Natural history of bleeding risk in colonic diverticulosis patients: a long‐term colonoscopy‐based cohort study

Niikura, Ryota; Nagata, Naoyoshi; Shimbo, Takuro; Aoki, Tomonori; Yamada, Atsuo; Hirata, Yoshihiro; Sekine, Katsunori; Okubo, Hidetaka; Watanabe, Kazuhiro; Sakurai, Toshiyuki; Yokoi, Chizu; Mizokami, Masashi; Yanase, Mikio; Akiyama, Junichi; Koike, Kazuhiko; Uemura, Naomi

doi:10.1111/apt.13148

Cited by 50 publications

(37 citation statements)

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“…Arteriosclerosis also plays a role in the pathogenesis patients during the natural history of diverticulosis, and most cases are relatively mild, resolving spontaneously in 75%93% of cases [15,16] . In a casecontrol study in Japan, risk factors for DH included the use of ATDs and NSAIDs, hypertension, diabetes, arteriosclerotic diseases such as ischemic disease mellitus and chronic kidney disease, age ≥ 70 years, obesity [13,15,17,18] .…”

Section: Discussionmentioning

confidence: 99%

“…In a casecontrol study in Japan, risk factors for DH included the use of ATDs and NSAIDs, hypertension, diabetes, arteriosclerotic diseases such as ischemic disease mellitus and chronic kidney disease, age ≥ 70 years, obesity [13,15,17,18] . Our study also found higher rates of use for both ATDs and NSAIDs, higher age and male sex, obesity, smoking, alcohol drinking, and arteriosclerotic diseases in patients with colonic DH compared to those with bleeding from other causes.…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Increase in colonic diverticular hemorrhage and confounding factors

Kinjo¹,

Matsui²,

Hisabe³

et al. 2016

WJGPT

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“…The actual incidence of acute diverticulitis was as low as 4.3% over a period of 15 years, challenging the previously reported risk rates [3,11,12]. The study had some limitations in- cluding patient selection, a restrictive definition of outcome, and the lack of ascertainment of diverticular bleeding, another important complication estimated to occur in 3-5% of the patients with diverticulosis [24]. Over an 11-year period, 23 patients (1%) developed rigorously confirmed diverticulitis for an incidence rate of 1.5 per 1,000 patient-years.…”

Section: Natural Historymentioning

confidence: 84%

“…Importantly, the study population consisted of patients with incidental diverticulosis on all-indication colonoscopies and not a well-defined cohort of patients undergoing screening colonoscopy. The second study by Niikura et al [24] from Japan examined the bleeding risk in 1,514 patients with asymptomatic diverticulosis identified over a 12-year period (2001-2013). The median follow-up period was 3.8 years.…”

Section: Natural Historymentioning

confidence: 99%

The Natural History of Colonic Diverticulosis: Much Ado about Nothing?

Rustom

Sharara²

2018

Inflamm Intest Dis

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Background: Colonic diverticulosis is the most common incidental lesion found on routine colonoscopy. However, its true natural history is unclear. The aim of this review is to examine the epidemiology of colonic diverticulosis and the incidence of complications, namely acute diverticulitis and diverticular hemorrhage. Summary: Many studies have evaluated the epidemiology and risk factors of diverticulosis. Despite the common nature of this entity, little is known about the risk of complications in asymptomatic individuals. It has been suggested that the lifetime risk of acute diverticulitis is 10–25% and that of diverticular hemorrhage is 3–5%. These risk estimates were based on older literature without accurate studies on true prevalence. Three recent retrospective observational cohort studies including subjects identified at colonoscopy have addressed this issue, providing information on the long-term risk of complications of colonic diverticulosis. Cumulative data from these studies support an incidence of acute diverticulitis of 1.5–6.0 per 1,000 patient-years and 0.46 per 1,000 patient-years for diverticular hemorrhage. Key Messages: Diverticulosis is a very common condition in individuals > 50 years of age. Based on population-based colonoscopy studies, the natural history of colonic diverticulosis appears favorable with a far lower incidence of complications than previously thought.

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“…Ezen laesiók találati ará-nyában nem volt különbség a vérző és nem vérző betegpopuláció között, és a gyakoriságok megfelelnek a korábban említett irodalmi adatoknak [35,36,42,43]. Bár a diverticulumokból eredő vérzés az akut alsó GI-vérzé-sek leggyakoribb oka (24-47%), a diverticulumok csak igen csekély hányadából származik vérzés [47,48]. A colorectalis daganatok találati arányában már szignifikáns különbség adódott vérző és nem vérző betegcsoportok között (13,2% vs. 4,3%).…”

Section: Megbeszélésunclassified

A felső és alsó endoszkópiák indikációja, a diagnózisok megoszlása és minőségi mutatók 2010–2011-ben a Semmelweis Egyetem I. Belgyógyászati Klinikáján

et al. 2016

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Bevezetés és célkitűzés:A Semmelweis Egyetem I. Belgyógyászati Klinikájának endoszkópos laboratóriumában vizsgál-ták a felső és alsó endoszkópiák indikációit, a diagnózisok megoszlását indikációk szerint, valamint a kolonoszkópiák minőségi mutatóit. Módszer: 2010. január 1. és 2011. december 31. között 2987 beteg felső és alsó endoszkópos vizsgálatának adatait elemezték (férfi/nő: 1361/1626, átlagéletkor: 60,7 év, SD: 16,7 év) a fekvő-és járóbeteg-megjelenések riportjaiból. Eredmények: A felső endoszkópiák során a jóindulatú fekélybetegség, nyelőcső-varicositas, gyomorpolip és gyomorrák előfordulási gyakorisága 10,8%, 4,5%, 6,1% és 2,9% volt. Az alsó endoszkópos vizsgálatok vastagbélpolipot, diverticulosist, daganatot és gyulladásos bélbetegséget 29,9%, 22,4%, 6,9% és 9,7%-ban írtak le. A betegek 26,3%-át vizsgálták okkult/manifeszt GI-vérzés indikációjával. A vérzés indikációjával vizsgált betegek idősebbek voltak (p<0,01), több volt a férfi (p<0,001, OR: 1,64), gyakrabban szedtek acenocoumarol-vagy heparinkészítményeket (p<0,001), gyakoribb volt a jóindulatú fekélybetegség (p<0,001, OR: 2,83) és nyelőcső-varicositas (p<0,001, OR: 2,79), a gasztroszkópiák, valamint a kolonoszkópiák során a colorectalis daganat (p<0,001,OR: 3,27). A kolonoszkópiák 81%-a volt komplett. Az inkomplett vizsgálat hátterében elégtelen előkészítés (38,2%), technikai nehézség (25,1%) és daganat miatti szűkület (20,5%) állt. Következtetés: A diagnózisok megoszlása és a minőségi mutatók (adenomatalálat, komplettálási arány) megfeleltek az adott populációban várhatónak. Orv. Hetil., 2016Hetil., , 157(52), 2074Hetil., -2081

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Natural history of bleeding risk in colonic diverticulosis patients: a long‐term colonoscopy‐based cohort study

Abstract: SUMMARY BackgroundThe natural history of bleeding risk from colonic diverticulosis remains unclear.

Cited by 50 publications

References 29 publications

Increase in colonic diverticular hemorrhage and confounding factors

Increase in colonic diverticular hemorrhage and confounding factors

The Natural History of Colonic Diverticulosis: Much Ado about Nothing?

A felső és alsó endoszkópiák indikációja, a diagnózisok megoszlása és minőségi mutatók 2010–2011-ben a Semmelweis Egyetem I. Belgyógyászati Klinikáján

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