SCAD: diverticular inflammation or IBD in diverticular ...

Courtesy of dr V. Arena, anatomopathoogist, Cat

tholic University, Rome

Dia

• definition still under ap
standardized

• not clear defined clinica
at diagnosis

• Lack of guidelines and c

agnosis of SCAD:
limits

pproval and not

al entity and phenotypes

consensus





“CD is a heterogeneo
a variety of comp

in terms of age of onse
disease behaviour”-----

ous entity comprising

plex phenotypes

et, disease location and

--- different entities?

DIS
sa

 Pathogenesis

 Diagnosis

 Natural history

 therapy

SEASE DEFINITION:
ame or different?

J Clin Gastroenterol 2006;40:S132–S135

Noam Harpaz et al, J Clin Gastroenterol 2006;40:

:S132–S135

J Clin Gastroenterol 2006;40:S132–S135

TOTAL 50 PATIENTS

Noam Harpaz et al, J Clin Gastroenterol 2006;40:

:S132–S135

J Clin Gastroenterol 2006;40:S132–S135

TOTAL 50 PATIENTS

Noam Harpaz et al, J Clin Gastroenterol 2006;40:

:S132–S135

J Clin Gastroenterol 2006;40:S132–S135

TOTAL 50 PATIENTS

Noam Harpaz et al, J Clin Gastroenterol 2006;40:

For a TOTAL of
3 PATIENTS

PROGRESSION
TO CD

:S132–S135

Noam Harpaz et al, J Clin Gastroenterol 2006;40:

:S132–S135

Noam Harpaz et al, J Clin Gastroenterol 2006;40:

:S132–S135

Noam Harpaz et al, J Clin Gastroenterol 2006;40:

Around
12%

:S132–S135

Noam Harpaz et al, J Clin Gastroenterol 2006;40:

Around Around
12% 8%

:S132–S135

Natu

• Natural history not wel
for surgery, possibility o
possible evolution in IB

• Risk factors and progno
defined

ural history of SCAD:
limits

ll known, altough need
of complication and
BD is suggested

ostic factors not well

Lo
of Croh

Cumulative probability of remaining 100
free of complications (%)
90

80

70

60

50

40

30 Inflammatory

20

10

0

0 12 24 36 48 60 72 84 96

Patients at risk: Mo
n = 2,002
552

Cosnes J, et al. Inflamm Bowel Dis 2002;8:244–50

ong-term Evolution
hn’s disease behaviour

Penetrating

Stricturing

108 120 132 144 156 168 180 192 204 216 228 240

onths

229 95 37

0

Digestive damage Cu
in

Progression of digestive damage
inflammatory activity in a theore
patient with Crohn’s disease

F
Stricture

Disease Diagnosis Early
onset diseas

Pre-clinical Clinical

CDAI: Crohn’s disease activity index; CDEIS: Crohn’s dis

Pariente B, et al. Inflamm Bowel Dis 2010; epub 28 Nov

umulative Damage
n Crohn’s disease

e and Stricture Inflammatory activity
etical Surgery (CDAI, CDEIS, CRP)

Fistula / abscess
e

se

sease endoscopic index of severity; CRP: C-reactive protein

EL

Aliment Pharmacol Ther 2014

LDERLY vs YOUNG
IBD

EL

Aliment Pharmacol Ther 2014

LDERLY vs YOUNG
IBD

DIS
sa

 Pathogenesis

 Diagnosis

 Natural history

 therapy

SEASE DEFINITION:
ame or different?

A

Up to now, several drugs have b
based in clinical practice:
 High-fiber diet and/or fiber su

prevent possible evolution

 Spasmolitics

 Probiotics

 Antibiotics

 Mesalazine (5 salicylic acid)

 Immune suppressants and An

Tursi A et al, Dig Dis Sci (2011) 56:27–34

Available therapy
for SCAD

been proposed and regularly

upplementation, in order to

Shared
with IBD

nti-TNF-a

In Sum

mmary

SCAD

 Pathogenesis
 Diagnosis
 Natural history
 therapy

as IBD: same entity?
IBD SCAD

ULCERATIVE
COLITIS

• Continuous chronic

inflammation of the colonic

mucosa

• Prevalence 7.6-246.0 cases

per 100,000 in young adult INDETER
and lower pick in elderly COLI
• Atipical presentations:
5-10% of t

- backwash ileitis SCA
- rectal sparing (children)

- Inflmmation of the

appendix area

IBD

RMINATE CROHN’S
ITIS DISEASE

the cases • Transmural inflammation
of the intestine
AD
• Potentially interested
every segment of the GI
tract, as segmental o
regional inflammation

• Pick of incidece at 15-40
years, second pick at 60s

• Granuloma are often
found in histology

• Perianal disease and/or
fistulizing disease

SCAD
Yes wi

• Include SCAD in studies
genetics

• Promote Clinical studies
factors or to describe na
disease

• Access to “old” and “ne
nowadays available only

as IBD?
ith benefits…

s on pathogenesis and

s to identify predictors
atural history of the

ew” drugs,
y for IBD

S

SCAD as IBD?