title: Diaphragmatic disease of the colon: systematic review.
abstract: OBJECTIVE
  Diaphragmatic disease is rare. This review aims to increase awareness of this condition and its management.
  
  
  METHODS
  A literature search was conducted using the key terms 'colon' or 'colonic' in combination with 'diaphragm' or 'diaphragm disease' for publications until August 2012. All cases of colonic diaphragm syndrome were identified and the required data were collected.
  
  
  RESULTS
  Forty-five cases of colon diaphragm disease were included. The highest incidence was in the seventh decade of life, with a female preponderance (40F:5M). Most patients presented with chronic (median 3 months) and multiple symptoms. The median use of nonsteroidal anti-inflammatory drugs (NSAIDs) was 5 years including diclofenac as the most commonly used NSAID. Colonoscopy was the most informative investigation and the ascending colon was the most common site of diaphragm disease. Nearly two-thirds of the patients were treated by discontinuing NSAID treatment combined with other forms of treatment, mostly surgery.
  
  
  CONCLUSIONS
  Diaphragm disease of the colon is a rare condition associated with long-term use of NSAIDs with a range of presentations and symptoms. Based on this review, when colon diaphragm disease is diagnosed we would recommend a trial cessation of NSAIDs. Therapeutic endoscopic techniques should be considered but surgery may be required for definitive treatment.
authors.affiliation: Department of General Surgery, Friarage Hospital, Northallerton, North Yorks, UK.
authors.forename: P C
authors.initials: PC
authors.lastname: Munipalle
authors.forename: T
authors.initials: T
authors.lastname: Garud
authors.forename: D
authors.initials: D
authors.lastname: Light
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D044682:Colon, Ascending / Q000503:physiopathology; D003108:Colonic Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D013577:Syndrome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Colonic diaphragm disease; bowel resection; colopathy; endoscopic dilatation; nonsteroidal anti-inflammatory drugs