What’s New in Diagnosing Diverticular Disease

Abstract

In this session different issues for the diagnosis of diverticular disease (DD) were considered including “Biomarkers”, “Computer tomography”, “Ultrasonography in detecting acute diverticulitis”, “Endoscopy” and “The DICA classification: a new predictive tool in managing diverticular disease”. Most patients affected by DD suffer from recurrent attacks of abdominal pain without evidence of an active inflammatory process, causing a difficult differential diagnosis with other intestinal conditions. Several biomarkers, serological, fecal, urinary and genetic were considered, but recent studies confirmed that only CRP and fecal calprotectin are matching with the criteria for an ideal biomarker for DD. Colonoscopy still remains the gold standard for the diagnosis of DD, playing a key role in many clinical settings, such as colonic diverticular bleeding, or to differentiate inflammatory bowel disease (IBD) and segmental colitis associated with diverticulosis (SCAD); Moreover, in 2015 has been developed the DICA (Diverticular Inflammation and Complication Assessment) endoscopic classification that considers 10 different parameters, each one with a score, and the sum of items scores represents the severity of the disease; in this way the endoscopic exam would be able to predict the outcome of DD for each patient. On the other hand, computer tomography (CT) is the gold standard for acute diverticulitis (AD) with an excellent sensitivity and specificity; recently, metanalysis of prospective studies have shown that intestinal ultrasonography (IUS) and CT have the same sensitivity for the diagnosis of an AD and the advantage is that IUS is less expensive, non-invasive and easily accessible.

Diverticulosis: Knowledge and challenges

“…If there is an option, it is always better not to expose the patient to ionizing radiation, and if the circumstances allow, nuclear magnetic resonance of the colon should be performed. This method provides equally good visualization and correct diagnosis as computed tomography of the abdomen [8,16].…”

“…Уколико не дође до побољшања општег стања, треба размотрити контролне дијагностичке методе и поновну евалуацију стања, те евентуално потребу за хируршким лечењем. Погоршање општег стања и евентуални развој перитонитиса захтева ургентно хируршко лечење [16].…”

La enfermedad diverticular hoy. Revisión de la evidencia.

“…Recientemente, se ha propuesto una clasificación endoscópica para evaluar la inflamación y la complicación diverticular (DICA) que toma en consideración varios ítems puntuados y subítems, clasificándolo en DICA 1, DICA 2 y DICA 3. Al ser tan reciente hay pocos estudios que lo utilicen, pero parece que los pacientes con DICA 2 se benefician de un tratamiento programado para prevenir la aparición y recurrencia de la DA 13 .…”

Diverticular Inflammation and Complication Assessment classification, CODA score and fecal calprotectin in clinical assessment of patients with diverticular disease: A decision curve analysis

“…Increased levels of FC may also be found in systemic diseases involving the gastrointestinal tract, 17 such as diverticular disease (DD). FC was found to increase in symptomatic uncomplicated diverticular diseases (SUDD) 18 . It was able to discriminate SUDD from Irritable Bowel Syndrome, 18 and dropped significantly after treatment 19–21 .…”

“…FC was found to increase in symptomatic uncomplicated diverticular diseases (SUDD). 18 It was able to discriminate SUDD from Irritable Bowel Syndrome, 18 and dropped significantly after treatment. 19 , 20 , 21 However, we do not know whether and when FC may be included in the decision‐making process for DD.…”