Pathogenesis of massively bleeding colonic diverticulosis: new observations

Meyers, Morton A.; Alonso, Daniel R.; Baer, Jeanne W.

doi:10.2214/ajr.127.6.901

Cited by 83 publications

(64 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With repeated mechanical sti muli, intimal thickening of the vasa recta occurs, often with thinning of the media. These changes can cause segmental weakening of the vasa recta, which may lead to arterial hemorrhage in the bowel lumen [19] . Thus, because DH represents a form of arterial bleeding, trans fusion may be required more often than with bleeding due to other disorders.…”

Section: Discussionmentioning

confidence: 99%

Increase in colonic diverticular hemorrhage and confounding factors

Kinjo¹,

Matsui²,

Hisabe³

et al. 2016

WJGPT

View full text Add to dashboard Cite

AIM:To classify changes over time in causes of lower gastrointestinal bleeding (LGIB) and to identify factors associated with changes in the incidence and characteristics of diverticular hemorrhage (DH). METHODS:A total of 1803 patients underwent colonoscopy for overt LGIB at our hospital from 1995 to 2013. Patients were divided into an early group (EG, 1995(EG, -2006 n = 828) and a late group (LG, 2007(LG, -2013 Author contributions: Kinjo K collected and analyzed the data, and drafted the manuscript; Matsui T designed and supervised the study; Washio M performed the statistical analysisl; Hisabe T, Ishihara H, Maki S, Chuman K, Koga A, Ohtsu K, Takatsu N, Hirai F and Yao K performed the colonoscopy and revised the manuscript for important intellectual content; all authors have read and approved the final version to be published.Institutional review board statement: This study was approved by the institutional review board of Fukuoka University Chikushi Hospital (R15-024) and was conducted in accordance with the Declaration of Helsinki.Informed consent statement: In this study, We do not necessarily need the individual agreement from a study subject. Because this study is retrospective study and based on the ethical guidelines for medical studies intended for people "taken from the human body undergoes No. 12 informed consent procedures was used samples not research". Information about the implementation of this research exposes to Fukuoka University Chikushi Hospital clinical research support Center home page. Conflict-of-interest statement:In connection with this manuscript, there is no Conflict of Interest to be disclosed with any companies.Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at matsui@ fukuoka-u.ac.jp. Participants gave informed consent was not obtained but the presented data are anonymized and risk of identification is low. Retrospective Studybetween patients with and without DH. RESULTS:Older patients (≥ 70 years old) and those with colonic DH were more frequent in LG than in EG (P < 0.01). Patients using ATDs as well as NSAIDs, male sex, obesity (body mass index ≥ 25 kg/m 2 ), smoking, alcohol drinking, and arteriosclerotic diseases were more frequent in patients with DH than in those without. CONCLUSION:Incidence of colonic DH seems to increase with aging of the population, and factors involved include use of ATDs and NSAIDs, male sex, obesity, smoking, alcohol drinking, and arteriosclerotic disease. These factors are of value in handling DH patients. Core tip: Colonic diverticular hemorrhage (DH) is the most frequent cause of lower gastrointestinal bleeding. A rapid increase in the incidence of colonic DH has been seen with the aging population. One reason is the widespread adoption of antithrombotic drugs (ATDs) since the early 2000s, based on guidelines to prevent ischemic heart disease and ischemic cerebrovascular disease. DH is more likely in patients who are older, are men, obesity, use nonsteroidal anti-inf...

show abstract

Section: Discussionmentioning

confidence: 99%

Increase in colonic diverticular hemorrhage and confounding factors

Kinjo¹,

Matsui²,

Hisabe³

et al. 2016

WJGPT

View full text Add to dashboard Cite

show abstract

“…Severe hemorrhage can arise in 3-5% of patients with diverticulosis [63,64] . Despite the fact that most diverticula are in the left colon in subjects from developed Western countries, the site of bleeding may more often be located in the proximal colon [63,[65][66][67][68] . Microangiography on resected specimens from patients with bleeding diverticula shows intimal thickening and medial thinning of the vasa recta as it courses over the dome of the diverticulum [65] .…”

