Assessment of the Risk Factors for Colonic Diverticular Hemorrhage

Yamada, Atsuo; Sugimoto, Takafumi; Kondo, Shintaro; Ohta, Miki; Watabe, Hirotsugu; Maeda, Shin; Togo, Goichi; Yamaji, Yutaka; Ogura, Keiji; Okamoto, Makoto; Yoshida, Haruhiko; Kawabe, Takao; Kawase, Tateo; Omata, Masao

doi:10.1007/s10350-007-9137-8

Cited by 116 publications

(129 citation statements)

References 19 publications

Supporting

Mentioning

117

Contrasting

Unclassified

Order By: Relevance

“…Although diverticular hemorrhage ceases spontaneously in many cases, delayed recurrent bleeding may occur in 16-38% of patients. As shown in a previous report (21), patients with diverticular bleeding often exhibit various comorbidities and have a history of antithrombotic drug use; thus, surgical intervention sometimes carries a very high risk. Therefore, identifying the source of bleeding prior to surgery using CE-CT may result in a less invasive urgent colonoscopy procedure and more effective hemostasis.…”

Section: Discussionmentioning

confidence: 99%

Urgent Computed Tomography for Determining the Optimal Timing of Colonoscopy in Patients with Acute Lower Gastrointestinal Bleeding

et al. 2015

View full text Add to dashboard Cite

Objective We evaluated the diagnostic performance of computed tomography (CT) as an initial radiologic test for assessing the optimal timing of colonoscopy in patients with acute lower gastrointestinal bleeding (LGIB) and investigated the effectiveness of contrast-enhanced (CE) CT for detecting colonic diverticular bleeding. Methods This was a retrospective study of 1,604 consecutive patients who visited or were referred to St. Marianna University Hospital due to acute LGIB and underwent colonoscopy within three months after presentation between September 2004 and December 2012. The clinicopathological data of the subjects were obtained from their medical records. Results Among the 1,604 patients presenting with LGIB, 879 (55%) underwent a CT scan. Elective colonoscopy was considered in cases in which typical colonic wall thickening was observed on CT, suggesting colonic inflammation or malignancy (239 patients; 27%). The diagnoses in the elective cases included ischemic colitis (38%), infectious colitis (8%), inflammatory bowel disease (8%) and malignancy (5%). Urgent colonoscopy was performed after the CT examination in 640 cases (73%). The most common presumptive CT diagnosis was diverticulum (402/640; 63%). Of the 638 patients who underwent CE-CT, diverticula were observed in 346 cases, including 104 cases of extravasation indicating ongoing diverticular bleeding. Among these 104 patients, the site of bleeding was identified in 71 subjects (68%) during colonoscopy. The rate of detection of the bleeding source on colonoscopy was significantly higher in the patients with extravasation on CE-CT than in those without extravasation on CE-CT (68% vs. 20%, respectively; p<0.001). Conclusion Urgent CT is useful for determining the optimal timing of colonoscopy in cases of acute LGIB. CE-CT may be used to depict the presence and location of active hemorrhage and provides useful information for subsequent colonoscopy, especially in patients with diverticular bleeding.

show abstract

Section: Discussionmentioning

confidence: 99%

Urgent Computed Tomography for Determining the Optimal Timing of Colonoscopy in Patients with Acute Lower Gastrointestinal Bleeding

et al. 2015

View full text Add to dashboard Cite

show abstract

“…In LG, colonic DH was the most common disorder causing LGIB. Moreover, colonic DH has also recently been reported as the most common cause of LGIB in Japan [2,12] . Compared to a few decades ago, changes in the agingassociated diseases that cause LGIB have been occurring.…”

