Tursi Antonio, Nenna Rosanna
Territorial Gastroenterology Service, ASL BAT, Andria (Antonio Tursi).
Department of Medical and Surgical Sciences, School of Medicine, Catholic University, Rome (Antonio Tursi).
Ann Gastroenterol. 2024 May-Jun;37(3):377-380. doi: 10.20524/aog.2024.0875. Epub 2024 Mar 6.
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.
We reviewed clinical, endoscopic and histologic data from selected patients with endoscopically visualized signs of SCAD.
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).
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.
最近研究表明，与憩室病相关的节段性结肠炎（SCAD）在所有患有结肠憩室病的患者中患病率约为2%。然而，如果仅应用内镜标准，有时可能会过度诊断。我们在患有SCAD以外的各种病症的患者中识别出了SCAD的内镜征象（憩室间黏膜病变，憩室和直肠未受累）。
我们回顾了选定的有内镜可见SCAD征象患者的临床、内镜和组织学数据。
本研究纳入了5例有SCAD内镜征象的患者。由于缺乏特定的活检结果并结合实验室检查，排除了SCAD。最终诊断为免疫治疗所致医源性结肠炎（n = 1）、嗜酸性结肠炎（n = 1）、伤寒沙门菌感染（n = 1）、未定型炎症性肠病（n = 1）和克罗恩病（n = 1）。
憩室间黏膜病变，憩室和直肠未受累并非SCAD所特有，而是疾病的一个预测指标。因此，组织学检查以及必要时的实验室分析对于支持SCAD的正确诊断必不可少。
