title: Predictive value of the Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification on the outcome of diverticular disease of the colon: An international study.
abstract: BACKGROUND
  Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification has been recently developed for patients suffering from diverticulosis and diverticular disease.
  
  
  OBJECTIVE
  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.
authors.affiliation: Gastroenterology Service, Azienda Sanitaria Locale Barletta-Andria-Trani, Andria, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Tursi
authors.affiliation: Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Brandimarte
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Mario
authors.affiliation: Division of Gastroenterology, Istituto di Rocovero e Cura a Carattere Scientifico San Donato, San Donato Milanese, Italy.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Annunziata
authors.affiliation: Instituto Goiano de Gastroenterologia e Endoscopia digestiva, Faculdade de Medicina da Universidade Federal de Goiás, Goiânia, Brasil.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bafutto
authors.affiliation: Division of Gastroenterology, T. Maresca Hospital, Torre del Greco, Italy.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Bianco
authors.affiliation: Digestive Endoscopy Unit, San Matteo degli Infermi Hospital, Spoleto, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Colucci
authors.affiliation: Division of Digestive Endoscopy, Sant'Agostino Estense Hospital, Baggiovara, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Conigliaro
authors.affiliation: Humanitas University, IBD Center, Humanitas Clinical and Research Hospital, Via Manzoni, Rozzano, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Danese
authors.affiliation: Service of Territorial Gastroenterology, Feltre, Italy.
authors.forename: Rudi
authors.initials: R
authors.lastname: De Bastiani
authors.affiliation: Division of Gastroenterology, Azienda Sanitaria Locale Azienda Sanitaria Locale Roma H., Rome, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Elisei
authors.affiliation: Loira Medical Center, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Escalante
authors.affiliation: Division of Gastroenterology, Belcolle Hospital, Viterbo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Faggiani
authors.affiliation: Service of Gastroenterology and Digestive Endoscopy, Villa dei Pini Home Care, Civitanova, Marche, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Ferrini
authors.affiliation: Division of Digestive Endoscopy, S. Maria Goretti Hospital, Latina, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Forti
authors.affiliation: Division of Gastroenterology, S. Salvatore Hospital, L'Aquila, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Latella
authors.affiliation: Service of Digestive Endoscopy, S. Camillo Hospital, Rome, Italy.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Graziani
authors.affiliation: Department of Surgery, Federal University of Goiás, Goiânia, Brasil.
authors.forename: Enio C
authors.initials: EC
authors.lastname: Oliveira
authors.affiliation: Division of Internal Medicine and Gastroenterology, C.I. Columbus Catholic University, Rome, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Papa
authors.affiliation: Division of Gastroenterology, S. Paolo Hospital, Bari, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Penna
authors.affiliation: Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Portincasa
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Søreide
authors.affiliation: Division of Gastroenterology and Digestive Endoscopy, Padre Pio Hospital, Vasto, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Spadaccini
authors.affiliation: Division of Gastroenterology, Monserrato University Hospital, University of Cagliari, Cagliari, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Usai
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Bonovas
authors.affiliation: Laboratory of Clinical Pharmacology, University of Parma, Parma, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Scarpignato
authors.affiliation: Division of Surgery, P. Colombo Hospital, Rome, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Picchio
authors.affiliation: Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy.
authors.forename: Piera G
authors.initials: PG
authors.lastname: Lecca
authors.affiliation: Division of Gastroenterology, Belcolle Hospital, Viterbo, Italy.
authors.forename: Costantino
authors.initials: C
authors.lastname: Zampaletta
authors.affiliation: Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cassieri
authors.affiliation: Service of Gastroenterology and Digestive Endoscopy, Villa dei Pini Home Care, Civitanova, Marche, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Damiani
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway.
authors.forename: Kari F
authors.initials: KF
authors.lastname: Desserud
authors.affiliation: Division of Gastroenterology and Digestive Endoscopy, Padre Pio Hospital, Vasto, Italy.
authors.forename: Serafina
authors.initials: S
authors.lastname: Fiorella
authors.affiliation: Division of Internal Medicine and Gastroenterology, C.I. Columbus Catholic University, Rome, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Landi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Goni
authors.affiliation: Division of Gastroenterology, Monserrato University Hospital, University of Cagliari, Cagliari, Italy.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Lai
authors.affiliation: Division of Digestive Endoscopy, Sant'Agostino Estense Hospital, Baggiovara, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Pigò
authors.affiliation: Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rotondano
authors.affiliation: Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schiaccianoce
keywords: Colonoscopy; colon; diverticular disease; endoscopic classification; outcome; surgery