The association between arteriosclerosis related diseases and diverticular bleeding

We previously reported that hypertension is related to colonic diverticular bleeding, suggesting the involvement of arteriosclerosis. The recurrence of diverticular bleeding has been little investigated. We aimed to elucidate additional risk factors for diverticular bleeding and also to investigate the incidence rates and risk factors for re-bleeding.

Between January 2006 and September 2010, 62 patients with diverticular bleeding were admitted to our hospital. We then selected 124 control subjects with non-bleeding diverticula from the colonoscopy database of our department. Additionally, a retrospective cohort study was conducted using these case patients to estimate the re-bleeding rate after initial diverticular bleeding and the risk factors for re-bleeding. Odds ratios for diverticular bleeding were calculated by multivariate logistic regression in a case-control study. Cumulative re-bleeding rates since initial bleeding and hazard ratios of risk factors were estimated by Kaplan-Meier method and Cox proportional hazard model.

Sixty-two patients presented 99 bleeding episodes including the initial ones. Diabetes mellitus (OR 2.5, 95 % CI 1.2-5.2, P = 0.03), cardio- or cerebrovascular diseases (OR 4.2, 95 % CI 1.7-11.3, P = 0.003), and NSAID use (OR 3.7, 95 % CI 1.3-11.6, P = 0.02) were shown to be independent risk factors. The cumulative re-bleeding rates were 21 %, 34 %, and 40 % at 1, 2, and 3 years, respectively, in which NSAID use (HR 6.3, 95 % CI 1.7-20.7, P = 0.007) was a risk factor for re-bleeding.

Diabetes mellitus and vascular diseases were risk factors for diverticular bleeding, suggesting systemic metabolic disorders and arteriosclerosis might play an important role.