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Tursi A, Piovani D, Brandimarte G, Di Mario F, Elisei W, Picchio M, Allegretta L, Annunziata ML, Bafutto M, Bassotti G, Bianco MA, Colucci R, Conigliaro R, Dumitrascu DL, Escalante R, Ferrini L, Forti G, Franceschi M, Graziani MG, Lammert F, Latella G, Maconi G, Compare D, Nardone G, Camara De Castro Oliveira L, Chaves Oliveira E, Papagrigoriadis S, Pietrzak A, Pontone S, Stundiene I, Pranzo G, Reichert MC, Rodinò S, Regula J, Scaccianoce G, Scaldaferri F, Vassallo R, Zampaletta C, Zullo A, Spaziani E, Bonovas S, Papa A, Danese S. Prevalence and Natural History of Segmental Colitis Associated With Diverticulosis. Am J Gastroenterol 2023; 118:2088-2092. [PMID: 37314163 DOI: 10.14309/ajg.0000000000002362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/27/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION We assessed the prevalence and clinical outcomes of segmental colitis associated with diverticulosis (SCAD) in patients with newly diagnosed diverticulosis. METHODS A 3-year international, multicenter, prospective cohort study was conducted involving 2,215 patients. RESULTS SCAD diagnosis was posed in 44 patients (30 male patients; median age: 64.5 years; prevalence of 1.99%, 95% confidence interval, 1.45%-2.66%). Patients with SCAD types D and B showed worse symptoms, higher fecal calprotectin values, needed more steroids, and reached less likely complete remission. DISCUSSION Although SCAD generally had a benign outcome, types B and D were associated with more severe symptoms and worse clinical course.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria, Barletta-Andria-Trani, Italy
- Department of Medical and Surgical Sciences, School of Medicine, Catholic University, Rome, Italy
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Brandimarte
- Division of Internal Medicine and Gastroenterology, "Cristo Re" Hospital, Rome, Italy
| | - Francesco Di Mario
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Parma, Parma, Italy
| | - Walter Elisei
- Division of Gastroenterology, "S. Camillo" Hospital, Rome, Italy
| | - Marcello Picchio
- Division of Surgery, "P. Colombo" Hospital, ASL RM6, Velletri, Rome, Italy
| | - Leonardo Allegretta
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina, Lecce, Italy
| | - Maria Laura Annunziata
- Division of Gastroenterology, "San Donato" Hospital, San Donato Milanese, Michigan, Italy
| | - Mauro Bafutto
- Institute of Gastroenterology and Digestive Endoscopy, Goiânia, Goiás, Brazil
| | - Gabrio Bassotti
- Department of Medicine and Surgery, Gastroenterology and Hepatology Unit, "Santa Maria Della Misericordia" University Hospital, University of Perugia, Perugia, Italy
| | - Maria Antonia Bianco
- Division of Gastroenterology, "T. Maresca" Hospital, Torre Del Greco, Naples, Italy
| | - Raffaele Colucci
- Digestive Endoscopy Unit, "San Matteo Degli Infermi" Hospital, Spoleto, Perugia, Italy
| | - Rita Conigliaro
- Digestive Endoscopy Unit, "Sant'Agostino Estense" Hospital, Baggiovara, Missouri, Italy
| | - Dan L Dumitrascu
- 2nd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ricardo Escalante
- Central University of Venezuela, Loira Medical Center, Caracas, Venezuela
| | - Luciano Ferrini
- Service of Digestive Endoscopy, "Villa Dei Pini" Home Care, Civitanova Marche, Macerata, Italy
| | - Giacomo Forti
- Digestive Endoscopy Unit, "Santa Maria Goretti" Hospital, Latina, Italy
| | - Marilisa Franceschi
- Digestive Endoscopy Unit, ULSS7 Alto Vicentino, Santorso, Virgin Islands, Italy
| | - Maria Giovanna Graziani
- Division of Gastroenterology and Digestive Endoscopy "S. Giovanni-Addolorata" Hospital, Rome, Italy
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
- Health Sciences, Hannover Medical School (MHH), Hannover, Germany
| | - Giovanni Latella
- Division of Gastroenterology, Hepatology and Nutrition, San Salvatore Hospital, Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giovanni Maconi
- Division of Gastroenterology, "L. Sacco" University Hospital, Milan, Italy
| | - Debora Compare
- Department of Clinical Medicine and Surgery, Division of Gastroenterology and Hepatology, Federico II" University Hospital, Naples, Italy
| | - Gerardo Nardone
- Department of Anorectal Physiology, "São José" Home Care, Rio de Janeiro, Brazil
| | | | - Enio Chaves Oliveira
- Department of Colorectal Surgery, King's College Hospital, London, United Kingdom
