title: NSAIDs are a significant risk factor for colonic diverticular hemorrhage in elder patients: evaluation by a case-control study.
abstract: OBJECTIVE
  Diverticular bleeding is a common cause of lower gastrointestinal hemorrhage. Several factors, including use of non-steroidal anti-inflammatory drugs (NSAIDs), antithrombotic agents and arteriosclerosis, could be risk factors. The aim of this study is to identify these risk factors.
  
  
  METHODS
  Between January 2000 and December 2008, 51 patients among 178 acute lower gastrointestinal hemorrhages who visited Saga Medical School were diagnosed as colonic diverticular hemorrhage, established by emergency endoscopy and diagnostic criteria. Gender and age matched control cases were selected from patients of other diseases hospitalized during the same period. We evaluated by using logistic regression analysis the influences of comorbidities such as cerebrovascular disease, ischemic heart disease, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, and osteoporosis, medications including NSAIDs and antithrombotic agents, and habits of smoking, alcohol, and chronic constipation.
  
  
  RESULTS
  Fifty one patients out of 178 acute lower gastrointestinal bleeding (28.7%) were diagnosed as diverticular hemorrhage, which was the most common cause of lower gastrointestinal hemorrhage. Sex ratio of men versus women for colonic diverticular hemorrhage was 35:16. NSAIDs were a significant risk factor for colonic diverticular hemorrhage in elder patients (odds ratio [OR] = 7.492, 95% CI: 1.516-37.024, P = 0.0135). Hypertension and hyperlipidemia had significant association with diverticular hemorrhage among patients younger than 65 years old. This study also indicated that use of NSAIDs was a risk factor for re-bleeding (OR = 5.4, 95% CI: 1.01-28.78, P = 0.048).
  
  
  CONCLUSIONS
  This case-control study revealed that the use of NSAIDs was a significant risk factor for colonic diverticular hemorrhage in elder patients. In addition, use of NSAIDs is a risk factor for re-bleeding from colonic diverticula.
authors.affiliation: Department of Internal Medicine, Saga Medical School, Saga, Japan.
authors.forename: Nanae
authors.initials: N
authors.lastname: Tsuruoka
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Iwakiri
authors.forename: Megumi
authors.initials: M
authors.lastname: Hara
authors.forename: Natsuko
authors.initials: N
authors.lastname: Shirahama
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Sakata
authors.forename: Koichi
authors.initials: K
authors.lastname: Miyahara
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Eguchi
authors.forename: Ryo
authors.initials: R
authors.lastname: Shimoda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ogata
authors.forename: Seiji
authors.initials: S
authors.lastname: Tsunada
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakata
authors.forename: Kazuma
authors.initials: K
authors.lastname: Fujimoto
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D003113:Colonoscopy; D015897:Comorbidity; D004241:Diverticulum, Colon / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal