Distinct Clinical Factors in Hospitalized Patients with Diverticular Bleeding and Diverticulitis

Urabe, Makiko; Nishida, Tsutomu; Shimakoshi, Hiromi; Shimoda, Akiyoshi; Amano, Takahiro; Sugimoto, Aya; Takahashi, Kei; Mukai, Kaori; Matsubara, Tokuhiro; Yamamoto, Masashi; Hayashi, Shiro; Nakajima, Sachiko; Fukui, Koji; Tanida, Tsukasa; Komori, Takamichi; Morita, Shunji; Inada, Masami

doi:10.1159/000491875

Cited by 16 publications

(8 citation statements)

References 20 publications

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“…For patients aged 40 years or older, the CRC detection rate and ANDR were not significantly different between the two groups. Colonic diverticulosis is an age-dependent disease, but diverticulitis was more common in younger patients than diverticular bleeding [18]. In the present study, patients under 40 years of age were more common in the diverticulitis group than in the FIT-positive group.…”

Section: Diverticulitiscontrasting

confidence: 40%

Comparison of colonoscopy after colonic diverticulitis and positive fecal immunochemical tests for the detection of colorectal neoplasia

et al. 2021

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Background and study aims The relationship between acute colonic diverticulitis and colorectal cancer (CRC) is unclear, but colonoscopy is recommended to exclude malignancy. We compared the detection rates for colorectal neoplasia in patients with colonic diverticulitis and asymptomatic patients who had positive fecal immunochemical tests (FITs). Patients and methods In total, 282 patients with acute colonic diverticulitis were hospitalized in our hospital from February 2011 to December 2019. Of them, 143 patients with diverticulitis and 1819 with positive FITs patients during the same period underwent colonoscopy without a prior colonoscopy within 5 years. We retrospectively compared these patients in terms of the invasive CRC rate, advanced neoplasia detection rate (ANDR), adenoma detection rate (ADR), and polyp detection rate (PDR). Results Compared to the diverticulitis group, the FIT-positive group had a significantly higher CRC rate (0 vs 2.7 %, P = 0.0061), ANDR (5.6 vs. 14.0 %, P = 0.0017), ADR (19.6 vs. 53.2 %, P < .0001), and PDR (44.1 vs. 91.0 %, P < .0001). Using 1:1 propensity score matching based on age and sex, we obtained 276 matched patients in both groups. After matching, no difference was found in the CRC rate (0 vs 0.7 %) or ANDR (5.8 vs 7.3 %) between groups, but the ADR and PDR were significantly higher in the FIT-positive group (20.3 vs 43.5 %, P < .0001; 45.7 % vs 86.2 %, P < .0001). Conclusion Patients with acute diverticulitis had lower ADRs and PDRs than patients with positive FITs.

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Section: Diverticulitiscontrasting

confidence: 40%

Comparison of colonoscopy after colonic diverticulitis and positive fecal immunochemical tests for the detection of colorectal neoplasia

et al. 2021

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“…In addition, we performed a subgroup analysis according to the number of years of endoscopy experience among nonexperts; however, nonexperts performed as well as experts regardless of their years of experience. A possible explanation is that it is difficult for even experts to achieve a higher rate of SRH identification in cases of diverticular bleeding [6], which accounts for approximately 30 % to 50 % of cases of ALGIB [7][8][9], as these cases involve intermittent bleeding or spontaneous cessation of bleeding [6,10]. Another explanation is that the completion rate of insertion by nonexperts alone was as high as 98.4 %, suggesting that the nonexpert group may be quite experienced.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of colonoscopy performed by nonexperts for acute lower gastrointestinal bleeding: post hoc analysis