| | - Savvas Papagrigoriadis
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Pietrzak
- 1st Division of General Surgery, "Umberto I" University Hospital, "Sapienza" University, Rome, Italy
| | - Stefano Pontone
- Institute of Clinical Medicine, Vilnius University Hospital, Vilnius, Lithuania
| | - Ieva Stundiene
- Digestive Endoscopy Unit, "Valle D'Itria" Hospital, Martina Franca, Taranto, Italy
| | - Giuseppe Pranzo
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | | | - Stefano Rodinò
- 1st Division of General Surgery, "Umberto I" University Hospital, "Sapienza" University, Rome, Italy
| | - Jaroslaw Regula
- Institute of Clinical Medicine, Vilnius University Hospital, Vilnius, Lithuania
| | | | - Franco Scaldaferri
- Division of Internal Medicine and Gastroenterology, IRCCS "A. Gemelli" Hospital, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
| | - Roberto Vassallo
- Division of Gastroenterology and Digestive Endoscopy, "Bucchieri-La Ferla" Hospital, Palermo, Italy
| | | | - Angelo Zullo
- Division of Gastroenterology, "Nuovo Regina Margherita" Territorial Hospital, Rome, Italy
| | - Erasmo Spaziani
- Division of Gastroenterology, "Nuovo Regina Margherita" Territorial Hospital, Rome, Italy
- Department of Surgery, "Sapienza" University of Rome-Polo Pontino, Terracina, Latina, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alfredo Papa
- Division of Internal Medicine and Gastroenterology, IRCCS "A. Gemelli" Hospital, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale "San Raffaele" and University "Vita-Salute San Raffaele," Milan, Italy
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Sbarigia C, Ritieni C, Annibale B, Carabotti M. Common Diagnostic Challenges and Pitfalls in Segmental Colitis Associated with Diverticulosis (SCAD). J Clin Med 2023; 12:6084. [PMID: 37763023 PMCID: PMC10532061 DOI: 10.3390/jcm12186084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Marilia Carabotti
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University, 00189 Rome, Italy; (C.S.); (C.R.); (B.A.)
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Sabo CM, Ismaiel M, Ismaiel A, Leucuta DC, Popa SL, Grad S, Dumitrascu DL. Do Colonic Mucosal Tumor Necrosis Factor Alpha Levels Play a Role in Diverticular Disease? A Systematic Review and Meta-Analysis. Int J Mol Sci 2023; 24:9934. [PMID: 37373082 PMCID: PMC10298590 DOI: 10.3390/ijms24129934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Diverticular disease (DD) is the most frequent condition in the Western world that affects the colon. Although chronic mild inflammatory processes have recently been proposed as a central factor in DD, limited information is currently available regarding the role of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α). Therefore, we conducted a systematic review and meta-analysis aiming to assess the mucosal TNF-α levels in DD. We conducted a systematic literature search using PubMed, Embase, and Scopus to identify observational studies assessing the TNF-α levels in DD. Full-text articles that satisfied our inclusion and exclusion criteria were included, and a quality assessment was performed using the Newcastle-Ottawa Scale (NOS). The principal summary outcome was the mean difference (MD). The results were reported as MD (95% confidence interval (CI)). A total of 12 articles involving 883 subjects were included in the qualitative synthesis, out of which 6 studies were included in our quantitative synthesis. We did not observe statistical significance related to the mucosal TNF-α levels in symptomatic uncomplicated diverticular disease (SUDD) vs. the controls (0.517 (95% CI -1.148-2.182)), and symptomatic vs. asymptomatic DD patients (0.657 (95% CI -0.883-2.196)). However, the TNF-α levels were found to be significantly increased in DD compared to irritable bowel disease (IBS) patients (27.368 (95% CI 23.744-30.992)), and segmental colitis associated with diverticulosis (SCAD) vs. IBS patients (25.303 (95% CI 19.823-30.784)). Between SUDD and the controls, as well as symptomatic and asymptomatic DD, there were no significant differences in the mucosal TNF-α levels. However, the TNF-α levels were considerably higher in DD and SCAD patients than IBS patients. Our findings suggest that TNF-α may play a key role in the pathogenesis of DD in specific subgroups and could potentially be a target for future therapies.
