Colonic diverticular hemorrhage associated with the use of nonsteroidal anti‐inflammatory drugs, low‐dose aspirin, antiplatelet drugs, and dual therapy

Nagata, Naoyoshi; Niikura, Ryota; Aoki, Tomonori; Shimbo, Takuro; Kishida, Yoshihiro; Sekine, Katsunori; Tanaka, Shohei; Watanabe, Kazuhiro; Sakurai, Toshiyuki; Yokoi, Chizu; Akiyama, Junichi; Yanase, Mikio; Mizokami, Masashi; Uemura, Naomi

doi:10.1111/jgh.12595

Cited by 64 publications

(66 citation statements)

References 36 publications

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“…In multivariate analysis, we included factors such as the use of NSAIDs, low-dose aspirin, and non-aspirin antiplatelet agents, which showed a significant association with bleeding in the univariate analysis. In addition, we also included age, gender, alcohol, smoking, and metabolic factors, such as diabetes mellitus, dyslipidemia, and hypertension, and chronic kidney disease, which showed association with obesity in univariate analysis and which affects the risk of diverticular bleeding, as previously reported [7,8,22]. Thus, the multivariate model was developed using age, gender, alcohol, smoking, NSAIDs, low-dose aspirin, non-aspirin antiplatelet agents, metabolic factors, and chronic kidney disease (Model 1).…”

Section: Discussionmentioning

confidence: 97%

“…Besides the use of nonsteroidal antiinflammatory drugs (NSAIDs) and low-dose aspirin [7,8], arteriosclerotic diseases have been recently reported to be a risk factor for diverticular bleeding [9][10][11]. Furthermore, arteriolar changes such as the intimal thickening and medial thinning of the vasa recta over the dome of the diverticulum have been considered in the pathogenesis of diverticular bleeding [12].…”

Section: Introductionmentioning

confidence: 99%

“…Colonoscopy has enabled the detection of incidental diverticulosis [6,7,14] and is also an essential diagnostic tool for detecting diverticular bleeding [15,16]; however, no data are available from colonoscopic studies regarding the association of diverticular bleeding and obesity. In this study, we conducted a case-control (endoscopically verified colonic diverticula versus bleeding diverticula) study of Japanese adults who underwent colonoscopy and CT.…”

Section: Introductionmentioning

confidence: 99%

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Visceral fat accumulation affects risk of colonic diverticular hemorrhage

Nagata

Sakamoto

Arai

et al. 2015

Int J Colorectal Dis

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Visceral fat accumulation affects risk of colonic diverticular hemorrhage

Nagata

Sakamoto

Arai

et al. 2015

Int J Colorectal Dis

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“…The drugs significantly associated with diverticular bleeding were some NSAIDs, LDA, clopidogrel, and cilostazol. Dual antiplatelet therapy carried a higher risk than monotherapy (single therapy, adjusted OR 2.0, 95 % CI and dual, adjusted OR 4.1, 95 % CI) [27].…”

Section: Effects Of Low-dose Aspirin In the Gastrointestinal Tractmentioning

confidence: 96%

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

Lanas

Gargallo²

2015

J Gastroenterol

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Low-dose aspirin, alone or combined with other antiplatelet agents, is increasingly prescribed for cardiovascular prevention. However, the cardiovascular benefits should be evaluated together with the gastrointestinal risks. Low-dose aspirin is associated with upper and lower gastrointestinal injury, although lower gastrointestinal effects are poorly characterized. This gastrointestinal risk differs among antiplatelets drugs users. The most important risk factors are history of peptic ulcer, older age, and concomitant use of non-steroidal anti-inflammatory drugs or dual antiplatelet therapy. Effective upper gastrointestinal prevention strategies are available and should be used in at-risk patients taking low-dose aspirin or clopidogrel. Proton pump inhibitors seem to be the best gastroprotective agents, whereas the benefits of Helicobacter pylori eradication are still unclear. Low-dose aspirin has additional effects in the gastrointestinal tract. A large body of evidence indicates that it can protect against different cancers, in particular colorectal cancer. This effect could modify the future indications for use of low-dose aspirin and the risk-benefit balance.

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“…The drugs significantly associated with bleeding were loxoprofen (aOR 5.0), diclofenac (aOR 3.1), diclofenac suppository (aOR 8.0), etodolac (aOR 4.9), enteric-coated aspirin (aOR 3.9), buffered aspirin (aOR 9.9), clopidogrel (aOR 2.5), and cilostazol (aOR 7.3). Dual therapy carried a higher risk than monotherapy (single NSAID, aOR 3.6, p<0.01; dual, aOR 23, p<0.01; single antiplatelet drug, aOR 2.0, p<0.01; dual, aOR 4.1, p<0.01) [19]. Those patients taking one or more NSAIDS or antiplatelet drugs should be therefore carefully monitored for diverticular hemorrhage if having diverticulosis.…”

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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Colonic diverticular hemorrhage associated with the use of nonsteroidal anti‐inflammatory drugs, low‐dose aspirin, antiplatelet drugs, and dual therapy

Cited by 64 publications

References 36 publications

Visceral fat accumulation affects risk of colonic diverticular hemorrhage

Visceral fat accumulation affects risk of colonic diverticular hemorrhage

Management of low-dose aspirin and clopidogrel in clinical practice: a gastrointestinal perspective

The Role of Colonoscopy in Managing Diverticular Disease of the Colon

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