Intest Res.  2018 Jul;16(3):458-466. 10.5217/ir.2018.16.3.458.

Risk factors for severity of colonic diverticular hemorrhage

• Kinjo K
• Matsui T
• Hisabe T
• Ishihara H
• Kojima T
• Chuman K
• Yasukawa S
• Beppu T
• Koga A
• Ishikawa S
• Kishi M
• Takatsu N
• Hirai F
• Yao K
• Ueki T
• Washio M

• KMID: 2417658
• DOI: http://doi.org/10.5217/ir.2018.16.3.458

Abstract

BACKGROUND/AIMS
Colonic diverticular hemorrhage (DH) was a rare disease until the 1990s, and its incidence has increased rapidly since 2000 in Japan. In recent years, colonic DH has been the most frequent cause of lower gastrointestinal bleeding (LGIB). Nearly all cases of DH are mild, with the bleeding often stopping spontaneously. Some cases, however, require surgery or arterial embolization. In this study, using a cohort at Fukuoka University Chikushi Hospital, we investigated factors associated with severe colonic DH.
METHODS
Among patients with LGIB who underwent colonoscopy at our hospital between 1995 and 2013, DH was identified in 273 patients. Among them, 62 patients (22.7%) were defined as having severe colonic DH according to recurrence of bleeding in a short period, and/or the necessity of transfusion, arterial embolization, or surgery. We then evaluated risk factors for severe DH among DH patients in this retrospective cohort.
RESULTS
Among the 273 patients with DH, use of non-steroidal anti-inflammatory drugs (NSAIDs) (odds ratio [OR], 2.801; 95% confidence interval [CI], 1.164-6.742), Charlson Risk Index (CRI) ≥2 (OR, 3.336; 95% CI, 1.154-7.353), right-sided colonic DH (OR, 3.873; 95% CI, 1.554-9.653), and symptoms of cerebral hypoperfusion (such as light-headedness, dizziness, or syncope) (OR, 2.926; 95% CI, 1.310-6.535) showed an increased risk of severe DH even after controlling for other factors.
CONCLUSIONS
Severe DH occurred in 23% of DH patients, and NSAID use, CRI ≥2, right-sided colonic DH, and symptoms of cerebral hypoperfusion are suggested to be predictors of severe DH.

Keyword

Colonic diverticular hemorrhage; Severity risk factors; Anti-inflammatory agents, non-steroidal; Right-sided colonic diverticular hemorrhage

MeSH Terms

Anti-Inflammatory Agents, Non-Steroidal
Cohort Studies
Colon*
Colonoscopy
Dizziness
Hemorrhage*
Humans
Incidence
Japan
Rare Diseases
Recurrence
Retrospective Studies
Risk Factors*
Anti-Inflammatory Agents, Non-Steroidal

Figure

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  Fig. 1 Change in number of patients with colonic diverticular hemorrhage (DH): number of server DH patients (1995 to 2013). The number of patients with DH increased in association with an increase in the number of server DH patients.

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  Fig. 2 Change in diverticula distribution (type) in colonic diverticular hemorrhage (DH) (1995 to 2013). Looking at cases of DH by diverticula distribution, bilateral colonic diverticular-type DH has been the most common type since 2007.

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  Fig. 3 Proportion (%) of the site of hemorrhaging diverticulum in severe and non-severe diverticular hemorrhage (DH). In a comparison of severe and non-severe DH by site of hemorrhaging diverticulum, the proportion of DH in the right colon was significantly higher among severe cases

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