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Affiliation(s)
- Cristina Maria Sabo
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (C.M.S.); (S.-L.P.); (S.G.); (D.L.D.)
| | - Mohamed Ismaiel
- Department of General Surgery, Altnagelvin Hospital, Londonderry BT47 6LS, UK;
| | - Abdulrahman Ismaiel
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (C.M.S.); (S.-L.P.); (S.G.); (D.L.D.)
| | - Daniel-Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Stefan-Lucian Popa
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (C.M.S.); (S.-L.P.); (S.G.); (D.L.D.)
| | - Simona Grad
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (C.M.S.); (S.-L.P.); (S.G.); (D.L.D.)
| | - Dan L. Dumitrascu
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (C.M.S.); (S.-L.P.); (S.G.); (D.L.D.)
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Abstract
PURPOSE OF REVIEW A distinctive, possibly "novel" form of a segmental inflammatory colonic disease process associated with diverticular disease (so-called SCAD or segmental-colitis-associated-diverticulosis) is reviewed. RECENT FINDINGS Although this phenotype of inflammatory colonic disease was initially recognized decades ago, mainly in the elderly, recent evidence from long term natural history studies along with meta-analyses confirms that its clinical course is usually benign and drug-responsive. Interestingly, its appearance in some treated with monoclonal agents (eg., ipilimumab associated colitis) or infected with coronavirus-19 may have critical implications for its pathogenesis. This review further explores the implications of recognition of this pattern of colonic inflammatory disease, with relevance for physicians involved in both clinical practice and clinical trials of newer therapeutic agents.
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Affiliation(s)
- Hugh J Freeman
- Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC, Canada.
- Gastroenterology, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, V6T 1W5, Canada.
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Danese S, Lahat A. Segmental Colitis Associated with Diverticulosis. COLONIC DIVERTICULAR DISEASE 2022:119-126. [DOI: 10.1007/978-3-030-93761-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Layer P, Andresen V, Allescher H, Bischoff SC, Claßen M, Elsenbruch S, Freitag M, Frieling T, Gebhard M, Goebel-Stengel M, Häuser W, Holtmann G, Keller J, Kreis ME, Kruis W, Langhorst J, Jansen PL, Madisch A, Mönnikes H, Müller-Lissner S, Niesler B, Pehl C, Pohl D, Raithel M, Röhrig-Herzog G, Schemann M, Schmiedel S, Schwille-Kiuntke J, Storr M, Preiß JC, Andus T, Buderus S, Ehlert U, Engel M, Enninger A, Fischbach W, Gillessen A, Gschossmann J, Gundling F, Haag S, Helwig U, Hollerbach S, Karaus M, Katschinski M, Krammer H, Kuhlbusch-Zicklam R, Matthes H, Menge D, Miehlke S, Posovszky MC, Schaefert R, Schmidt-Choudhury A, Schwandner O, Schweinlin A, Seidl H, Stengel A, Tesarz J, van der Voort I, Voderholzer W, von Boyen G, von Schönfeld J, Wedel T. Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) – Juni 2021 – AWMF-Registriernummer: 021/016. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:1323-1415. [PMID: 34891206 DOI: 10.1055/a-1591-4794] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- P Layer
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - V Andresen
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - H Allescher
- Zentrum für Innere Medizin, Gastroent., Hepatologie u. Stoffwechsel, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
| | - S C Bischoff
- Institut für Ernährungsmedizin, Universität Hohenheim, Stuttgart, Deutschland
| | - M Claßen
- Klinik für Kinder- und Jugendmedizin, Klinikum Links der Weser, Bremen, Deutschland
| | - S Elsenbruch
- Klinik für Neurologie, Translational Pain Research Unit, Universitätsklinikum Essen, Essen, Deutschland.,Abteilung für Medizinische Psychologie und Medizinische Soziologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - M Freitag
- Abteilung Allgemeinmedizin Department für Versorgungsforschung, Universität Oldenburg, Oldenburg, Deutschland
| | - T Frieling
- Medizinische Klinik II, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - M Gebhard
- Gemeinschaftspraxis Pathologie-Hamburg, Hamburg, Deutschland
| | - M Goebel-Stengel
- Innere Medizin II, Helios Klinik Rottweil, Rottweil, und Innere Medizin VI, Psychosomat. Medizin u. Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - W Häuser
- Innere Medizin I mit Schwerpunkt Gastroenterologie, Klinikum Saarbrücken, Saarbrücken, Deutschland
| | - G Holtmann
- Faculty of Medicine & Faculty of Health & Behavioural Sciences, Princess Alexandra Hospital, Brisbane, Australien
| | - J Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - M E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | | | - J Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Deutschland
| | - P Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin, Deutschland
