Risk factors for severity of colonic diverticular hemorrhage

Kinjo, Ken; Matsui, Toshiyuki; Hisabe, Takashi; Ishiguro, Hiroshi; Kojima, Toshiki; Chuman, Kenta; Yasukawa, Shigeyoshi; Beppu, Tsuyoshi; Koga, Akihiro; Ishikawa, Satoshi; Kishi, Masahiro; Takatsu, Noritaka; Hirai, Fumihito; Yao, Kenshi; Ueki, Toshiharu; Washio, Masakazu

doi:10.5217/ir.2018.16.3.458

Cited by 10 publications

(10 citation statements)

References 31 publications

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“…43,44 This may have limited the ability to adjust for multiple variables. Thirdly, we did not evaluate medications, including NSAIDs, statins, or opiates, which were reported to be risk factors for diverticular disease 45 due to missing data. However, no association between these medications and asymptomatic diverticulosis has been reported.…”

Section: Discussionmentioning

confidence: 99%

Vegetarianism as a protective factor for asymptomatic colonic diverticulosis in Asians: a retrospective cross-sectional and case-control study

et al. 2020

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ymptomatic, with only 10% to 25% of subjects with diverticulosis developing symptomatic diseases. 3 Diverticular disease of the colon is defined as symptomatic and clinically significant diverticulosis which includes symptomatic uncomplicated diverticular disease, diverticulitis, diverticular bleeding, and segmental colitis associated with diverticular disease. At present, diverticulosis is considered to be one of the most common GI disorders, and trends suggest an increasing incidence of associated complications and health care costs. 4-7 It is an essential cause of hospital admissions and a tremendous contributor to healthcare prices in Western countries. 5,8 Two features dominate the epidemiologic profile of diverticulosis:

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Section: Discussionmentioning

confidence: 99%

Vegetarianism as a protective factor for asymptomatic colonic diverticulosis in Asians: a retrospective cross-sectional and case-control study

et al. 2020

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“…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]. Colonic diverticular bleeding and diverticulitis are both acute illnesses, but because they tend to recur and necessitate colectomy when severe, their clinical significance is increasing.…”

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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“…[8] Recently, it has been used to predict the prognosis in various patient groups, [9][10][11][12]36] with high CCI scores becoming a risk factor for severe CDB. [37] In this study, the CCI scores of the two patients who died at rst admission were 4 and 5. A high CCI score is also a risk factor for rCDB.…”

Section: Discussionmentioning

confidence: 58%

High Charlson comorbidity index scores are associated with recurrent colon diverticular bleeding

Kim

You

Cho

et al. 2022

Preprint

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Background/Aims: Colonic diverticular bleeding (CDB) is a common cause of acute lower gastrointestinal bleeding. Patients with CDB are at increased risk for recurrence. Here, we aimed to evaluate the clinical course of patients with CDB and identify risk factors, including the Charlson comorbidity index (CCI), for recurrent CDB (rCDB).Methods: We retrospectively included patients who were hospitalized at the Chonnam National University Hospital for management of CDB between January 2005 and March 2020, and data on the underlying disease, drug history, treatment method, post-discharge rCDB, and death were checked.Results: Among 221 investigated patients (mean age, 68.1 years; 56 females), 56 and 165 had definite and presumptive CDB, respectively, 122 (55.2%) had a right-sided CDB, and 51 (23.3%) experienced rCDB throughout a median period of 339 days (range, 3–4817 days). The most common comorbidities were hypertension (62.4%) and diabetes (33.5%). The median length of hospitalization was 5 days (range, 2–119 days). The CDB-related morality rate was 0.9% at first admission. The cumulative incidence rates of rCDB after 1, 6, 12, 24 months were 4.6%, 9.1%, 12.3%, and 16.9%, respectively. In Cox regression analysis, rCDB more frequently occurred in patients with CCI ≥ 4 than in patients with CCI < 4 (adjusted hazard ratio, 2.76; 95% confidence interval, 1.30–5.88; p < 0.01).Conclusions: rCDB occurred frequently at any time in patients with previous CDB. High CCI scores were associated with rCDB. Clinicians need to consider possible rCDB for patients with high CCIs.

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Risk factors for severity of colonic diverticular hemorrhage

Cited by 10 publications

References 31 publications

Vegetarianism as a protective factor for asymptomatic colonic diverticulosis in Asians: a retrospective cross-sectional and case-control study

Vegetarianism as a protective factor for asymptomatic colonic diverticulosis in Asians: a retrospective cross-sectional and case-control study

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

High Charlson comorbidity index scores are associated with recurrent colon diverticular bleeding

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