Prognostic Role of the Endoscopic Classification "DICA".
Diverticular inflammation and complication assessment (DICA) endoscopic classification has been recently developed for patients suffering from diverticulosis and diverticular disease. Its predictive value in those patients was recently retrospectively assessed. For each patient, the following parameters were recorded: age, severity of DICA, presence of abdominal pain, C-reactive protein, fecal 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, and need of surgery. A total of 1651 patients (793 male, 858 female, mean age 66.6±11.1 y) were enrolled: 939 (56.9%) classified as DICA 1, 501 (30.3%) as DICA 2, and 211 (12.8%) as DICA 3. The median follow-up was 24 (9 to 138) months. Acute diverticulitis (AD) occurred/recurred in 263 (15.9%) patients, and surgery was necessary in 57 (21.7%) cases. DICA was the only factor significantly associated with the occurrence/recurrence of diverticulitis and surgery either at univariate (χ=405.029; P<0.0001) or multivariate analysis (hazard ratio=4.319; 95% CI, 3.639-5.126; P<0.0001). Only in DICA 2 patients scheduled therapy was 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 need of surgery with a hazard ratio (95% CI) of 0.2103 (0.122-0.364) and 0.459 (0.258-0.818), respectively. DICA classification seems to be a valid parameter to predict the risk of diverticulitis occurrence/recurrence in patients suffering from diverticular disease of the colon.
*Gastroenterology Service, ASL BAT, Andria (BT) †Division of Internal Medicine and Gastroenterology, "Cristo Re" Hospital, GIOMI Group §Division of Gastroenterology, ASL RMH, Albano Laziale ¶Division of Surgery, "P. Colombo" Hospital, ASL RMH, Velletri, Rome ‡Department of Clinical & Experimental Medicine, Gastroenterology Unit ∥Department of Clinical & Experimental Medicine, Clinical Pharmacology & Digestive Pathophysiology Unit, University of Parma, Italy.
Antonio
A
Tursi
Giovanni
G
Brandimarte
Francesco
F
Di Mario
Walter
W
Elisei
Carmelo
C
Scarpignato
Marcello
M
Picchio
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D043963:Diverticulosis, Colonic / Q000145:classification* / Q000150:complications / Q000188:drug therapy; D004240:Diverticulum / Q000145:classification* / Q000150:complications / Q000188:drug therapy; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D039841:Leukocyte L1 Antigen Complex; D019804:Mesalamine; D002097:C-Reactive Protein