| | - A Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover, Hannover, Deutschland
| | - H Mönnikes
- Klinik für Innere Medizin, Martin-Luther-Krankenhaus, Berlin, Deutschland
| | | | - B Niesler
- Abteilung Molekulare Humangenetik Institut für Humangenetik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Pehl
- Medizinische Klinik, Krankenhaus Vilsbiburg, Vilsbiburg, Deutschland
| | - D Pohl
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - M Raithel
- Medizinische Klinik II m.S. Gastroenterologie und Onkologie, Waldkrankenhaus St. Marien, Erlangen, Deutschland
| | | | - M Schemann
- Lehrstuhl für Humanbiologie, TU München, Deutschland
| | - S Schmiedel
- I. Medizinische Klinik und Poliklinik Gastroenterologie, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - J Schwille-Kiuntke
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen, Tübingen, Deutschland.,Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M Storr
- Zentrum für Endoskopie, Gesundheitszentrum Starnberger See, Starnberg, Deutschland
| | - J C Preiß
- Klinik für Innere Medizin - Gastroenterologie, Diabetologie und Hepatologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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Zullo A, Gatta L, Vassallo R, Francesco VD, Manta R, Monica F, Fiorini G, Vaira D. Paradigm shift: the Copernican revolution in diverticular disease. Ann Gastroenterol 2019; 32:541-553. [PMID: 31700230 PMCID: PMC6826076 DOI: 10.20524/aog.2019.0410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022] Open
Abstract
Diverticular disease (DD) is an umbrella definition that includes different clinical conditions ranging from diverticulosis to severe and potentially life-threatening complications. In the last decade, new concepts regarding pathogenetic alterations have been developed, while the diagnostic, clinical and therapeutic approaches to the management of DD patients have changed. The protective role of dietary factors (i.e., fiber) has been questioned, whilst some drugs widely used in clinical practice have been found to have a deleterious effect. The use of antibiotics in all patients with acute uncomplicated diverticulitis was reconsidered, as well as the need for a surgical approach in these patients. Conflicting recommendations in different guidelines were proposed for the treatment of symptomatic uncomplicated DD. An endoscopic classification of DD was introduced, and a "curative" endoscopic approach has been pioneered. Based on these observations, which together amount to a kind of "Copernican revolution" in the management of DD patients, we performed a comprehensive and critical reappraisal of the proposed modifications, aiming to discriminate between certainties and doubts on this issue.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome (Angelo Zullo)
| | - Luigi Gatta
- Gastroenterology and Endoscopy Unit, Versilia Hospital, Lido di Camaiore (Luigi Gatta)
| | - Roberto Vassallo
- Gastroenterology and Digestive Endoscopy; “Buccheri la Ferla, Fatebenefratelli”, Hospital, Palermo (Roberto Vassallo)
| | - Vincenzo De Francesco
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia (Vincenzo De Francesco)
| | - Raffaele Manta
- Gastroenterology and Digestive Endoscopy, “Generale” Hospital, Perugia (Raffaele Manta)
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, Academic Hospital Cattinara, Trieste (Fabio Monica)
| | - Giulia Fiorini
- Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna (Giulia Fiorini, Dino Vaira), Italy
| | - Dino Vaira
- Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna (Giulia Fiorini, Dino Vaira), Italy
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Kucejko RJ, Poggio JL. Considerations and Changes in the Evaluation, Management, and Outcomes in the Management of Diverticular Disease: The Diagnosis, Pathology, and Treatment of Diverticular Colitis. Clin Colon Rectal Surg 2018; 31:221-225. [PMID: 29942211 DOI: 10.1055/s-0037-1607467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Diverticular colitis, also known as segmental colitis associated with diverticulosis, is a colonic inflammatory disorder on the spectrum of inflammatory bowel disease (IBD). The disease consists of macroscopic and microscopic inflammation affecting inter-diverticular mucosa, sparing peri-diverticular mucosa, with inflammation confined to the descending and sigmoid colon. The disease likely arises from the altered immune response of an individual, genetically susceptible to the IBD spectrum of diseases. Patients with segmental colitis associated with diverticulosis (SCAD) are typically older, and likely represent a subgroup of IBD-susceptible patients who lacked an environmental trigger until that point in their life. Most patients remain in remission with initial treatments of mesalamine or topical steroids, and maintenance mesalamine afterwards. Only the most severe form of the disease necessitates immunomodulatory therapy and the consideration of surgery.
