Analysis of risk factors for colonic diverticular bleeding and recurrence

Abstract

The increase in incidence of colonic diverticular bleeding is relative to an age-related rise in the incidence of colonic diverticulosis and use of antithrombotic medication. However, risk factors related to the onset, recurrence, and prophylaxis have not been established. Therefore, we aimed to determine risk factors for the onset and recurrence of colonic diverticular bleeding.An age- and sex-matched case-control study was performed to assess the risk factors for the onset of colonic diverticular bleeding. The distribution of diverticulosis, comorbidity, and medication were evaluated from medical records. We also assigned patients with a first-time bleeding into groups with and without rebleeding during follow-up to determine risk factors for recurrence.Bilateral colonic diverticulosis, nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin (LDA), and anticoagulants were significant risk factors for the onset of colonic diverticular bleeding on multivariate analysis. In contrast, the use of selective cyclooxygenase-2 (COX-2) inhibitor was not a risk factor for the onset. The incidence of bleeding in direct oral anticoagulant and warfarin users was not different between the 2 groups. The cumulative recurrence rate at 1 year was 15%. Recurrence rate was significantly higher in patients with a prior history of colonic diverticular bleeding than those without. Steroid use was associated with recurrence.Extensive distribution of diverticulosis and use of nonselective NSAIDs, LDA, and anticoagulants are regarded as risk factors for the onset of colonic diverticular bleeding. In addition, a prior history of colonic diverticular bleeding is related to the recurrence.

Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular Hemorrhage

“…is result was consistent with previous reports showing that early colonoscopy did not contribute to the reduced incidence of recurrent bleeding [14]. With regard to the risk factors of recurrent bleeding, a previous history of diverticular hemorrhage as well as use of thienopyridine derivative was significantly associated with recurrent bleeding, although there was a report showing that the use of nonsteroidal anti-inflammatory drugs and antiplatelet drugs as well as high blood pressure increased the frequency of rebleeding [16,33,35,36]. Moreover, in the present study, patients with DAPT had an extremely high recurrent bleeding rate, which was also anticipated to increase.…”

Calcified Diverticula in the Setting of Per Rectal Bleed

“…After initial resuscitation and stabilization of our patient, the next concern was the risk of rebleeding. After an initial diverticular bleed, the rate of rebleeding can up to 51% within two years of the initial bleed [11] with the main risk factor being that initial bleed. With calcification being a rare occurrence with diverticula, it should be monitored with dedicated surveillance to ascertain rebleeding rates for this particular phenomenon.…”

Diverticular Disease

“…Occult bleeding and iron deficiency anemia are not features of DD. Nearly 40% of lower gastrointestinal bleeding is due to colonic diverticula, but bleeding complicates only 5% of all cases of colonic diverticulosis (Taki et al 2017). The bleeding is self-limiting in most, but in 20%, it persists, requiring emergency treatment.…”