Section: Comparison Of Specific Diseases In Eg and Lgmentioning

confidence: 96%

Increase in colonic diverticular hemorrhage and confounding factors

Kinjo¹,

Matsui²,

Hisabe³

et al. 2016

WJGPT

View full text Add to dashboard Cite

AIM:To classify changes over time in causes of lower gastrointestinal bleeding (LGIB) and to identify factors associated with changes in the incidence and characteristics of diverticular hemorrhage (DH). METHODS:A total of 1803 patients underwent colonoscopy for overt LGIB at our hospital from 1995 to 2013. Patients were divided into an early group (EG, 1995(EG, -2006 n = 828) and a late group (LG, 2007(LG, -2013 Author contributions: Kinjo K collected and analyzed the data, and drafted the manuscript; Matsui T designed and supervised the study; Washio M performed the statistical analysisl; Hisabe T, Ishihara H, Maki S, Chuman K, Koga A, Ohtsu K, Takatsu N, Hirai F and Yao K performed the colonoscopy and revised the manuscript for important intellectual content; all authors have read and approved the final version to be published.Institutional review board statement: This study was approved by the institutional review board of Fukuoka University Chikushi Hospital (R15-024) and was conducted in accordance with the Declaration of Helsinki.Informed consent statement: In this study, We do not necessarily need the individual agreement from a study subject. Because this study is retrospective study and based on the ethical guidelines for medical studies intended for people "taken from the human body undergoes No. 12 informed consent procedures was used samples not research". Information about the implementation of this research exposes to Fukuoka University Chikushi Hospital clinical research support Center home page. Conflict-of-interest statement:In connection with this manuscript, there is no Conflict of Interest to be disclosed with any companies.Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at matsui@ fukuoka-u.ac.jp. Participants gave informed consent was not obtained but the presented data are anonymized and risk of identification is low. Retrospective Studybetween patients with and without DH. RESULTS:Older patients (≥ 70 years old) and those with colonic DH were more frequent in LG than in EG (P < 0.01). Patients using ATDs as well as NSAIDs, male sex, obesity (body mass index ≥ 25 kg/m 2 ), smoking, alcohol drinking, and arteriosclerotic diseases were more frequent in patients with DH than in those without. CONCLUSION:Incidence of colonic DH seems to increase with aging of the population, and factors involved include use of ATDs and NSAIDs, male sex, obesity, smoking, alcohol drinking, and arteriosclerotic disease. These factors are of value in handling DH patients. Core tip: Colonic diverticular hemorrhage (DH) is the most frequent cause of lower gastrointestinal bleeding. A rapid increase in the incidence of colonic DH has been seen with the aging population. One reason is the widespread adoption of antithrombotic drugs (ATDs) since the early 2000s, based on guidelines to prevent ischemic heart disease and ischemic cerebrovascular disease. DH is more likely in patients who are older, are men, obesity, use nonsteroidal anti-inf...

show abstract

“…Yamada et al (11), whilst studying risk factors for CDB, also reported that the proportion of bilateral diverticulosis was larger among patients with hemorrhage, and Faucheron et al (9) and Suzuki et al (8) stated that right-sided diverticula location was associated with a significant risk of bleeding, which was independent of age. Even though right-sided diverticula are less prevalent in the western population than left-sided ones (9), these results highlight the need to monitor patients with known right-sided diverticulosis closely and to alert clinicians to the greater risk of severe bleeding in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Several risk factors for CDB were identified in previous studies, namely previous episodes of CDB (7), right-sided diverticula (8,9), obesity (10), hypertension (11), diabetes mellitus, cardiovascular or cerebrovascular diseases (12). It has also been demonstrated that several medicaments are associated with an increased risk of CDB, including steroidal (13) and non-steroidal anti-inflammatory drugs (11,14,15) and antihypertensive medication (calcium-channel blockers) (13).…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Risk factors for severity and recurrence of colonic diverticular bleeding

Joaquim¹,

Caldeira²,

Antunes³

et al. 2016

Rev Esp Enferm Dig

View full text Add to dashboard Cite

Background: Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Risk factors related to severity and repeated bleeding episodes are not completely clearly defined.Objective: To characterize a Portuguese population hospitalized due to colonic diverticular bleeding and to identify the clinical predictors related to bleeding severity and rebleeding.Methods: Retrospective analysis of all hospitalized patients diagnosed with colonic diverticular bleeding from January 2008 to December 2013 at our institution. The main outcomes evaluated were bleeding severity, defined as any transfusion support requirements and/or signs of hemodynamic shock, and 1-year recurrence rate.Results: Seventy-four patients were included, with a mean age of 75.7 ± 9.5 years; the majority were male (62.2%). Thirty-six patients (48.6%) met the criteria for severe bleeding; four independent risk factors for severe diverticular bleeding were identified: low hemoglobin level at admission (≤ 11 g/dL; OR 18.8), older age (≥ 75 years; OR 4.7), bilateral diverticular location (OR 14.2) and chronic kidney disease (OR 5.6). The 1-year recurrence rate was 12.9%. We did not identify any independent risk factor for bleeding recurrence in this population.Conclusion: In this series, nearly half of the patients hospitalized with diverticular bleeding presented with severe bleeding. Patients with low hemoglobin levels, older age, bilateral diverticular location and chronic kidney disease had a significantly increased risk for severe diverticular bleeding. In addition, a small number of patients rebled within the first year after the index episode, although we could not identify independent risk factors associated with the recurrence of diverticular bleeding.

show abstract

Assessment of the Risk Factors for Colonic Diverticular Hemorrhage

Abstract: Hypertension, nonsteroidal anti-inflammatory drugs, and anticoagulants, including aspirin, are independent risk factors for colonic diverticular hemorrhage.

Cited by 116 publications

References 19 publications

Urgent Computed Tomography for Determining the Optimal Timing of Colonoscopy in Patients with Acute Lower Gastrointestinal Bleeding

Urgent Computed Tomography for Determining the Optimal Timing of Colonoscopy in Patients with Acute Lower Gastrointestinal Bleeding

Increase in colonic diverticular hemorrhage and confounding factors

Risk factors for severity and recurrence of colonic diverticular bleeding

Contact Info

Product

Resources

About