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Affiliation(s)
- Robert J Kucejko
- Department of Surgery, Division of Colon and Rectal Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Juan L Poggio
- Department of Surgery, Division of Colon and Rectal Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Effects of sevoflurane on NF-кB and TNF-α expression in renal ischemia–reperfusion diabetic rats. Inflamm Res 2017; 66:901-910. [DOI: 10.1007/s00011-017-1071-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 06/06/2017] [Accepted: 06/17/2017] [Indexed: 10/19/2022] Open
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Schembri J, Bonello J, Christodoulou DK, Katsanos KH, Ellul P. Segmental colitis associated with diverticulosis: is it the coexistence of colonic diverticulosis and inflammatory bowel disease? Ann Gastroenterol 2017; 30:257-261. [PMID: 28469355 PMCID: PMC5411375 DOI: 10.20524/aog.2017.0126] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 12/13/2016] [Indexed: 01/14/2023] Open
Abstract
Segmental colitis associated with diverticulosis (SCAD) is an inflammatory process that affects colonic luminal mucosa in segments that are also affected by diverticulosis. Its prevalence varies between 1.15% and 11.4% amongst those suffering from diverticular disease (DD). Being closely associated with DD, it is slightly commoner in males and usually presents in the sixth decade of life. Although the exact pathogenesis of SCAD is unknown, it is probably heterogeneous and includes mechanisms that also play a part in inflammatory bowel disease (IBD). The clinical presentation is non-specific and similar to that of other pathologies involving the sigmoid colon, and its diagnosis is based on endoscopic findings in correlation with histology. Currently, there are no guidelines for its management, which is usually based on the administration of salicylates and antibiotics, with surgery being reserved for refractory cases. The rarity of SCAD may be multifactorial: whereas milder forms go undiagnosed or are attributed to DD, more severe forms can be misdiagnosed as IBD. This latter distinction is an important one to make, since SCAD and IBD differ as regards their natural history and prognosis, while very often no long-term medications are required in SCAD.
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Affiliation(s)
- John Schembri
- Department of Internal Medicine, Division of Gastroenterology, Mater Dei Hospital, Malta (John Schembri, John Bonello, Pierre Ellul)
| | - John Bonello
- Department of Internal Medicine, Division of Gastroenterology, Mater Dei Hospital, Malta (John Schembri, John Bonello, Pierre Ellul)
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina Greece (Dimitrios K. Christodoulou, Konstantinos H. Katsanos)
| | - Konstantinos H Katsanos
- Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina Greece (Dimitrios K. Christodoulou, Konstantinos H. Katsanos)
| | - Pierre Ellul
- Department of Internal Medicine, Division of Gastroenterology, Mater Dei Hospital, Malta (John Schembri, John Bonello, Pierre Ellul)
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11
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How to Differentiate Segmental Colitis Associated With Diverticulosis and Inflammatory Bowel Diseases. J Clin Gastroenterol 2016; 50 Suppl 1:S36-8. [PMID: 27622359 DOI: 10.1097/mcg.0000000000000630] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The segmental colitis associated with diverticulosis," better known by its acronym "SCAD," is a chronic inflammatory process localized in the colonic area presenting diverticulosis, and therefore mainly in the sigmoid colon. By definition, both the rectum and the right colon are spared from any inflammation both endoscopically and from a histologic point of view. Recent data have hypothesized that SCAD may be an independent clinical entity within the inflammatory bowel disease set of diseases. Compared with inflammatory bowel disease, SCAD seems to have a more benign outcome, with low rate of complications.
