Prevalence and Natural History of Segmental Colitis Associated With Diverticulosis

Tursi, Antonio; Piovani, Daniele; Brandimarte, Giovanni; Mario, F. Di; Elisei, Walter; Picchio, Marcello; Allegretta, Leonardo; Annunziata, Maria Laura; Boiocchi, Mauro; Bassotti, Gabrio; Bianco, Maria Antonia; Colucci, Raffaele; Conigliaro, Rita; Dumitraşcu, Dan L.; Escalante, Ricardo; Ferrini, Luciano; Forti, Giacomo; Franceschi, Marilisa; Graziani, Maria Giovanna; Lammert, Frank; Latella, Giovanni; Maconi, Giovanni; Compare, Debora; Nardone, Gerardo; Oliveira, L.; Oliveira, Ênio Chaves de; Papagrigoriadis, Savvas; Pietrzak, Anna; Pontone, Stefano; Stundiene, Ieva; Pranzo, Giuseppe; Reichert, Matthias Christian; Rodinò, Stefano; Reguła, Jarosław; Scaccianoce, Giuseppe; Scaldaferri, Franco; Vassallo, Roberto; Zampaletta, Costantino; Zullo, Angelo; Spaziani, Erasmo; Bonovas, Stefanos; Papa, Alfredo; Danese, Silvio

doi:10.14309/ajg.0000000000002362

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…Currently, there is limited understanding of the pathogenesis, incidence, treatment, and prognosis of this disease. The frequency of SCAD reportedly ranges from 1.9% to 11% in patients with diverticulosis and varies by cohort 9,13,14 . SCAD also occurs more frequently in middle‐aged and elderly men, 13,14 with a median age at diagnosis of 52.2 years and a male prevalence of 76.9%.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic and clinicopathological features of segmental colitis associated with diverticulosis

Obata,

Uchiyama,

Murai

2024

DEN Open

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ObjectivesSegmental colitis associated with diverticulosis (SCAD) has close endoscopic and pathological similarities to ulcerative colitis (UC) and Crohn's disease. Clinical data on SCAD are limited in Japan. We examined the endoscopic and clinicopathological features of patients with SCAD.MethodsThis single‐center retrospective study included 13 patients with SCAD between 2012 and 2022. Endoscopic findings were categorized as follows: type A (swollen red patches 5–10 mm at the top of mucosal folds), mild and moderate type B (mild‐to‐moderate UC‐like findings), type C (aphthous ulcers resembling Crohn's disease), and type D (severe UC‐like findings).ResultsOverall, six, five, and two patients were diagnosed with type A, mild type B, and moderate type B disease, respectively. Among the type A cases, two spontaneously progressed to moderate type B and one escalated to type D, necessitating an emergency sigmoidectomy owing to perforation peritonitis, despite repeated antibiotic treatments. Histopathologically, diffuse neutrophil and lymphocyte infiltration with cryptitis were noted in all type A cases, whereas UC‐like alterations were observed in type B and D cases. Seven type B cases were treated with oral 5‐aminosalicylic acid and/or salazosulfapyridine. Clinical remission was achieved in three mild type B cases and one moderate type B case, while clinical relapse and remission were noted in three moderate type B cases. No anti‐inflammatory treatment was required in three type A and two mild type B cases.ConclusionsAggressive anti‐inflammatory treatment should be considered for SCAD with UC‐like findings due to the potential risk of severe ulceration, stenosis, and/or perforation.

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Section: Discussionmentioning

confidence: 99%

Endoscopic and clinicopathological features of segmental colitis associated with diverticulosis

Obata,

Uchiyama,

Murai

2024

DEN Open

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“…Although SCAD prevalence is estimated at around 2% of patients with diverticulosis [ 3 - 6 ], and although the diagnostic criteria are now well known [ 2 , 7 ], sometimes the endoscopic criteria are not applied correctly. For example, Fig.…”

