Moderate to Severe and Prolonged Left Lower-abdominal Pain is the Best Symptom Characterizing Symptomatic Uncomplicated Diverticular Disease of the Colon A Comparison With Fecal Calprotectin in Clinical Setting

Background: Left lower-abdominal pain is considered the best symptom to differentiate between symptomatic uncomplicated diverticular disease (SUDD) and irritable bowel syndrome (IBS). However, this statement has not been validated yet. Goals: The aim of this study was to assess whether prolonged left lower-quadrant pain is the best symptom characterizing SUDD and be able to differentiate SUDD from IBS-like symptoms in diverticulosis, and to compare the location of abdominal pain with fecal calprotectin (FC) expression. Study: Seventy-two patients suffering from abdominal pain and having diverticula at colonoscopy were enrolled. Patients were classified according to SUDD definition (abdominal pain for at least 24 consecutive hours in left lower abdomen) (42 patients) and IBS-like symptoms fulfilling Rome III criteria (30 patients). Abdominal pain was assessed using a 10-point visual scale, assigning numerical values from 0 (absence of pain) to 10 (severe pain). FC expression was assessed by a rapid test in all patients enrolled. Results: FC test was positive in 27 (64.3%) patients in the SUDD group and in no patient in the IBS-like group (P < 0.0001). In patients with SUDD, there was a significant correlation between the severity of the abdominal pain and the FC score (P = 0.0015). Extension of diverticulosis correlated with FC score (P = 0.022) and the severity of diverticulosis (P = 0.005). Conclusions: Severe and prolonged left lower-abdominal pain seems to be the best symptom characterizing SUDD, and it can differentiate these patients from those harboring diverticula but suffering from IBS-like according to Rome III criteria.