Predictive value of the Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification on the outcome of diverticular disease of the colon: An international study
Antonio Tursi, Giovanni Brandimarte, Francesco Di Mario, Maria L Annunziata, Mauro Bafutto, Maria A Bianco, Raffaele Colucci, Rita Conigliaro, Silvio Danese, Rudi De Bastiani, Walter Elisei, Ricardo Escalante, Roberto Faggiani, Luciano Ferrini, Giacomo Forti, Giovanni Latella, Maria G Graziani, Enio C Oliveira, Alfredo Papa, Antonio Penna, Piero Portincasa, Kjetil Søreide, Antonio Spadaccini, Paolo Usai, Stefanos Bonovas, Carmelo Scarpignato, Marcello Picchio, DICA Collaborative Group: Luigi Di Cesare, Piera G Lecca, Costantino Zampaletta, Claudio Cassieri, Alberto Damiani, Kari F Desserud, Serafina Fiorella, Rosario Landi, Elisabetta Goni, Maria A Lai, Flavia Pigò, Gianluca Rotondano, Giuseppe Schiaccianoce, Antonio Tursi, Giovanni Brandimarte, Francesco Di Mario, Maria L Annunziata, Mauro Bafutto, Maria A Bianco, Raffaele Colucci, Rita Conigliaro, Silvio Danese, Rudi De Bastiani, Walter Elisei, Ricardo Escalante, Roberto Faggiani, Luciano Ferrini, Giacomo Forti, Giovanni Latella, Maria G Graziani, Enio C Oliveira, Alfredo Papa, Antonio Penna, Piero Portincasa, Kjetil Søreide, Antonio Spadaccini, Paolo Usai, Stefanos Bonovas, Carmelo Scarpignato, Marcello Picchio, DICA Collaborative Group: Luigi Di Cesare, Piera G Lecca, Costantino Zampaletta, Claudio Cassieri, Alberto Damiani, Kari F Desserud, Serafina Fiorella, Rosario Landi, Elisabetta Goni, Maria A Lai, Flavia Pigò, Gianluca Rotondano, Giuseppe Schiaccianoce
Abstract
Background: Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification has been recently developed for patients suffering from diverticulosis and diverticular disease.
Aims: We assessed retrospectively the predictive value of DICA in patients for whom endoscopic data and clinical follow-up were available.
Methods: For each patient, we recorded: age, severity of DICA, presence of abdominal pain, C-reactive protein and faecal 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; need of surgery.
Results: We enrolled 1651 patients (793 M, 858 F, mean age 66.6 ± 11.1 years): 939 (56.9%) patients were classified as DICA 1, 501 (30.3%) patients as DICA 2 and 211 (12.8%) patients as DICA 3. The median follow-up was 24 (9-38) months. Acute diverticulitis (AD) occurred/recurred in 263 (15.9%) patients; surgery was necessary in 57 (21.7%) cases. DICA was the only factor significantly associated to the occurrence/recurrence of diverticulitis and surgery either at univariate (χ(2 )= 405.029; p < 0.0001) or multivariate analysis (hazard ratio = 4.319, 95% confidence interval (CI) 3.639-5.126; p < 0.0001). Only in DICA 2 patients was therapy 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 needs of surgery with a hazard ratio (95% CI) of 0.2103 (0.122-0.364) and 0.459 (0.258-0.818), respectively.
Conclusions: DICA classification is a valid parameter to predict the risk of diverticulitis occurrence/recurrence in patients suffering from diverticular disease of the colon.
Keywords: Colonoscopy; colon; diverticular disease; endoscopic classification; outcome; surgery.
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Source: PubMed