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Freeman HJ. Segmental colitis associated diverticulosis syndrome. World J Gastroenterol 2016; 22:8067-8069. [PMID: 27688648 PMCID: PMC5037075 DOI: 10.3748/wjg.v22.i36.8067] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/21/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
Segmental colitis associated diverticulosis (SCAD) has become increasingly appreciated as a form of inflammatory disease of the colon. Several features suggest that SCAD is a distinct disorder. SCAD tends to develop almost exclusively in older adults, predominately, but not exclusively, males. The inflammatory process occurs mainly in the sigmoid colon, and usually remains localized to this region of the colon alone. SCAD most often presents with rectal bleeding and subsequent endoscopic visualization reveals a well localized process with non-specific histopathologic inflammatory changes. Granulomas are not seen, and if present, may be helpful in definition of other disorders such as Crohn’s disease of the colon, an entity often confused with SCAD. Bacteriologic and parasitic studies for an infectious agent are negative. Normal rectal mucosa (i.e., “rectal sparing”) is present and can be confirmed with normal rectal biopsies. SCAD often resolves spontaneously without treatment, or completely after a limited course of therapy with only a 5-aminosalicylate. Recurrent episodes may occur, but most often, patients with this disorder have an entirely self-limited clinical course. Occasionally, treatment with other agents, including corticosteroids, or surgical resection has been required.
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Torii Y, Katano Y, Yoshino J, Inui K, Wakabayasi T, Kobayashi T, Kosaka T. A case of diverticular colitis with lesions resembling ulcerative colitis and correlation of tumor necrosis factor-alpha staining with clinical manifestations. Clin J Gastroenterol 2015; 8:377-84. [PMID: 26464173 DOI: 10.1007/s12328-015-0608-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/19/2015] [Indexed: 11/26/2022]
Abstract
A 45-year-old male with a 3-month history of abdominal pain and melena underwent colonoscopy (CS) at our hospital in May 2009. He was diagnosed with diverticular colitis based on findings of redness around diverticula in the sigmoid colon and biopsy findings of non-specific inflammation. The second CS, which was performed in July 2009 to investigate relapse, showed diffuse redness around diverticula in the sigmoid colon. As seen in active ulcerative colitis (UC), the formation of crypt abscesses was observed in the biopsy. Although the patient was making satisfactory progress after administration of oral mesalazine, CS was performed again in September 2011 because of recurrence of melena, which revealed redness and erosion around diverticula in the ascending and sigmoid colon. Biopsy findings were similar to those of active UC. Immunohistochemical staining of the biopsy specimen with anti-tumor necrosis factor (TNF)-a antibody showed 80 % of lymphocytes were positive for TNF-a compared with 20 % at the first biopsy. The patient’s symptoms subsided with an increase in the dose of mesalazine and concurrent administration of prednisolone at 10 mg. He has remained on oral mesalazine and is currently asymptomatic. The findings of this study suggested a correlation between clinical manifestations and the proportion of TNF-a-positive lymphocytes.
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14
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Tursi A, Elisei W, Brandimarte G, Giorgetti GM, Inchingolo CD, Nenna R, Picchio M, Giorgio F, Ierardi E. Musosal tumour necrosis factor α in diverticular disease of the colon is overexpressed with disease severity. Colorectal Dis 2012; 14:e258-e263. [PMID: 22469482 DOI: 10.1111/j.1463-1318.2012.02926.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Inflammation occurs in diverticular disease (DD), but there is little information on inflammatory cytokines such as tumour necrosis factor α (TNF-α). The aim of this study was to assess TNF-α expression in DD and to see whether it is related to the severity of the disease. METHOD Twenty-four patients with symptomatic DD were divided into those with acute uncomplicated diverticulitis (AUD) (12 patients) and those with symptomatic uncomplicated diverticular disease (SUDD) (12 patients). Twelve further patients with asymptomatic diverticulosis (AD), six with segmental colitis associated with diverticulosis (SCAD), with ulcerative colitis (UC) and six healthy individuals (HC) were enrolled as controls. TNF-α expression in the colonic mucosa was assessed by the amount of mRNA codifying for the synthesis of TNF-α. RESULTS TNF-α expression was significantly higher in AUD than in HC (P=0.0007), in AD (P=0.0001) and in SUDD (P=0.0179). It was significantly higher also in SUDD than in HC (P=0.0007) and in AD (P=0.0001). TNF-α expression in AUD did not differ significantly from that in UC (P=0.0678) and SCAD (P=0.0610). It was significantly higher in UC, SCAD and AUD than in SUDD (P=0.0007, P=0.0001, P=0.0179). CONCLUSION TNF-α expression in DD seems to be related to the severity of the disease. In particular, it appears to be overexpressed in DD with inflammation (AUD and SUDD) compared with DD without (AD).
