Increase in colonic diverticulosis and diverticular hemorrhage in an aging society: lessons from a 9-year colonoscopic study of 28,192 patients in Japan

Nagata, Naoyoshi; Niikura, Ryota; Aoki, Tomonori; Shimbo, Takuro; Itoh, Toshiyuki; Yoshimasa, Goda; Suda, Ryuichiro; Yano, Hideaki; Akiyama, Junichi; Yanase, Mikio; Mizokami, Masashi; Uemura, Naomi

doi:10.1007/s00384-013-1808-4

Cited by 103 publications

(132 citation statements)

References 38 publications

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“…During the period from 1960 to the 1980s, Kubo et al [13] reported that the prevalence of colonic diverticula was only 8.9% among patients who underwent barium enema examination. Since the 1990s, the prevalence of div erticulosis seen on barium enema examination or colonoscopy has increased to 15%25% [5,14] . In addition, more than 80% of patients who had diverticulosis were elderly.…”

Section: Comparison Of Specific Diseases In Eg and Lgmentioning

confidence: 99%

“…In addition, more than 80% of patients who had diverticulosis were elderly. Diverticulosis is thus thought to increase with aging [5] . As the absolute number of diverticula in colonic diverticulosis increases with the aging of the population, the risk of DH is increased.…”

Section: Comparison Of Specific Diseases In Eg and Lgmentioning

confidence: 99%

“…In particular, the prevalence of colonic diverticulum is increasing. The aging population in Japan, as in Western countries, is showing an increase in diverticulosis [4,5] . DH is also increasing in Japan.…”

Section: Introductionmentioning

confidence: 99%

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Increase in colonic diverticular hemorrhage and confounding factors

Kinjo¹,

Matsui²,

Hisabe³

et al. 2016

WJGPT

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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...

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Section: Comparison Of Specific Diseases In Eg and Lgmentioning

confidence: 99%

Section: Comparison Of Specific Diseases In Eg and Lgmentioning

confidence: 99%

See 1 more Smart Citation

Increase in colonic diverticular hemorrhage and confounding factors

Kinjo¹,

Matsui²,

Hisabe³

et al. 2016

WJGPT

View full text Add to dashboard Cite

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“…In Japan, opportunities to treat patients with colonic diverticular disease (diverticular bleeding and diverticulitis) have been increasing in recent years as the prevalence of colonic diverticula has increased [1,2]. In particular, the number of reports of colonic diverticular bleeding from Japan has been increasing in the past 2 or 3 years [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

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Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.

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“…Moreover, as increase of colon diverticulosis [3-5], CDB incidence appears to be increasing in both western and eastern countries [5-8]. CDB is characterized as arterial bleeding, which is caused by the rupture of vasa recta penetrating through diverticula [9].…”

Section: Introductionmentioning

confidence: 99%

Initial Management of Colonic Diverticular Bleeding: Observational Study

et al. 2018

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Background/Aims: Although colonic diverticular bleeding (CDB) often ceases spontaneously, re-bleeding occurs in about 30%. Bleeding diverticulum can be treated directly by endoscopic hemostasis; however, it is difficult to perform colonoscopy in all cases with limited medical resource and certain risks. The aim of this study was to clarify who should undergo colonoscopy as well as appropriate methods of initial management in CDB patients. Methods: A total of 285 patients who were diagnosed as CDB and underwent colonoscopy from March 2004 to October 2015 were retrospectively analyzed. First, the association between re-bleeding and various factors including patients’ background and initial management were analyzed. Second, the examination conditions that influenced bleeding point identification were analyzed. Results: Of 285 patients, 187 were men and 98 were women. Median age was 75 years, and the median observation period was 17.5 months. Re-bleeding was observed in 79 patients (28%). A history of CDB (OR 2.1, p = 0.0090) and chronic kidney disease (CKD; OR 2.3, p = 0.035) were risk factors, and bleeding point identification (OR 0.20, p = 0.0037) was a preventive factor for re-bleeding. Bleeding point identification significantly reduced approximately 80% of re-bleeding. Furthermore, extravasation on CT (OR 3.7, p = 0.031) and urgent colonoscopy (OR 5.3, p < 0.001) were predictors for identification of bleeding point. Compared to bleeding point identification of 11% in all patients who underwent colonoscopy, identification rate in those who had extravasation on CT and underwent urgent colonoscopy was as high as 70%. Conclusions: Contrast-enhanced CT upon arrival is suggested, and patients with extravasation on CT would be good candidates for urgent colonoscopy, as well as patients who have a history of CDB and CKD.

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Increase in colonic diverticulosis and diverticular hemorrhage in an aging society: lessons from a 9-year colonoscopic study of 28,192 patients in Japan

Abstract: Colonic diverticulosis and diverticular bleeding are prevalent and increasing in Japan. Given the significant association of age with this trend, both diseases can be expected to increase for decades to come.

Cited by 103 publications

References 38 publications

Increase in colonic diverticular hemorrhage and confounding factors

Increase in colonic diverticular hemorrhage and confounding factors

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

Initial Management of Colonic Diverticular Bleeding: Observational Study

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