S393 Segmental Colitis Associated With Diverticulosis (SCAD): A Systematic Review of Clinical Features, Diagnosis, and Management Strategies

Introduction: Segmental colon inflammation (SCAD) is seen in people with diverticulosis, usually in the sigmoid colon, and is not caused by inflammatory bowel disease. The typical age for people with SCAD is about 63, and the disease is somewhat more frequent in men. Signs of SCAD are like those of inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS), but only diverticular tissue has inflammation, while the rest is healthy. Methods: Clinical features and management results related to SCAD were investigated using a systematic review. PubMed, WOS, Cochrane Library, and Scopus were checked through 2024 to find series and retrospective studies on SCAD. Demographic data, information about symptoms, the findings from endoscopy and biopsy, and treatment outcomes were all gathered. Most enrolled studies were small collections of cases. We carried out a qualitative synthesis. Results: We reviewed 22 studies on SCAD, a condition presenting with persistent abdominal pain, diarrhea, and occasionally rectal bleeding. Inflammation was confined to diverticular segments of the colon, with the remainder appearing normal on imaging or endoscopy. Histologically, SCAD may mimic ulcerative colitis, showing crypt distortion or chronic inflammation, or may exhibit localized inflammatory changes around diverticula. Most patients achieved remission with oral mesalamine and/or rifaximin. Approximately 25% of those with refractory symptoms required surgical intervention. Notably, SCAD rarely progressed to diffuse ulcerative colitis and generally followed a mild, manageable course when promptly diagnosed and treated. Conclusion: SCAD is a special kind of colitis related to diverticulosis, often seen in older patients when part of the sigmoid area is affected. We should always tell SCAD apart from classic ulcerative colitis or Crohn's, as the prognosis is better and the treatment is not the same. Most people with SCAD are significantly helped by treatment with mesalamine and/or antibiotics, meaning they rarely need strong immunosuppressive drugs. A limited number of individuals with advanced, unresponsive disease require surgery to treat the tumor. Identifying SCAD from IBD is needed to stop unnecessary treatments. SCAD provides a good treatment response and is generally not severe in comparison to the clinical behavior of idiopathic IBD.