Abstract
Localized inflammation of the sigmoid colon or segmental colitis associated with diverticulosis (SCAD syndrome) is an increasingly recognized, apparently uncommon, clinical and pathological disorder usually described in older adults. In the present study, 24 symptomatic patients, including 14 males, (58.3%) and 10 females (41.7%) were evaluated over a 20-year period with follow-up intervals ranging from 2 to 16 years. In most, initial clinical symptoms appeared after age 40 years and included rectal bleeding, diarrhea, and abdominal pain. Most (21 of 24, over 80%) initially responded with long-term resolution of their disease after treatment only with a 5-aminosalicylate. In addition, however, spontaneous remissions without any form of drug therapy were documented. In some, persistent, chronically active disease or true episodic recurrences were seen, leading to use of corticosteroids and/or resective surgery. Evidence here also suggested that colonic neoplasia, including adenoma development and cancer, were not related to the presence of this uniquely localized mucosal inflammatory process defined within the sigmoid colon. This study documents the natural history and long-term clinical behavior of this unusual segmental inflammatory process, associated with diverticulosis, and provides additional strong evidence that the SCAD syndrome is very distinct and can be readily separated from other forms of chronic inflammatory bowel disease.
Similar content being viewed by others
References
Cawthorn SJ, Gibbs NM, Marks CG (1983) Segmental colitis: a new complication of diverticular disease. Gut 24:A500
Sladen GE, Filipe MI (1984) Is segmental colitis a complication of diverticular disease? Dis Colon Rectum 27:513–514
Peppercorn MA (1992) Drug-responsive chronic segmental colitis associated with diverticula: a clinical syndrome in the elderly. Am J Gastroenterol 87:609–612
Gore S, Shepherd NA, Wilkinson SP (1992) Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance. Int J Colorectal Dis 7:76–81
Makapugay LM, Dean PJ (1996) Diverticular disease-associated chronic colitis. Am J Surg Pathol 20:94–102
Van Rosendaal GM, Andersen MA (1996) Segmental colitis complicating diverticular disease. Can J Gastroenterol 10:361–364
Imperiali G, Meucci G, Alvisi C, Fasoli R, Ferrara A, Girelli CM, Rocca F, Saibeni S, Minoli G (2000) Segmental colitis associated with diverticula: a prospective study. Am J Gastroenterol 95:1014–1016
Goldstein NS, Leon-Armin C, Mani A (2000) Crohn’s colitis-like changes in sigmoid diverticulitis specimens is usually an idiosyncratic inflammatory response to the diverticulosis rather than Crohn’s colitis. Am J Surg Pathol 24:668–675
Jani N, Finkelstein S, Blumberg D, Regueiro M (2002) Segmental colitis associated with diverticulosis. Dig Dis Sci 47:1175–1181
Evans JP, Cooper J, Roediger WE (2002) Diverticular colitis—therapeutic and etiological considerations. Colorectal Dis 4:208–212
Peppercorn MA (2004) The overlap of inflammatory bowel disease and diverticular disease. J Clin Gastroenterol 38(Suppl 1):S8–S10
Koutroubakis IE, Antoniou P, Tzardi M, Kouroumalis EA (2005) The spectrum of segmental colitis associated with diverticulosis. Int J Colorectal Dis 20:28–32
Freeman HJ, Roeck B, Devine DV, Carter CJ (1997) Double-blind prospective evaluation of neutrophil auto-antibodies in 500 consecutive patients with inflammatory bowel disease. Can J Gastroenterol 11:203–207
Freeman HJ (1997) Atypical perinuclear anti-neutrophil cytoplasmic antibodies in patients with Crohn’s disease. Can J Gastroenterol 11:689–693
Freeman HJ (2001) Application of the Vienna Classification for Crohn’s disease to a single clinician database of 877 patients. Can J Gastroenterol 15:89–93
Freeman HJ (2007) Application of the Montreal Classification for Crohn’s disease to a single clinician database of 1015 patients. Can J Gastroenterol 21:363–366
Freeman HJ (2007) Granuloma positive Crohn’s disease. Can J Gastroenterol 21:583–587
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Freeman, H.J. Natural History and Long-Term Clinical Behavior of Segmental Colitis Associated with Diverticulosis (Scad Syndrome). Dig Dis Sci 53, 2452–2457 (2008). https://doi.org/10.1007/s10620-007-0173-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-007-0173-y