et al. 2021

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Background and study aims It remains unclear whether the experience of endoscopists affects clinical outcomes for acute lower gastrointestinal bleeding (ALGIB). We aimed to determine the feasibility and safety of colonoscopies performed by nonexperts using secondary data from a randomized controlled trial for ALGIB. Patients and methods We analyzed clinical outcomes in 159 patients with ALGIB who underwent colonoscopies performed by two groups of endoscopists: experts and nonexperts. We compared endoscopy outcomes, including identification of stigmata of recent hemorrhage (SRH), successful endoscopic treatment, adverse events (AEs), and clinical outcomes between the two groups, including 30-day rebleeding, transfusion, length of stay, thrombotic events, and 30-day mortality. Results Expert endoscopists alone performed colonoscopies in 96 patients, and nonexperts performed colonoscopies in 63 patients. The use of antiplatelets and warfarin was significantly higher in the expert group. The SRH identification rate (24.0 and 17.5 %), successful endoscopic treatment rate (95.0 and 100 %), rate of AEs during colonoscopy (0 and 0 %), transfusion rate (6.3 and 4.8 %), length of stay (8.0 and 6.4 days), rate of thrombotic events (0 and 1.8 %), and mortality (0 and 0 %) were not different between the expert and nonexpert groups. Rebleeding within 30 days occurred more often in the expert group than in the nonexpert group (14.3 vs. 5.4 % P = 0.0914). Conclusions The performance of colonoscopies for ALGIB by nonexperts did not result in worse clinical outcomes, suggesting that its use could be feasible for nonexperts for diagnosis and treatment of ALGIB.

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“…It is well documented that of the manifestations of diverticular disease, those presenting with diverticular bleeding tend to be older than those with diverticulitis [17,18] . While the peak age for diverticulitis in our data is around 50 years of age, there are almost no cases of diver- Age ticular bleeding in patients 50 years or younger (Figure 3).…”

Section: Discussionmentioning

confidence: 99%

Redefining Hemorrhage in Diverticulitis: Complicated Diverticulitis or Exacerbation of Diverticular Bleeding?

French

Johnson

2020

Journal of Gastroenterology and Hepatology Research

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AIM: Lower gastrointestinal hemorrhage in a patient presenting with diverticulitis shifts the diagnosis from uncomplicated to complicated diverticulitis leading to more aggressive treatment measures. This study sought to determine the demographic characteristics of patients hospitalized with diverticular bleeding and diverticulitis with a focus on identifying factors that predispose to hemorrhage. We aim to use demographic information to elucidate whether hemorrhage in the setting of diverticulitis is more similar mechanistically to diverticular bleeding or diverticulitis. MATERIALS AND METHODS: Inpatient data collected by the Pennsylvania Health Care Cost Containment Council was used to analyze 29,479 hospitalizations spanning from 2002 to 2018 at Philadelphia healthcare institutions where the primary diagnosis for admission was diverticulitis or diverticular bleeding. Age, race, and gender were collected for patients hospitalized with diverticular bleeding, di-verticulitis, and diverticulitis complications. Demographic data from the 2010 US Census was used for comparison. RESULTS: Diverticulitis (n = 20,260) disproportionately affects White individuals (p < 0.0001) while diverticular bleeding (n = 9,219) disproportionately affects Black individuals (p < 0.0001). Of all diverticulitis complications, hemorrhage (n = 1,429) had the highest proportion of Black individuals. Patients admitted for diverticular bleeding tend to be older (75.0 ± 12.1) than patients admitted for diverticulitis (60.2 ± 15.9; p < 0.00001). Among those with complicated diverticulitis, patients with hemorrhage are the oldest (70.2 ± 14.7). CONCLUSION: Patients admitted with diverticulitis complicated by hemorrhage were more similar demographically to patients admitted with diverticular bleeding than those admitted with other forms of diverticulitis. Reframing diverticulitis complicated by hemorrhage as uncomplicated diverticulitis with diverticular bleeding could prompt more appropriate treatment with avoidance of potentially unnecessary antibiotics and imaging.Synopsis: An epidemiological assessment of diverticular bleeding and diverticulitis found that patients admitted with diverticulitis complicated by hemorrhage were more similar demographically to patients admitted with diverticular bleeding than those admitted with other forms of diverticulitis. Because prior studies have suggested that demographic differences between diverticular bleeding and diverticulitis suggest distinct etiologies, we conclude that hemorrhage in the setting of diverticulitis should be treated as a diverticular bleed and not as a complication of diverticulitis itself.

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Distinct Clinical Factors in Hospitalized Patients with Diverticular Bleeding and Diverticulitis

Cited by 16 publications

References 20 publications

Comparison of colonoscopy after colonic diverticulitis and positive fecal immunochemical tests for the detection of colorectal neoplasia

Comparison of colonoscopy after colonic diverticulitis and positive fecal immunochemical tests for the detection of colorectal neoplasia

Feasibility and safety of colonoscopy performed by nonexperts for acute lower gastrointestinal bleeding: post hoc analysis

Redefining Hemorrhage in Diverticulitis: Complicated Diverticulitis or Exacerbation of Diverticular Bleeding?

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