Risk factors for colonic diverticular bleeding: a Westernized community based hospital study.
OBJECTIVE
To evaluate the risk factors-other than nonsteroidal anti-inflammatory drugs-for colonic diverticular bleeding in a westernized population.


METHODS
One hundred and forty patients, treated for symptomatic diverticular disease in a community based hospital, were included. Thirty (21%) had signs of diverticular bleeding. Age, gender, and the results of colonoscopy were collected and compared to a group of patients with nonbleeding symptomatic diverticulosis. Records were reviewed for comorbidities, such as obesity, alcohol consumption, smoking habits and metabolic diseases. Special emphasis was put on arterial hypertension, cardiovascular events, diabetes mellitus, hyperuricemia and hypercholesterinemia.


RESULTS
There was no difference between patients with diverticular hemorrhage and those with nonbleeding symptomatic diverticulosis regarding gender ratio (male/female 9/21 vs 47/63) and diverticular localisation. Bleeding patients differed in respect to age (73.4+/-9.9 vs 67. 8+/-13.0, P<0.013). Significant differences were found between both groups regarding the presence of hyperuricemia and use of steroids and nonsteroidal anti-inflammatory drugs. Patients with three concomitant metabolic diseases were also identified as being at risk of bleeding. A forward stepwise logistic regression analysis revealed steroids, hyperuricemia and the use of calcium-channel blockers as independent risk factors of bleeding.


CONCLUSIONS
Beside nonsteroidal anti-inflammatory steroid drug use, antihypertensive medication and concomitant arteriosclerotic diseases are risk factors for colonic diverticular hemorrhage. Our results support the hypothesis of an altered arteriosclerotic vessel as the source of bleeding.
Jansen
Antje
A
Department of Gastroenterology, St. Elisabeth Hospital, PO Box 580, 46225 Dorsten, Germany.
Harenberg
Sabine
S
Grenda
Uwe
U
Elsing
Christoph
C
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000009:adverse effects; D001161:Arteriosclerosis / Q000150:complications; D004241:Diverticulum, Colon / Q000209:etiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000532:radiotherapy*; D005858:Germany; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000959:Antihypertensive Agents