J Gastrointestin Liver Dis, March 2013 Vol. 22 No 1: 13-19 1) Gastroenterology Service, ASL BAT, Andria (BT) 2) Division of Gastroenterology, ASL Roma H, Albano Laziale (Roma) 3) Digestive Endoscopy and Nutrition Unit, “S. Eugenio” Hospital, Roma 4) Department of Pathology, “Lorenzo Bonomo” Hospital, ASL BAT, Andria (BT) 5) Division of Surgery, “P. Colombo” Hospital, ASL RMH, Velletri (RM) 6) Division of Gastroenterology, “Cristo Re” Hospital, Roma, Italy Address for correspondence: Dr. Antonio Tursi, MD Servizio di Gastroenterologia Territoriale DSS n°4, ASL BAT Via Torino, 49 76123 Andria (BT), Italy antotursi@tiscali.it Received: 21.09.2012 Accepted: 28.12.2012 Detection of Endoscopic and Histological Inflammation aſter an Attack of Colonic Diverticulitis is Associated with Higher Diverticulitis Recurrence Antonio Tursi 1 , Walter Elisei 2 , Gian Marco Giorgetti 3 , Cosimo Damiano Inchingolo 4 , Rosanna Nenna 4 , Marcello Picchio 5 , Giovanni Brandimarte 6 INTRODUCTION Diverticular disease (DD) of the colon is common in westernized societies, and its prevalence increases with age. Diverticulosis affects about two- thirds of the elderly population but a large majority will remain entirely asymptomatic. Nonetheless, an estimated 20- 25% of patients may manifest clinical illness (the so-called “Diverticular Disease” ) [1]. The most important complication of diverticular disease is represented by acute diverticulitis [2]. It may be subdivided as uncomplicated diverticulitis, characterized by acute inflammation of diverticula ORIGINAL PAPERS ABSTRACT Background & Aims: Colonic diverticulitis shows a high recurrence rate, but the factors associated with such recurrence are still unknown. e aim of our study was to investigate the role of endoscopic and histological inflammation as predictors for the recurrence of diverticulitis. Methods: One hundred and thirty patients suffering from Acute Uncomplicated Diverticulitis (AUD) (81 males, 49 females, mean age 64.71 years, range 40-85) were prospectively assessed. All patients had AUD confirmed by computerized tomography (CT) and endoscopy. Clinical, endoscopic and histological follow- up was performed aſter 6, 12 and thereaſter 24 months aſter diagnosis of AUD. Results: Sixteen patients were lost to follow-up. Diverticulitis recurred in 18 patients (13.84%): 15 (13.15%) patients showed recurrence of AUD, whilst 3 (2.63%) showed recurrence of complicated diverticulitis. At the end of the follow-up period, endoscopic inflammation was still detected in 31 (27.67%) patients, and active histological inflammation in 41 patients (36.6 %). Only detection of endoscopic and of histological inflammation during the follow-up was a predictor of diverticulitis recurrence (Log rank test, p = 0.0004). Conclusions: Detection of endoscopic and histological inflammation aſter attack of AUD was identified as a predictor of diverticulitis recurrence. Key words: diverticulitis – endoscopy – follow-up – histology – recurrence. but without complications, and as complicated diverticulitis, characterized by acute diverticular inflammation associated with complications (abscesses, fistulas, stenoses) [3]. Some factors have been identified as predictive of diverticulitis recurrence. For example, severity of computerized tomography (CT) scan at entry [4], high white blood cell count (WBC >12.000) [5] or high body mass index [6] seem to be prognostic factors for the outcome of these patients. No information is available about possible additional risk factors, in particular whether the persistence of microscopic inflammation or the choice of maintenance treatment might in any way influence the outcome of these patients. e aim of this study was therefore to investigate the value of detecting macroscopic and microscopic inflammation as predictive factors regarding the outcome of patients aſter an attack of acute uncomplicated diverticulitis (AUD). MATERIAL AND METHODS From January 2004 to June 2009, 130 patients were diagnosed with AUD (81 males, 49 females, mean age 64.71