Section: Discussionmentioning

confidence: 99%

“…By definition, endoscopic and histological inflammation spares the rectum and proximal colon [ 2 ]. According to the current literature, its prevalence is estimated to be around 2% of patients with diverticulosis [ 3 - 6 ]. The endoscopic appearance has been considered the main tool for supporting the diagnosis, and an endoscopic classification to grade the endoscopic lesions in SCAD patients has been developed [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic appearance is not sufficient for a diagnosis of segmental colitis associated with diverticulosis

Tursi

2024

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Background It has been recently shown that the prevalence of segmental colitis associated with diverticulosis (SCAD) is about 2% of all patients who have colonic diverticulosis. However, sometimes it can be overdiagnosed if only endoscopic criteria are applied. We have recognized endoscopic signs of SCAD (lesions of the interdiverticular mucosa with diverticular and rectal sparing) in patients with a variety of conditions other than SCAD. Method We reviewed clinical, endoscopic and histologic data from selected patients with endoscopically visualized signs of SCAD. Results Five patients with endoscopic signs of SCAD were included in this study. SCAD was excluded by the lack of specific biopsy findings, combined with laboratory exams. Final diagnoses were iatrogenic colitis due to immunotherapy (n=1), eosinophilic colitis (n=1), Salmonella typhi (n=1), undetermined inflammatory bowel disease (n=1), and Crohn’s disease (n=1). Conclusions Lesions of the interdiverticular mucosa with diverticular and rectal sparing are not specific for SCAD, but rather a predictor of disease. In consequence, histology and, if necessary, laboratory analyses are mandatory to support a correct SCAD diagnosis.

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“…SCAD was initially described in the early 1980s in a small cohort of patients as a form of colitis characterized by sigmoid diverticulosis with mucosal inflammation confined to the segment of the colon bearing the diverticula [ 5 , 6 ]. The exact prevalence of SCAD is not well determined, varying in different cohorts from 1.9 to 11% of patients with diverticulosis [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…SCAD involves patients who are typically male and over 60 years of age [ 8 , 9 , 10 , 11 ]. Clinical manifestations are heterogeneous, including haematochezia or intermittent rectal bleeding, lower abdominal pain and alterations to bowel habits, mainly diarrhoea [ 2 , 7 , 8 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Common Diagnostic Challenges and Pitfalls in Segmental Colitis Associated with Diverticulosis (SCAD)

Sbarigia,

Ritieni,

Annibale

et al. 2023

JCM

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Segmental colitis associated with diverticulosis (SCAD) is characterized by inflammation involving the sigmoid inter-diverticular mucosa, sparing the proximal colon and rectum. Due to the heterogeneity of clinical manifestations and endoscopic and histological findings, SCAD diagnosis might be challenging in clinical practice. This narrative review aimed to report the SCAD diagnostic criteria adopted in different studies, highlighting the current challenges and main pitfalls in its diagnosis. We analysed fourteen studies, mainly prospective observational studies. Haematochezia and rectal bleeding were the main complaints leading to diagnosis, followed by diarrhoea. An accurate endoscopic description was performed in 86% of studies, while a standardised biopsy sampling protocol (sigma, proximal colon and rectum) was scarcely adopted, being complete only in 28.5% of studies. The evaluation of concomitant drugs potentially inducing colitis was carried out in only 57% of studies. Great heterogeneity in sigmoid endoscopic (edema, erythema, erosions, ulcers, mucosal friability) and histological findings (chronic and/or acute inflammatory infiltrate) was observed. We showed that SCAD diagnosis is often based on not fully adequate macroscopic colonic description and scant biopsy protocol sampling. An accurate clinical and endoscopic evaluation, with an adequate sampling biopsy protocol, with attention to differential diagnosis, seemed to be crucial for a prompt SCAD diagnosis.

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Prevalence and Natural History of Segmental Colitis Associated With Diverticulosis

Cited by 5 publications

References 15 publications

Endoscopic and clinicopathological features of segmental colitis associated with diverticulosis

Endoscopic and clinicopathological features of segmental colitis associated with diverticulosis

Endoscopic appearance is not sufficient for a diagnosis of segmental colitis associated with diverticulosis

Common Diagnostic Challenges and Pitfalls in Segmental Colitis Associated with Diverticulosis (SCAD)

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