Therapeutic outcome of diverticular associated colitis – a retrospective single centre experience

Abstract

Background: Diverticular associated colitis (DAC) has become increasingly appreciated as a form of inflammatory disease, localized mainly in the sigmoid, and defined as chronic inflammation of the interdiverticular mucosa with sparing of rectum, right colon and diverticula themselves. Methods: A retrospective case identification from January 2005 to December 2016 was performed. Patients with a diagnosis of DAC based on clinical, endoscopic and histological findings were enrolled. We analyzed their characteristics and response to therapy, and performed a review of literature. Results: Out of 377 pathology reports, 37 cases of DAC were identified, with a median age of 73 years and followed during 1-13 years. Six patients (16.22%) were refractory to conservative treatment and required surgery. In three patients (8.11%) evolution to ulcerative colitis (UC) was observed. Patients were divided into four endoscopic patterns, with a more benign course for type A “crescentic fold disease” compared to the other subtypes. Patients with type B “mild to moderate ulcerative colitis-like” were at significantly higher risk of persistent disease activity or relapse (p < 0.01). Conclusion: DAC is a multifaceted disease and considered to be a relatively benign condition. However, a subset of patients requires surgery and/or may progress to develop UC.

Prevalence and Natural History of Segmental Colitis Associated With Diverticulosis

“…In this prospective international study, we found a prevalence of SCAD of approximately 2% among patients newly diagnosed with diverticulosis, aligning with the current data (3)(4)(5)(6)(7)(8). Our study confirms that this disease primarily affects men and causes mild symptoms.…”

“…SCAD is a chronic colitis that affects the diverticular segment with endoscopic and histological sparing of the rectum and proximal colon (2). Its prevalence is estimated to be approximately 2%-11% of patients with diverticulosis (3)(4)(5)(6)(7)(8). Although we know that patients with SCAD might develop inflammatory bowel disease and that some patients may require surgery (8,9), the evolution of the disease is still under debate.…”

“…Its prevalence is estimated to be approximately 2%-11% of patients with diverticulosis (3)(4)(5)(6)(7)(8). Although we know that patients with SCAD might develop inflammatory bowel disease and that some patients may require surgery (8,9), the evolution of the disease is still under debate. This study aimed to assess the prevalence of SCAD in a prospective international cohort study including patients newly diagnosed with diverticulosis and to describe its natural history during a 3-year follow-up.…”

When to Perform a Colonoscopy in Diverticular Disease and Why: A Personalized Approach

“…Segmental colitis associated with diverticulosis (SCAD) is a chronic inflammatory process in the colon harboring diverticula. Generally located in the sigmoid colon, this disease is relatively rare, with a prevalence of 0.25–1.4% in the general population and 1.15–11.4% amongst patients having diverticulosis [ 15 , 16 , 17 ]. It mainly affects older males (the mean age at diagnosis is 60 years), and rectal bleeding is the main symptom [ 18 ].…”

“…It mainly affects older males (the mean age at diagnosis is 60 years), and rectal bleeding is the main symptom [ 18 ]. The pathogenesis is unknown but likely multifactorial, including genetic susceptibility, microbiome imbalance, local ischemia, mucosal prolapse, and more [ 17 , 18 ]. The endoscopic features of SCAD can be subdivided into four subtypes, which also reflect different histological characteristics [ 16 , 19 ]: type A (or “crescentic fold disease”) is characterized by red patches involving colonic folds and diverticular sparing, with neutrophil and lymphocyte infiltrates limited to crypt epithelium; type B (or “mild-to-moderate ulcerative colitis-like”) shows endoscopic and histological features resembling mild to moderate ulcerative colitis (UC), with erosions and hyperemic areas involving the colonic folds and the interdiverticular mucosa ( Figure 1 ), as well as crypt distortion, cryptitis, and crypt abscesses; type C (or “mild to moderate Crohn’s disease-like”) is characterized by Crohn’s disease (CD)-like changes, with isolated aphthous ulcers and transmural inflammatory changes; type D (or “moderate to severe ulcerative colitis-like”) shows the same endoscopic and histological features as type B, but is more severe.…”