Tursi Antonio, Piovani Daniele, Brandimarte Giovanni, Di Mario Francesco, Elisei Walter, Picchio Marcello, Figlioli Gisella, Bassotti Gabrio, Allegretta Leonardo, Annunziata Maria Laura, Bafutto Mauro, Bianco Maria Antonia, Colucci Raffaele, Conigliaro Rita, Dumitrascu Dan L, Escalante Ricardo, Ferrini Luciano, Forti Giacomo, Franceschi Marilisa, Graziani Maria Giovanna, Lammert Frank, Latella Giovanni, Lisi Daniele, Maconi Giovanni, Compare Debora, Nardone Gerardo, Camara de Castro Oliveira Lucia, Enio Chaves Oliveira, Papagrigoriadis Savvas, Pietrzak Anna, Pontone Stefano, Stundiene Ieva, Poškus Tomas, Pranzo Giuseppe, Reichert Matthias Christian, Rodino Stefano, Regula Jaroslaw, Scaccianoce Giuseppe, Scaldaferri Franco, Vassallo Roberto, Zampaletta Costantino, Zullo Angelo, Spaziani Erasmo, Bonovas Stefanos, Papa Alfredo, Danese Silvio
Territorial Gastroenterology Service, ASL BAT, Andria, Italy.
Department of Medical and Surgical Sciences, School of Medicine, Catholic University, Rome, Italy.
Intest Res. 2025 Jan;23(1):96-106. doi: 10.5217/ir.2024.00046. Epub 2024 Aug 12.
BACKGROUND/AIMS: Patients with diverticular disease (DD) frequently have abnormal bowel movements. However, it is unknown whether the entity of these alterations is associated with the severity of DD. We aimed to assess bowel habits and their relationship with the severity of DD according to Diverticular Inflammation and Complication Assessment (DICA) classification, Combined Overview on Diverticular Assessment (CODA) score, and fecal calprotectin (FC).
An international, multicenter, prospective cohort study was conducted in 43 centers. A 10-point visual analog scale (VAS) was used to assess the severity of constipation and diarrhea. The association of constipation and diarrhea with DICA classification, CODA score, and basal FC was tested using non-parametric tests. Survival methods for censored observations were applied to test the association of constipation and diarrhea with the incidence of acute diverticulitis over a 3-year follow-up.
Of 871 patients with DD were included in the study. Of these, 208 (23.9%) and 199 (22.9%) reported a VAS score for constipation and diarrhea at least 3 at baseline, respectively. Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P< 0.001). Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.04-1.27; P=0.004; and HRdiarrhea =1.14; 95% CI, 1.03-1.26; P=0.014, respectively).
In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.
背景/目的：憩室病（DD）患者常出现肠道运动异常。然而，这些改变的具体情况是否与DD的严重程度相关尚不清楚。我们旨在根据憩室炎和并发症评估（DICA）分类、憩室评估综合概述（CODA）评分以及粪便钙卫蛋白（FC）来评估排便习惯及其与DD严重程度的关系。
在43个中心进行了一项国际多中心前瞻性队列研究。采用10分视觉模拟量表（VAS）评估便秘和腹泻的严重程度。使用非参数检验来检验便秘和腹泻与DICA分类、CODA评分及基础FC之间的关联。对于删失观察值采用生存方法来检验便秘和腹泻与3年随访期间急性憩室炎发病率之间的关联。
本研究纳入了871例DD患者。其中，分别有208例（23.9%）和199例（22.9%）在基线时报告便秘和腹泻的VAS评分至少为3分。便秘和腹泻评分越高，与DICA分类、CODA评分及基础FC的增加相关（P<0.001）。便秘和腹泻评分与发生急性憩室炎的风险增加独立相关（便秘的风险比[HR]每增加1个VAS点为1.15，95%置信区间[CI]为1.04 - 1.27；P = 0.004；腹泻的HR = 1.14；95% CI为1.03 - 1.26；P = 0.014）。
在新诊断的DD患者中，较高的DD严重程度内镜和综合评分与基线时较高的便秘和腹泻评分相关。便秘和腹泻都是急性憩室炎的独立预后因素。
