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Analysis of risk factors for colonic diverticular bleeding and recurrence
Masato Taki1, Tadayuki Oshima, Katsuyuki Tozawa
1Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Insights
Extensive colonic diverticulosis and certain medications like nonsteroidal anti-inflammatory drugs increase the risk of colonic diverticular bleeding. A history of bleeding and steroid use are linked to recurrence.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Colonic diverticular bleeding incidence is rising due to aging populations and antithrombotic medication use.
- Established risk factors for onset, recurrence, and prophylaxis of colonic diverticular bleeding remain unclear.
Purpose of the Study:
- To identify risk factors associated with the initial onset of colonic diverticular bleeding.
- To determine factors contributing to the recurrence of colonic diverticular bleeding.
Main Methods:
- An age- and sex-matched case-control study was conducted to evaluate risk factors for bleeding onset.
- Medical records were analyzed for diverticulosis distribution, comorbidities, and medication use.
- Patients with first-time bleeding were assessed for rebleeding risk factors during follow-up.
Main Results:
- Bilateral colonic diverticulosis, nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin (LDA), and anticoagulants were significant risk factors for bleeding onset.
- Selective cyclooxygenase-2 (COX-2) inhibitors were not associated with increased onset risk.
- A prior history of bleeding and steroid use were associated with a higher recurrence rate.
Conclusions:
- Extensive diverticulosis and use of nonselective NSAIDs, LDA, and anticoagulants are key risk factors for colonic diverticular bleeding onset.
- Previous episodes of colonic diverticular bleeding and steroid use are significant predictors of recurrence.
Abstract:
The increase in incidence of colonic diverticular bleeding is relative to an age-related rise in the incidence of colonic diverticulosis and use of antithrombotic medication. However, risk factors related to the onset, recurrence, and prophylaxis have not been established. Therefore, we aimed to determine risk factors for the onset and recurrence of colonic diverticular bleeding.An age- and sex-matched case-control study was performed to assess the risk factors for the onset of colonic diverticular bleeding. The distribution of diverticulosis, comorbidity, and medication were evaluated from medical records. We also assigned patients with a first-time bleeding into groups with and without rebleeding during follow-up to determine risk factors for recurrence.Bilateral colonic diverticulosis, nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin (LDA), and anticoagulants were significant risk factors for the onset of colonic diverticular bleeding on multivariate analysis. In contrast, the use of selective cyclooxygenase-2 (COX-2) inhibitor was not a risk factor for the onset. The incidence of bleeding in direct oral anticoagulant and warfarin users was not different between the 2 groups. The cumulative recurrence rate at 1 year was 15%. Recurrence rate was significantly higher in patients with a prior history of colonic diverticular bleeding than those without. Steroid use was associated with recurrence.Extensive distribution of diverticulosis and use of nonselective NSAIDs, LDA, and anticoagulants are regarded as risk factors for the onset of colonic diverticular bleeding. In addition, a prior history of colonic diverticular bleeding is related to the recurrence.
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