Risk factors for colonic diverticular bleeding: A Westernized community based hospital study

Jansen, A.; Harenberg, Sabine; Grenda, Uwe; Elsing, Christoph

doi:10.3748/wjg.15.457

Cited by 69 publications

(81 citation statements)

References 19 publications

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“…abscess, perforation). In addition, three small case-control studies of diverticular bleeding found no relationship with alcohol intake [34,35,36]. …”

Section: Alcoholmentioning

confidence: 99%

Lifestyle Factors and the Course of Diverticular Disease

Strate¹

2012

Dig Dis

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The dramatic increase in the prevalence of diverticular disease after industrialization has led to the belief that diet and lifestyle factors play a significant role in its pathogenesis. Dietary fiber deficiency has received the most attention, although data are limited and conflicting. Two recent cross-sectional studies found no association between fiber intake and diverticulosis, and one found a positive association. However, fiber may improve symptoms associated with uncomplicated diverticulosis and decrease the risk of diverticulitis. Red meat intake may also increase the risk of diverticular symptoms and complications. Contrary to a long-standing belief, a large prospective study found that nuts and corn did not increase the risk of diverticulitis or diverticular bleeding. A number of case-control and prospective studies have found positive associations between obesity and diverticular complications. Central obesity may be particularly important. Vigorous physical activity appears to reduce the risk of diverticulitis and diverticular bleeding. Findings regarding smoking and diverticular complications have been inconsistent, but suggest that smokers are at increased risk for complications, particularly perforation. Alcohol may increase the risk of asymptomatic diverticulosis and diverticulitis. Research is needed to define the role of lifestyle modification in the primary and secondary prevention of diverticulosis and its complications.

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“…abscess, perforation). In addition, three small case-control studies of diverticular bleeding found no relationship with alcohol intake [34,35,36]. …”

Section: Alcoholmentioning

confidence: 99%

Lifestyle Factors and the Course of Diverticular Disease

Strate¹

2012

Dig Dis

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“…Previous studies have also reported very low mortality rates associated with CDB (2,5,13,16,17). This indicates that mortality is not a major outcome of CDB and that the therapeutic measures applied to these patients are in fact effective.…”

Section: Discussionmentioning

confidence: 85%

“…Mortality rates related to CDB are low, varying from 0 to 7% across studies (2,5,13,16,17). Severe bleeding is more difficult to assess, since its definition is not clearly established, and therefore different studies have used different criteria.…”

Section: Introductionmentioning

confidence: 99%

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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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“…The presence of hypercholesterolaemia was retrieved from the EPR and defined as elevated levels of cholesterol in the bloodstream compared with the reference range and requiring treatment. Usage of regularly prescribed medications, such as aspirin 22 and steroids, 23 was also recorded as these have been shown to be independent risk factors for diverticular haemorrhage.…”

Section: Ethnicity and Comorbiditiesmentioning

confidence: 99%

A cross sectional study of colonic diverticulosis in the London Bangladeshi population

et al. 2013

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Background: Diverticular disease is the most common morphological abnormality of the colon and the fifth most important gastrointestinal disease in terms of cost in the Western world. Tower Hamlets is the poorest borough in London containing a large Bangladeshi community. We observed that emergency admissions with complications of colonic diverticulosis were minimal in the Bangladeshi community. The objective was to compare the background prevalence of colonic diverticulosis in Bangladeshis with other ethnicities in patients undergoing colonoscopy at a single centre in Tower Hamlets. Methods: Four thousand four hundred and fifty-four consecutive colonoscopy reports over a 2-year period were retrospectively analysed. Patients under 40 years of age and repeat colonoscopies were excluded, leaving 3151 patients (mean age: 63 years; 48% male). Demographics including ethnicity and medical background were retrieved from the electronic patient record system and findings correlated with the prevalence of other 'Western' diseases in the cohort. Results: Six hundred and thirty out of 3151 (20%) colonoscopies were performed on Bangladeshis. The prevalence of colonic diverticulosis was significantly lower in Bangladeshis (17/630: 2.7%) than Caucasians (673/1869: 36%), Indians/Pakistanis (16/161: 9.9%), Oriental (15/44: 34%) and Black (90/369: 24.4%) patient groups ( 2 p < 0.0001 for all comparisons). The prevalence of classical sigmoid diverticulosis in the Bangladeshi cohort was only 1.0%, despite significantly more Bangladeshi patients undergoing colonoscopy for abdominal pain (p < 0.0001, 2 ) and diarrhoea (p < 0.0034, 2 ). There was also a significantly greater incidence of type 2 diabetes mellitus and ischaemic heart disease (p < 0.0001, 2 ) in Bangladeshi patients. Conclusions: There is a negligible prevalence of colonic diverticulosis in the Bangladeshi population of London who undergo colonoscopy. This is in spite of a high incidence of type 2 diabetes and ischaemic heart disease. The effect of diet and genetics on the prevalence of colonic diverticulosis in Bangladeshis is not known and merits further investigation.

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Risk factors for colonic diverticular bleeding: A Westernized community based hospital study

Abstract: Beside nonsteroidal anti-inflammatory steroid drug use, antihypertensive medication and concomitant arteriosclerotic diseases are risk factors for colonic diverticular hemorrhage. Our results support the hypothesis of an altered arteriosclerotic vessel as the source of bleeding.

Cited by 69 publications

References 19 publications

Lifestyle Factors and the Course of Diverticular Disease

Lifestyle Factors and the Course of Diverticular Disease

Risk factors for severity and recurrence of colonic diverticular bleeding

A cross sectional study of colonic diverticulosis in the London Bangladeshi population

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