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 Laura Annunziata, Mauro Bafutto, Maria Antonia Bianco, Raffaele Colucci, Rita Conigliaro, Silvio Danese, Rudi De Bastiani, Walter Elisei, Ricardo Escalante, Roberto Faggiani, Luciano Ferrini, Giacomo Forti, Giovanni Latella, Maria Giovanna Graziani, Enio C. Oliveira, Alfredo Papa, Antonio PennaPiero Portincasa, Kjetil Søreide, Antonio Spadaccini, Paolo Usai, Stefanos Bonovas, Carmelo Scarpignato, Marcello Picchio, 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, DICA Collaborative Group: Luigi Di Cesare

Research output: Contribution to journalArticle

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 (χ2= 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.

Original languageEnglish
Pages (from-to)604-613
Number of pages10
JournalUnited European Gastroenterology Journal
Volume4
Issue number4
DOIs
Publication statusPublished - Aug 1 2016

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Keywords

  • colon
  • Colonoscopy
  • diverticular disease
  • endoscopic classification
  • outcome
  • surgery

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Tursi, A., Brandimarte, G., Mario, F. D., Annunziata, M. L., Bafutto, M., Bianco, M. A., Colucci, R., Conigliaro, R., Danese, S., De Bastiani, R., Elisei, W., Escalante, R., Faggiani, R., Ferrini, L., Forti, G., Latella, G., Graziani, M. G., Oliveira, E. C., Papa, A., ... DICA Collaborative Group: Luigi Di Cesare (2016). Predictive value of the Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification on the outcome of diverticular disease of the colon: An international study. United European Gastroenterology Journal, 4(4), 604-613. https://doi.org/10.1177/2050640615617636