Sbarigia Caterina, Ritieni Camilla, Annibale Bruno, Carabotti Marilia
Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University, 00189 Rome, Italy.
J Clin Med. 2023 Sep 20;12(18):6084. doi: 10.3390/jcm12186084.
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.
与憩室病相关的节段性结肠炎（SCAD）的特征是炎症累及乙状结肠憩室间黏膜，不累及近端结肠和直肠。由于临床表现、内镜及组织学检查结果存在异质性，SCAD在临床实践中的诊断可能具有挑战性。本叙述性综述旨在报告不同研究中采用的SCAD诊断标准，突出其诊断中当前面临的挑战和主要陷阱。我们分析了14项研究，主要是前瞻性观察性研究。便血和直肠出血是导致诊断的主要主诉，其次是腹泻。86%的研究进行了准确的内镜描述，而很少采用标准化活检采样方案（乙状结肠、近端结肠和直肠），仅28.5%的研究完整采用。仅57%的研究对可能诱发结肠炎的伴随药物进行了评估。观察到乙状结肠镜检查（水肿、红斑、糜烂、溃疡、黏膜脆性）和组织学检查结果（慢性和/或急性炎症浸润）存在很大异质性。我们表明，SCAD的诊断通常基于对结肠宏观描述不够充分以及活检方案采样不足。准确的临床和内镜评估，采用适当的采样活检方案，并注意鉴别诊断，似乎对及时诊断SCAD至关重要。
