scarpignato, Carmelo
AU - Picchio, Marcello
AU - Lecca, Piera G
AU - Zampaletta, Costantino
AU - Cassieri, Claudio
AU - Damiani, Alberto
AU - Desserud, Kari F
AU - Fiorella, Serafina
AU - Landi, Rosario
AU - Goni, Elisabetta
AU - Lai, Maria A
AU - Pigò, Flavia
AU - Rotondano, Gianluca
AU - Schiaccianoce, Giuseppe
PY - 2016
Y1 - 2016
N2 - 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 (χ2= 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.
AB - 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 (χ2= 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.
KW - Colonoscopy
KW - colon
KW - diverticular disease
KW - endoscopic classification
KW - outcome
KW - surgery
KW - Colonoscopy
KW - colon
KW - diverticular disease
KW - endoscopic classification
KW - outcome
KW - surgery
UR - http://hdl.handle.net/10807/172528
U2 - 10.1177/2050640615617636
DO - 10.1177/2050640615617636
M3 - Article
SN - 2050-6406
VL - 4
SP - 604
EP - 613
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
ER -