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. 2025 Jan;23(1):96-106.
doi: 10.5217/ir.2024.00046. Epub 2024 Aug 12.

Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study

Antonio Tursi  1   2 , Daniele Piovani  3   4 , Giovanni Brandimarte  5 , Francesco Di Mario  6 , Walter Elisei  7 , Marcello Picchio  8 , Gisella Figlioli  3   4 , Gabrio Bassotti  9 , Leonardo Allegretta  10 , Maria Laura Annunziata  11 , Mauro Bafutto  12 , Maria Antonia Bianco  13 , Raffaele Colucci  14 , Rita Conigliaro  15 , Dan L Dumitrascu  16 , Ricardo Escalante  17 , Luciano Ferrini  18 , Giacomo Forti  19 , Marilisa Franceschi  20 , Maria Giovanna Graziani  21 , Frank Lammert  22   23 , Giovanni Latella  24 , Daniele Lisi  25 , Giovanni Maconi  26 , Debora Compare  27 , Gerardo Nardone  27 , Lucia Camara de Castro Oliveira  28 , Chaves Oliveira Enio  29 , Savvas Papagrigoriadis  30 , Anna Pietrzak  31 , Stefano Pontone  32 , Ieva Stundiene  33 , Tomas Poškus  33 , Giuseppe Pranzo  34 , Matthias Christian Reichert  22 , Stefano Rodino  35 , Jaroslaw Regula  31 , Giuseppe Scaccianoce  36 , Franco Scaldaferri  37 , Roberto Vassallo  38 , Costantino Zampaletta  39 , Angelo Zullo  40 , Erasmo Spaziani  41 , Stefanos Bonovas  3   4 , Alfredo Papa  37 , Silvio Danese  42 ; DICA International Group
Collaborators, Affiliations

Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study

Antonio Tursi et al. Intest Res. 2025 Jan.

Abstract

Background/aims: Patients with diverticular disease (DD) frequently have abnormal bowel movements. However, it is unknown whether the entity of these alterations is associated with the severity of DD. We aimed to assess bowel habits and their relationship with the severity of DD according to Diverticular Inflammation and Complication Assessment (DICA) classification, Combined Overview on Diverticular Assessment (CODA) score, and fecal calprotectin (FC).

Methods: An international, multicenter, prospective cohort study was conducted in 43 centers. A 10-point visual analog scale (VAS) was used to assess the severity of constipation and diarrhea. The association of constipation and diarrhea with DICA classification, CODA score, and basal FC was tested using non-parametric tests. Survival methods for censored observations were applied to test the association of constipation and diarrhea with the incidence of acute diverticulitis over a 3-year follow-up.

Results: Of 871 patients with DD were included in the study. Of these, 208 (23.9%) and 199 (22.9%) reported a VAS score for constipation and diarrhea at least 3 at baseline, respectively. Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P< 0.001). Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.04-1.27; P=0.004; and HRdiarrhea =1.14; 95% CI, 1.03-1.26; P=0.014, respectively).

Conclusions: In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.

Keywords: Acute diverticulitis; Bowel frequency; Diverticular Inflammation and Complication Assessment classification; Diverticular diseases; Fecal calprotectin.

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Conflict of interest statement

Conflict of Interest

Tursi A served as speaker and/or consultant for AbbVie, Galápagos, Janssen, Nalkein, and Omega Pharma. Maconi G served as speaker and/or advisory board fees for AlfaSigma, Arena, Janssen, Gilead, and Roche. Nardone G received funding for target projects from Apharm and Sofar. Pietrzak A served as a lecturer for AlfaSigma and Polpharma. Regula J served as a lecturer for AlfaSigma, Takeda, Ipsen, and Servier. Scaldaferri F served as a lecturer for AbbVie, Celltrion, Ferring, Janssen, Lilly, Pfizer, Sanofi, and Takeda. Papa A served as a speaker for Janssen. Danese S served as speaker, consultant, and/or advisory board member for AbbVie, Allergan, Alfa Wassermann, Biogen, Boehringer Ingelheim, Celgene, Celltrion, Ferring, Gilead, Hospira, Johnson & Johnson, Merck, MSD, Mundipharma, Pfizer Inc., Sandoz, Takeda, Tigenix, UCB Pharma, Vifor. The remaining authors declare no competing interests.

Figures

Fig. 1.
Fig. 1.
Box plots showing the distribution of symptoms scores for constipation and diarrhea (10-point VAS) across groups of patients def ined by DICA endoscopic classification levels (A, B), CODA score (C, D), and basal FC (E, F). Constipation and diarrhea 10-point VASs were tested as continuous variables across the DICA classification levels and CODA scores by applying the Kruskal-Wallis test (A-D; P<0.001) and across the 2 categories of FC by using the Wilcoxon rank-sum test (E, F; P<0.01). VAS, visual analog scale; DICA, Diverticular Inflammation and Complication Assessment; CODA, Combined Overview on Diverticular Assessment; FC, fecal calprotectin.
Fig. 2.
Fig. 2.
Kaplan-Meier curves of the cumulative incidence of acute diverticulitis. (A) Comparison between patients without symptoms of constipation (10-point VAS=0) and patients reporting any symptom of constipation (10-point VAS ≥1). (B) Comparison between patients without symptoms of diarrhea (10-point VAS=0) and patients reporting any diarrhea (10-point VAS ≥1). Two-sided P-values from log-rank tests are reported. VAS, visual analog scale.
See this image and copyright information in PMC

References

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