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Affiliation(s)
- A Tursi
- Servizio di Gastroenterologia Territoriale, ASL BAT, Andria BT, Italy.
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15
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Ierardi E, Giorgio F, Zotti M, Rosania R, Principi M, Marangi S, Della Valle N, De Francesco V, Di Leo A, Ingrosso M, Panella C. Infliximab therapy downregulation of basic fibroblast growth factor/syndecan 1 link: a possible molecular pathway of mucosal healing in ulcerative colitis. J Clin Pathol 2011; 64:968-972. [PMID: 21945924 DOI: 10.1136/jcp.2010.086892] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND It is known that syndecan 1 in inflammatory bowel diseases is able to migrate from epithelial basolateral site to the stromal area and apical surface of epithelium with a consequent activation and modulation of basic fibroblast growth factor (bFGF), and this process sustains mucosal healing of ulcers. On the other hand, tumour necrosis factor (TNF) α mucosal levels are directly related to the entity of the damage in these disorders. Aim of the study A 'post-hoc' retrospective study was performed to estimate mucosal TNF α in rectal biopsies of subjects with ulcerative colitis (UC) before and after effective infliximab therapy and its relationship with syndecan 1, bFGF and endoscopic mucosal healing. MATERIAL AND METHODS Paraffin-embedded rectal samples from 12 patients with UC responders to infliximab were analysed for TNF α, syndecan 1 and bFGF before and 6 months after therapy using a real-time reverse transcriptase polymersase chain reaction. Additionally, syndecan 1 location was evaluated by immunohistochemistry. Samples from 12 subjects with irritable bowel symptoms without endoscopic/histological abnormalities represented the control group. Mucosal healing induced by the treatment was defined by an endoscopic Mayo subscore changing from 2-3 to 0. ANOVA plus Student-Newman-Keuls was used for statistical analysis. RESULTS The authors found that in the active disease, an increase in TNF α (p<0.001) is accompanied by raised levels of both syndecan 1 (p<0.005) and bFGF (p<0.005) compared with the control group. Infliximab-induced TNF α decrease to levels similar to controls is associated with both endoscopic mucosal healing and adhesion molecule/growth factor significant reduction. Additionally, syndecan 1 location, which is predominant in the stromal cells and apical epithelium in the active disorder, is quite exclusively located at the basolateral epithelial area in both healed mucosa and controls. CONCLUSIONS Balanced interaction among TNF α inhibition by infliximab, syndecan 1 migration, bFGF repair modulation and final adhesion molecule reversal to its normal location might represent a suitable molecular pathway of endoscopic mucosal healing in UC.
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Affiliation(s)
- Enzo Ierardi
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy.
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Lee Y, Francone T. Special Situations in the Management of Colonic Diverticular Disease. SEMINARS IN COLON AND RECTAL SURGERY 2011. [DOI: 10.1053/j.scrs.2011.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Tursi A, Elisei W, Brandimarte G, Giorgetti GM, Inchingolo CD, Nenna R, Ierardi E. Tumour necrosis factor-alpha expression in segmental colitis associated with diverticulosis is related to the severity of the endoscopic damage. Dig Liver Dis 2011; 43:374-379. [PMID: 21195685 DOI: 10.1016/j.dld.2010.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 09/14/2010] [Accepted: 11/23/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tumour necrosis factor-α expression may be increased in segmental colitis associated with diverticulosis. AIMS To assess tumour necrosis factor-α expression in segmental colitis associated with diverticulosis in relation with the severity of the endoscopic damage. METHODS 21 patients affected by segmental colitis associated with diverticulosis were studied (15 M, 6 F, mean age 58.87 years, range 43-85 years). Segmental colitis associated with diverticulosis was graduated as mild-moderate (patterns A and C) and severe (patterns B and D). Ten patients with moderate-to-severe ulcerative colitis, 10 patients with moderate-to-severe Crohn's disease, and 10 patients with irritable bowel syndrome served as control groups. RESULTS Tumour necrosis factor-α expression was significantly higher in segmental colitis associated with diverticulosis B (42.7%) and segmental colitis associated with diverticulosis D (40%) than in segmental colitis associated with diverticulosis A (19.1%) and segmental colitis associated with diverticulosis C (21.1%).Tumour necrosis factor-α expression was lower in segmental colitis associated with diverticulosis A and C than in ulcerative colitis and Crohn's disease, whilst no different tumour necrosis factor-α expression was found between segmental colitis associated with diverticulosis B and D and both ulcerative colitis and Crohn's disease.Finally, tumour necrosis factor-α expression was significantly lower in irritable bowel syndrome (8%±4) than in every type of segmental colitis associated with diverticulosis. CONCLUSIONS Tumour necrosis factor-α expression in segmental colitis associated with diverticulosis seems to be related to the severity of the endoscopic damage. This behaviour, similar to that of the inflammatory bowel diseases (IBD), confirms that this disease should be considered as a subtype of IBD.
