Increase in colonic diverticular hemorrhage and confounding factors

Kinjo, Ken; Matsui, Toshiyuki; Hisabe, Takashi; Ishiguro, Hiroshi; Maki, Shinichiro; Chuman, Kenta; Koga, Akihiro; Ohtsu, Kensei; Takatsu, Noritaka; Hirai, Fumihito; Yao, Kenshi; Washio, Masakazu

doi:10.4292/wjgpt.v7.i3.440

Cited by 34 publications

(41 citation statements)

References 23 publications

(24 reference statements)

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“…The proportion of diverticular bleeding was increasing significantly from 1.02% (22 of 2,157 subjects) in 2003 to 1.67% (69 of 4,159 subjects) in 2011, and it was associated with an increased number of patients aged 40-59 years. Kinjo et al [49] also reported that patients with colonic diverticular bleeding were older male patients (≥70 years old) and that colonic diverticular bleeding was more frequent in the late-period group (2007-2013) than in the early-period group (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006).…”

Section: Diverticular Bleedingmentioning

confidence: 99%

The Burden of Diverticular Disease and Its Complications: West versus East

Imaeda¹,

Hibi²

2018

Inflamm Intest Dis

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Background: Colonic diverticulosis is prevalent and increasing not only in Western but also in Asian countries. Diverticulosis can be complicated by diverticulitis and diverticular bleeding. Diverticular disease is a burdensome digestive disease, because it is a major cause of hospital admissions and is associated with significant health-care costs. Summary: The incidence of diverticulosis increases with age. Most cases of diverticulosis in Western countries involve the left side of the colon, while diverticulosis is predominantly present on the right side of the colon in Asian countries. The incidence of diverticulitis also increases with age. Diverticulitis is predominantly located on the left side of the colon in Western countries, while it is predominantly located on the right side of the colon in Asian countries. The overall complication rate is higher in left-sided than in right-sided diverticulitis. The incidence of diverticular bleeding also increases with age. The right colon is the source of diverticular bleeding in more than 50% of patients in Western countries. In Asian countries, age greater than 70 years and both-sided diverticulosis increase the bleeding risk. Key Messages: In Western countries, diverticulosis and diverticulitis are predominantly located on the left side of the colon, whereas they are predominantly present on the right side of the colon in Asian countries. Diverticular bleeding is predominantly located on the right side in Western countries, and both-sided diverticulosis increases the risk of bleeding in Asian countries. Diverticular disease with complications requires admission and operation; moreover, it recurs frequently. Therefore, diverticular disease is associated with a significant economic burden in terms of health-care costs and resource utilization.

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Section: Diverticular Bleedingmentioning

confidence: 99%

The Burden of Diverticular Disease and Its Complications: West versus East

Imaeda¹,

Hibi²

2018

Inflamm Intest Dis

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“…The cases of colonic diverticular bleeding are increasing in relation to the rising incidence of colonic diverticulosis and antithrombotic drug use. [ 7 ] Although the mechanism of colonic diverticular bleeding is not fully understood, it is thought to be caused by a rupture of the vasa rectum at the neck or dome of the diverticulum. [ 8 ] Colonic diverticular bleeding ceases spontaneously in 70% to 90% of cases.…”

Section: Introductionmentioning

confidence: 99%

Analysis of risk factors for colonic diverticular bleeding and recurrence

Taki

Oshima²,

Tozawa³

et al. 2017

Medicine

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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.

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“…In contrast, re-bleeding was observed during conservative treatment in 16%-38% of the patients with diverticular bleeding [7], and in particular, it has been reported that the rate of re-bleeding is high at 66% in patients with SRH [21]. The rate of re-bleeding is believed to be higher in patients who are men, older (>70 years), severely anemic (hemoglobin levels <8 g/dL), use antithrombotic agents, have a history of hypertension and hyperlipidemia, have a high body mass index, have poor ability to perform activities of daily living [22], present with tachycardia at the time of the consultation, have the bleeding diverticulum located in the ascending colon, and who have a long hospital stay [22][23][24][25][26]. The present results regarding the characteristics of patients with a high rate of spontaneous hemostasis following conservative treatment are in agreement with the previously reported characteristics of patients with rebleeding.…”

Section: Plos Onementioning

confidence: 99%