Risk Factors for Colonic Diverticular Hemorrhage: Japanese Multicenter Study

Suzuki, Kaori; Uchiyama, S.; Imajyo, Kento; Tomeno, Wataru; Shimizu, Eiji; Yamada, Eiji; Tanida, Emiko; Akiyama, Tomoyuki; Watanabe, Seitaro; Endo, Hideki; Fujita, Koji; Yoneda, Masato; Takahashi, Hirokazu; Koide, Tomoko; Tokoro, Chikako; Abe, Yasunobu; Kawaguchi, Minoru; Gotoh, Eiji; Maeda, Shin; Nakajima, Atsushi; Inamori, Masahiko

doi:10.1159/000336351

Cited by 39 publications

(40 citation statements)

References 16 publications

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“…We identified 74 patients of advanced age, mainly males, who presented several co-morbidities and use of multiple medications. The dimension and characteristics of this group are similar to previous studies with similar designs and objectives (8,12,17,(24)(25)(26). The high number of co-morbidities and subsequent medication is in accordance with patient age.…”

Section: Discussionsupporting

confidence: 79%

“…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%

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Risk factors for severity and recurrence of colonic diverticular bleeding

Joaquim¹,

Caldeira²,

Antunes³

et al. 2016

Rev Esp Enferm Dig

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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.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Risk factors for severity and recurrence of colonic diverticular bleeding

Joaquim¹,

Caldeira²,

Antunes³

et al. 2016

Rev Esp Enferm Dig

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“…Several previous studies have reported an association between rebleeding and usage of NSAIDs and antiplatelet agents as well as the presence of comorbidities [21,22] . The use of aspirin or NSAIDs increases risk for CDB [20,22] and CDB recurrence [11,12,23] . The presence of diverticula on both sides of the colon is reported to be a risk factor for CDB [22] .…”

Section: Discussionmentioning

confidence: 99%

Long-Term Clinical Course after Conservative and Endoscopic Treatment of Colonic Diverticular Bleeding

et al. 2016

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Background/Aim: What naturally happens to patients after they undergo conservative and endoscopic treatment of colonic diverticular bleeding (CDB) is largely unknown. We retrospectively track the long-term outcome of the recurrence of CDB between patients with endoscopic and conservative treatment. Methods: The group was divided into 2 groups: patients treated with injection and/or clipping (endoscopic group) and patients in whom such treatment could not be performed (conservative group). CDB recurrence was assessed via a questionnaire, and recurrence rates were investigated between groups using the Kaplan-Meier's method. The Cox proportional hazards model was performed to identify potential risk factors for recurrence. Results: Eighty-eight patients answered the questionnaires. The median (interquartile range) follow-up period was 42.7 (61.8) months. Twenty-four (38.7%) of 62 conservatively treated patients and 16 (61.5%) of 26 endoscopically treated patients experienced recurrence of CDB during the follow-up period. Kaplan-Meier's analysis showed that the rate of recurrence was significantly higher (p < 0.05) in cases with endoscopic treatment than in those with conservative treatment (mean time to recurrence = 55.3 months (95% CI 30.8-79.9) vs. 99.9 months (95%CI 80.7-119.1)). The Cox proportional hazards model did not identify any significant variables. Conclusion: We should carefully follow-up patients to check for the recurrence of CDB, even when it could be successfully treated endoscopically. Can endoscopic treatment of CDB prevent CDB recurrence? Also, what happens to the patient's well-being after they undergo conservative and endoscopic treatment (cases diagnosed by Jensen's criteria) is largely unknown. We examined a population of patients undergoing conservative or endoscopic treatment to clarify the clinical course, particularly with regard to CDB recurrence.

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“…Suzuki et al found recently that the percentage of patients with diverticula on both the right and left colon was significantly higher in the diverticular than in the non-diverticular bleeding group (p=0.0011). Multiple regression analysis identified only the diverticular location as being significantly linked to the risk of diverticular bleeding (p= 0.0021) [18].…”

Section: Colonoscopy and Diverticular Bleedingmentioning

confidence: 99%

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

Tursi

2015

JGLD

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Diverticulosis of the colon is frequently found on routine colonoscopy, and the incidence of diverticular disease and its complications appears to be increasing. The role of colonoscopy in managing this disease is still controversial.Colonoscopy plays a key role in managing diverticular bleeding. Several techniques have been effectively used in this field, but band ligation seems to be the best in preventing rebleeding. Colonoscopy is also effective in posing a correct differential diagnosis with other forms of chronic colitis involving colon harbouring diverticula (in particular with Crohn's disease or Segmental Colitis Associated with Diverticulosis). The role of colonoscopy to confirm diagnosis of uncomplicated diverticulitis is still under debate, since the risk of advanced colonic neoplasia in patients admitted for acute uncomplicated diverticulitis is not increased as compared to the average-risk population. On the contrary, colonoscopy is mandatory if patients complain of persistent symptoms or after resolution of an episode of complicated diverticulitis. Finally, a recent endoscopic classification, called Diverticular Inflammation and Complications Assessment (DICA), has been developed and validated. This classification seems to be a promising tool for predicting the outcome of the colon harboring diverticula, but further, prospective studies have to confirm its predictive role on the outcome of the disease.

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Risk Factors for Colonic Diverticular Hemorrhage: Japanese Multicenter Study

Cited by 39 publications

References 16 publications

Risk factors for severity and recurrence of colonic diverticular bleeding

Risk factors for severity and recurrence of colonic diverticular bleeding

Long-Term Clinical Course after Conservative and Endoscopic Treatment of Colonic Diverticular Bleeding

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

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