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Published on: October 16, 2013
Prognostic Role of the Endoscopic Classification "DICA"
Antonio Tursi1, Giovanni Brandimarte, Francesco Di Mario
1*Gastroenterology Service, ASL BAT, Andria (BT) †Division of Internal Medicine and Gastroenterology, "Cristo Re" Hospital, GIOMI Group §Division of Gastroenterology, ASL RMH, Albano Laziale ¶Division of Surgery, "P. Colombo" Hospital, ASL RMH, Velletri, Rome ‡Department of Clinical & Experimental Medicine, Gastroenterology Unit ∥Department of Clinical & Experimental Medicine, Clinical Pharmacology & Digestive Pathophysiology Unit, University of Parma, Italy.
The Diverticular Inflammation and Complication Assessment (DICA) classification effectively predicts diverticulitis recurrence and surgery needs. This scoring system aids in managing patients with diverticular disease, guiding treatment decisions for better outcomes.
Area of Science:
- Gastroenterology
- Clinical Endoscopy
- Predictive Medicine
Background:
- Diverticular disease affects a significant portion of the population, often leading to complications.
- Accurate assessment of inflammation and complication risk is crucial for effective patient management.
- The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification is a recent tool for evaluating diverticular disease severity.
Purpose of the Study:
- To retrospectively assess the predictive value of the DICA endoscopic classification in patients with diverticulosis and diverticular disease.
- To identify factors associated with the occurrence, recurrence, and surgical management of diverticulitis.
- To evaluate the effectiveness of therapeutic interventions in preventing diverticulitis recurrence based on DICA classification.
Main Methods:
- Retrospective analysis of 1651 patients diagnosed with diverticular disease.
- Data collected included DICA severity, clinical symptoms, inflammatory markers (CRP, fecal calprotectin), follow-up duration, and treatment received.
- Statistical analyses, including univariate and multivariate assessments, were performed to determine the association between DICA and clinical outcomes.
Main Results:
- The DICA classification was the sole significant predictor of diverticulitis occurrence/recurrence and the need for surgery (P<0.0001).
- Acute diverticulitis occurred/recurred in 15.9% of patients, with 21.7% of those requiring surgery.
- Scheduled therapy in DICA 2 patients significantly reduced AD recurrence (HR=0.598), and mesalazine-based therapies showed a strong protective effect against recurrence and surgery.
Conclusions:
- The DICA endoscopic classification is a validated tool for predicting the risk of diverticulitis occurrence and recurrence in patients with diverticular disease.
- DICA severity is a critical factor in determining patient prognosis and guiding therapeutic strategies.
- Targeted therapies, particularly mesalazine-based regimens, demonstrate efficacy in preventing complications and reducing the need for surgery.
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