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Assessment of the risk factors for colonic diverticular hemorrhage
Atsuo Yamada1, Takafumi Sugimoto, Shintaro Kondo
1Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan. yamada-a@umin.ac.jp
Insights
Hypertension, nonsteroidal anti-inflammatory drugs (NSAIDs), and anticoagulants like aspirin are key risk factors for colonic diverticular hemorrhage. Identifying these can help manage bleeding risks in patients with diverticulosis.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Epidemiology
Background:
- Colonic diverticulosis is common but can lead to diverticular hemorrhage.
- Risk factors for diverticular hemorrhage, beyond NSAIDs, require further investigation.
Purpose of the Study:
- To identify and evaluate the significance of risk factors for colonic diverticular hemorrhage.
- To elucidate the role of comorbidities, habits, and medications in diverticular bleeding.
Main Methods:
- A case-control study involving 1,753 patients with colonic diverticulosis and 44 with diverticular hemorrhage.
- Matching cases with controls for age, gender, and diverticulosis location.
- Conditional logistic regression analysis to assess risk factors including comorbidities, alcohol, smoking, and medications.
Main Results:
- Hypertension (OR, 6.6), nonsteroidal anti-inflammatory drugs (OR, 15.6), and anticoagulants including aspirin (OR, 3) were significant independent risk factors for colonic diverticular hemorrhage.
- Bilateral diverticulosis was more common in patients with hemorrhage (43% vs. 22%).
- No significant differences in age or gender were observed between cases and controls.
Conclusions:
- Hypertension, NSAIDs, and anticoagulant use (including aspirin) are independently associated with colonic diverticular hemorrhage.
- These findings highlight crucial modifiable and non-modifiable risk factors for diverticular bleeding.
Purpose:
Colonic diverticulosis, although usually asymptomatic, sometimes causes diverticular hemorrhage. Studies about risk factors, other than nonsteroidal anti-inflammatory drugs, for colonic diverticular hemorrhage are limited. We conducted the present study to elucidate their significance as a risk factor.
Methods:
Colonic diverticulosis was found in 1,753 patients and diverticular hemorrhage in 44 patients among 9,499 total colonoscopy examinees at the authors' institutions between September 1995 and December 2005. After reviewing their clinical features, we chose two controls for each case with diverticular hemorrhage matched for age, gender, and the location of diverticulosis. We evaluated the effects of comorbidities (hypertension, hyperlipidemia, diabetes mellitus, cerebrovascular disease, ischemic heart disease), habits (alcohol, smoking), and medications, including nonsteroidal anti-inflammatory drugs, by using conditional logistic regression analysis.
Results:
There were no significant differences between patients with diverticular hemorrhage and those with nonbleeding diverticulosis regarding age (67 +/- 13 vs. 64 +/- 11 years) or gender ratio (male/female ratio: 36/8 vs. 1,237/472). As for location, the proportion of bilateral diverticulosis was larger among patients with hemorrhage (43 vs. 22 percent). In the case-control study, nonsteroidal anti-inflammatory drugs (odds ratio, 15.6; 95 percent confidence interval, 1.1-214; P = 0.04), hypertension (odds ratio, 6.6; 95 percent confidence interval, 2.1-20.5; P = 0.0011), and aspirin and/or other anticoagulant (odds ratio, 3; 95 percent confidence interval, 1.04-8.6; P = 0.042) were shown to be significant risk factors by multivariate analysis.
Conclusions:
Hypertension, nonsteroidal anti-inflammatory drugs, and anticoagulants, including aspirin, are independent risk factors for colonic diverticular hemorrhage.
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