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Affiliation(s)
- Antonio Tursi
- Servizio di Gastroenterologia Territoriale, ASL BAT, Andria (BAT), Italy.
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Tursi A. Segmental colitis associated with diverticulosis: complication of diverticular disease or autonomous entity? Dig Dis Sci 2011; 56:27-34. [PMID: 20411418 DOI: 10.1007/s10620-010-1230-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 03/25/2010] [Indexed: 12/09/2022]
Abstract
Segmental colitis associated with diverticulosis (SCAD) is a disease that affects colon harboring diverticula, mostly located in the sigmoid region. It has been considered a rare disease for many years, but new studies may contribute to easier recognition. Although its pathogenesis is not yet well defined, in the past SCAD has been considered a complication of diverticular disease, whilst new endoscopic, histological, and clinical data have encouraged the concept that SCAD includes pathogenetic and therapeutic aspects peculiar to inflammatory bowel diseases. We therefore describe herein current knowledge about this disease, and why it can be considered a truly autonomous entity instead of a complication of diverticular disease.
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Affiliation(s)
- Antonio Tursi
- Servizio di Gastroenterologia Territoriale, ASL BAT, Via Torino, 49, 70031, Andria, Italy.
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Abstract
Diverticular disease is one of the most prevalent gastrointestinal conditions to afflict Western populations. Although the majority of patients with diverticulosis remain asymptomatic, about one third will develop symptoms at some point in their lives. Symptomatic diverticular disease can range from chronic mild gastrointestinal distress to acute bouts of diverticulitis complicated by abscess or frank colonic perforation. The mainstay of treatment of symptomatic diverticular disease has long been bowel rest, antibiotics, and pain control, reserving surgery for those with complicated disease. This review discusses the epidemiology, pathophysiology, clinical presentation, and management of the spectrum of diverticular disease, including recent advances in the treatment of chronic diverticular disease.
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Affiliation(s)
- Jason Hemming
- Yale University School of Medicine, Section of Digestive Disease, New Haven, CT 06510, USA.
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Ierardi E, Hassan C, Zullo A, De Francesco V, Valle ND, Prencipe S, Rosania R, Morini S, Panella C. Segmental colitis associated with diverticula: a rare clinical entity and a new challenge for the gastroenterologist. Dig Liver Dis 2009; 41:794-797. [PMID: 19487168 DOI: 10.1016/j.dld.2009.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 04/02/2009] [Accepted: 04/15/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Segmental colitis associated with diverticula (SCAD) has recently drawn a particular attention in the field of rare forms of colitis because of some peculiarities suggesting both its autonomy as a clinical entity and a resemblance with the most relevant forms of inflammatory bowel diseases (IBD). Aim of this review was to report the state of art on this topic. METHODS Epidemiological, clinical, endoscopic/histological and diagnostic features are described. Moreover, from both the pathogenetic and therapeutic point of view, new relevant information is highlighted regarding the possible role of tumour necrosis factor alpha (TNF-alpha) in mucosal inflammation. RESULTS SCAD would appear as a rare autonomous clinical entity distinctive of old age, although it is still not well defined. It is likely that prevalence of SCAD could have been underestimated in the past since its main clinical presentation (namely bleeding without pain) is often found in elderly patients with diverticula. Endoscopy and histology could be helpful to discriminate it from infectious diverticulitis. Increasing evidence encourages the concept that SCAD includes pathogenetic and therapeutic aspects peculiar of IBD. This could be relevant for clinical management of SCAD. Indeed, the resolution of a severe, refractory case of SCAD has been recently reported with biological drugs used for IBD therapy. This observation could encourage, in the near future, the use of biological therapy in severe forms of SCAD as an alternative to surgery.
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Affiliation(s)
- E Ierardi
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy.
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