title: Perforated colonic diverticular disease: the importance of NSAIDs, opioids, corticosteroids, and calcium channel blockers.
abstract: OBJECTIVE
  Perforated colonic diverticular disease is associated with a high rate of late sequel and mortality. The risk of colonic perforation may relate to intracolonic pressure and mucosal barrier function in the wall of diverticula. The use of substances affecting these parameters may therefore be associated with the risk of developing a perforation. The aim was to study the effect of nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, calcium channel blockers, and antimuscarinics on perforation in diverticular disease.
  
  
  METHODS
  A review of 54 patients with colonic diverticular perforation-forming the case group-and 183 patients with verified colonic diverticular disease-forming the control group-was done. Patient characteristics and drug use was registered.
  
  
  RESULTS
  Case group and control group were comparable with respect to sex, age, and comorbidity. In multivariate analysis, the use of NSAIDs (OR 3.56; 95% CI 1.50-8.43), opioids (OR 4.51; 95% CI 1.67-12.18), and corticosteroids (OR 28.28; 95% CI 4.83-165.7) were significantly associated with perforated diverticular disease. Acetylsalicylic acid in cardiologic dose did not affect the rate of perforation (OR 0.66; 95% CI 0.27-1.61). The use of calcium channel blockers was associated with a reduced rate of diverticular complications (OR 0.14; 95% CI 0.02-0.95).
  
  
  CONCLUSIONS
  The administration of NSAIDs, opioids, and corticosteroids are associated with an increased risk of colonic diverticular perforation. Acetylsalicylic acid in cardiologic dose does not affect the risk of perforation. Calcium channel blockers are associated with a reduced risk of perforation.
authors.affiliation: Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden.
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Piekarek
authors.forename: Leif A
authors.initials: LA
authors.lastname: Israelsson
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002121:Calcium Channel Blockers / Q000009:adverse effects*; D003108:Colonic Diseases / Q000139:chemically induced*; D004241:Diverticulum, Colon / Q000150:complications*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged
chemical_list: D000305:Adrenal Cortex Hormones; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002121:Calcium Channel Blockers