Tursi Antonio, Brandimarte Giovanni, Di Mario Francesco, Elisei Walter, Scarpignato Carmelo, Picchio Marcello
*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.
J Clin Gastroenterol. 2016 Oct;50 Suppl 1:S16-9. doi: 10.1097/MCG.0000000000000656.
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.
憩室炎和并发症评估（DICA）内镜分类法最近已针对患有憩室病和憩室疾病的患者开发出来。最近对这些患者的预测价值进行了回顾性评估。对于每位患者，记录以下参数：年龄、DICA严重程度、腹痛情况、C反应蛋白、诊断时的粪便钙卫蛋白检测（如有）、随访月数、随访期间为维持缓解所采取的治疗（如有）、憩室炎的发生/复发情况以及手术需求。共纳入1651例患者（男性793例，女性858例，平均年龄66.6±11.1岁）：939例（56.9%）分类为DICA 1，501例（30.3%）为DICA 2，211例（12.8%）为DICA 3。中位随访时间为24（9至138）个月。263例（15.9%）患者发生/复发急性憩室炎（AD），57例（21.7%）病例需要进行手术。无论是单因素分析（χ=405.029；P<0.0001）还是多因素分析（风险比=4.319；95%CI，3.639 - 5.126；P<0.0001），DICA都是与憩室炎发生/复发及手术显著相关的唯一因素。仅在DICA 2患者中，预定的治疗对预防AD发生/复发有效，风险比（95%CI）为0.598（0.391 - 0.914）（P = 0.006，对数秩检验）。基于美沙拉嗪的治疗分别将AD发生/复发风险和手术需求降低，风险比（95%CI）分别为0.2103（0.122 - 0.364）和0.459（0.258 - 0.818）。DICA分类似乎是预测结肠憩室疾病患者憩室炎发生/复发风险的有效参数。