Section: Hemorrhagementioning

confidence: 99%

Diverticular Disease in the Elderly

Comparato

Pilotto

Franzè

et al. 2007

Dig Dis

125

View full text Add to dashboard Cite

There are few diseases whose incidence varies as greatly worldwide as that of diverticulosis. Its prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those ≧65 years of age. Of patients with diverticula, 80–85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15–20% of patients develop symptomatic diverticular disease. Traditional concepts regarding the causes of colonic diverticula include alterations in colonic wall resistance, disordered colonic motility and dietary fiber deficiency. Currently, inflammation has been proposed to play a role in diverticular disease. Goals of therapy in diverticular disease should include improvement of symptoms and prevention of recurrent attacks in symptomatic, uncomplicated diverticular disease, and prevention of the complications of disease such as diverticulitis. Diverticulitis is the most usual clinical complication of diverticular disease, affecting 10–25% of patients with diverticula. Most patients admitted with acute diverticulitis respond to conservative treatment, but 15–30% require surgery. Predictive factors for severe diverticulitis are sex, obesity, immunodeficiency and old age. Surgery for acute complications of diverticular disease of the sigmoid colon carries significant rates of morbidity and mortality, the latter of which occurs predominantly in cases of severe comorbidity. Postoperative mortality and morbidity are to a large extent driven by patient-related factors.

show abstract

“…Colonic diverticula are pseudodiverticula resulting from herniation of the mucosa and submucosa through a weakened portion of the colonic wall (1). Colonic diverticulosis is an acquired disease caused by an increased intestinal pressure due to the decreased intake of dietary fiber and mu-causes complications such as diverticulitis or bleeding.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

et al. 2015

View full text Add to dashboard Cite

Objective Diverticular bleeding is the most common cause of acute lower gastrointestinal bleeding, and its incidence has recently increased. However, the treatment strategy of diverticular bleeding has not yet been established. The aim of the study was to investigate the efficacy of contrast-enhanced computed tomography (CECT) to determine the indication for urgent colonoscopy to achieve hemostasis. Methods A total of 124 patients diagnosed with diverticular bleeding between 2012 and 2013 in our hospital were analyzed. The clinical behavior, factors related to detecting bleeding diverticula, and risk factors for early rebleeding of diverticular bleeding were evaluated. Results Clinical behavior: Bleeding diverticula were identified in 23 of 124 (19%) patients and most of them (16/23; 70%) were located in the ascending colon. Hemostasis was achieved in all 23 cases, however, six (26%) developed early rebleeding. Factors for detecting bleeding diverticula: In patients in whom extravasation was detected using CECT, the endoscopic detection rate of bleeding diverticula was 60% (12/20), while bleeding diverticula were detected in only 31% (11/35) of patients in whom extravasation was not detected using CECT (p<0.05). The interval between the first hematochezia and colonoscopy in which the bleeding point was detected by colonoscopy (median 23.5 hours) was shorter than that in which bleeding diverticula were not detected (median 43.6 hours) (p<0.01). Risk factors for short term rebleeding: Using a univariate analysis, atherosclerotic comorbidity, anti-inflammatory drugs including low-dose aspirin, antithrombotic agents, vital signs on admission, hemoglobin level on hospitalization, and extravasation on CECT were not found to be significant risk factors. Conclusion The finding of extravasation on CECT is the most important factor for identifying and treating bleeding diverticula by colonoscopy. In such cases, urgent colonoscopy is recommended.

show abstract

Pathogenesis of massively bleeding colonic diverticulosis: new observations

Cited by 83 publications

References 10 publications

Increase in colonic diverticular hemorrhage and confounding factors

Increase in colonic diverticular hemorrhage and confounding factors

Diverticular Disease in the Elderly

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

Contact Info

Product

Resources

About