Ultrasonographic and Functional Features of Symptomatic Uncomplicated Diverticular Disease

Aim: To evaluate the ability of intestinal ultrasound in discriminating symptomatic uncomplicated diverticular disease (SUDD) among patients with abdominal symptoms including irritable bowel syndrome (IBS). Design: This observational, prospective study included consecutive patients classified into the following categories: a) SUDD; b) IBS; c) unclassifiable abdominal symptoms; and d) controls, including asymptomatic healthy subjects and diverticulosis. The Intestinal ultrasound (IUS) evaluation of the sigmoid assessed the presence of diverticula, thickness of the muscularis propria and IUS-evoked pain, namely the intensity of pain evoked by compression with the ultrasound probe on sigmoid colon compared with an area of the left lower abdominal quadrant without underlying sigmoid colon. Results: We enrolled 40 patients with SUDD, 20 IBS, and 28 patients with unclassifiable abdominal symptoms, 10 healthy controls and 20 diverticulosis. SUDD patients displayed significantly (p<0.001) greater muscle thickness (2.25 ± 0.73 mm) compared to IBS patients (1.66±0.32 mm), patients with unclassifiable abdominal pain, and healthy subjects, but comparable to that of patients with diverticulosis (2.35 ± 0.71 mm). SUDD patients showed a greater (not significant) differential pain score than other patients. There was a significant correlation between the thickness of the muscularis propria and the differential pain score only for SUDD patients (r = 0.460; p: 0.01). Sigmoid diverticula were detected by colonoscopy in 40 patients (42.4%) and by IUS with a sensitivity of 96.0% and a specificity of 98.5%. Conclusion: IUS could represent a useful diagnostic tool for SUDD, potentially useful in characterizing the disease and appropriately address the therapeutic approach.