P281 Diverticular disease-associated segmental colitis and inflammatory bowel disease: a new subgroup of patients?
A. Variola*1, M. Fortuna2, R. Montanari1, P. Castelli3, G. Barugola4, G. Zamboni3, G. Ruffo4, P. Bocus5, A. Geccherle1
1Sacro Cuore Don Calabria Negrar Hospital, Multispecialistic Centre for Recto-Perineal Diseases (IBD Unit), Department of Gastroenterology,, Negrar (VR), Italy, 2San Camillo Hospital, Department of Gastroenterology, Trento (TN), Italy, 3Sacro Cuore Don Calabria Negrar Hospital, Department of Anatomic Pathology, Negrar (VR), Italy, 4Sacro Cuore Don Calabria Negrar Hospital, Department of General Surgery, Negrar (VR), Italy, 5Sacro Cuore Don Calabria Negrar Hospital, Department of Gastroenterology - Endoscopy, Negrar (VR), Italy
Diverticular disease-associated segmental colitis (SCAD) is a rare form of chronic colitis surrounding diverticula with rectal sparing. It affects 0.3-1.3% of all patients (pts) with diverticulitis, mainly men older than 60 years old. Clinical and histological features are similar both in SCAD and in inflammatory bowel disease (IBD). Association between SCAD and IBD is well documented in literature, although etiology is still unknown.
We evaluated the prevalence of SCAD (defined by clinical, endoscopic and histological features) in all IBD-Unit pts at Negrar Hospital (Verona-Italy) from January 2008 to October 2014 (598 pts, 298 females and 300 males).
Diverticulosis was present in 89 IBD pts (15%). Out of them, 9 pts (10%) presented SCAD (5 females and 4 males; 8 ulcerative colitis (UC): 4 pancolitis, 2 left-sided, 2 distal; 1 left-sided Crohn's disease; mean age at diagnosis (Dg) 48 years old). Prevalence of SCAD was 1.5%. Dg of IBD and SCAD was concomitant in 4/9 patients (mean age 60 years old). First dg of SCAD followed by IBD occurred in 3/9 pts (mean age 66 years old), viceversa in 2/9 pts (mean age 49 years old). Corticosteroid-resistance recurred in 5/9 pts. Surgery was necessary in 2 pts for diverticulitis complications (perforation and abscesses). Symptoms were overall diarrhea, rectal bleeding and abdominal pain. Extraintestinal manifestations occurred in 2/9 pts (arthritis).
In our cohort of study IBD pts with SCAD had a later onset of disease and a worse clinical course, with higher risk of surgery and reduced response to conventional treatments. SCAD was more frequent in pts affected by UC. Further evaluations are needed in order to identify the best treatment options and prevent surgery.