title: Impact of discontinuing non-steroidal antiinflammatory drugs on long-term recurrence in colonic diverticular bleeding.
abstract: OBJECTIVE
  To determine the effect of discontinuing non-steroidal antiinflammatory drugs (NSAIDs) on recurrence in long-term follow-up patients with colonic diverticular bleeding (CDB).
  
  
  METHODS
  A cohort of 132 patients hospitalized for CDB examined by colonoscopy was prospectively enrolled. Comorbidities, lifestyle, and medications (NSAIDs, low-dose aspirin, antiplatelet agents, anticoagulants, acetaminophen, and corticosteroids) were assessed. After discharge, patients were requested to visit the hospital on scheduled days during the follow-up period. The Kaplan-Meier method was used to estimate recurrence.
  
  
  RESULTS
  Median follow-up was 15 mo. The probability of recurrence at 1, 6, 12, and 24 mo was 3.1%, 19%, 27%, and 38%, respectively. Of the 41 NSAID users on admission, 26 (63%) discontinued NSAID use at discharge. Many of the patients who could discontinue NSAIDs were intermittent users, and could be switched to alternative therapies, such as acetaminophen or an antiinflammatory analgesic plaster. The probability of recurrence at 12 mo was 9.4% in discontinuing NSAID users compared with 77% in continuing users (P<0.01, log-rank test). The hazard ratio for recurrence in the discontinuing NSAIDs users was 0.06 after adjusting for age>70 years, right-sided diverticula, history of hypertension, and hemodialysis. No patients developed cerebrocardiovascular events during follow-up.
  
  
  CONCLUSIONS
  There is a substantial recurrence rate after discharge among patients hospitalized for diverticular bleeding. Discontinuation of NSAIDs is an effective preventive measure against recurrence. This study provides new information on risk reduction strategies for diverticular bleeding.
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Naoyoshi
authors: N
authors: Nagata
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Ryota
authors: R
authors: Niikura
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Tomonori
authors: T
authors: Aoki
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Takuro
authors: T
authors: Shimbo
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Katsunori
authors: K
authors: Sekine
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Hidetaka
authors: H
authors: Okubo
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Kazuhiro
authors: K
authors: Watanabe
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Toshiyuki
authors: T
authors: Sakurai
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Chizu
authors: C
authors: Yokoi
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Junichi
authors: J
authors: Akiyama
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Mikio
authors: M
authors: Yanase
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Masashi
authors: M
authors: Mizokami
authors: Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors: Naomi
authors: N
authors: Uemura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D003113:Colonoscopy; D004241:Diverticulum, Colon / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004334:Drug Administration Schedule; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Antithrombotic drugs; Diverticular hemorrhage; Drug withdrawal; Hemodialysis; Non-steroidal anti-inflammatories
references: Kidney Int. 2003 Oct;64(4):1455-61
references: 12969166
references: Am J Med. 1985 Nov;79(5):552-9
references: 3933340
references: Ann Surg. 1994 Nov;220(5):653-6
references: 7979613
references: Am J Gastroenterol. 1995 Oct;90(10):1779-84
references: 7572894
references: Am J Gastroenterol. 1997 Mar;92(3):419-24
references: 9068461
references: Dig Dis Sci. 1997 May;42(5):990-7
references: 9149053
references: Gastrointest Endosc. 1999 Feb;49(2):228-38
references: 9925703
references: Arch Intern Med. 2004 Dec 13-27;164(22):2472-6
references: 15596638
references: Am J Gastroenterol. 2007 Mar;102(3):507-15
references: 17338735
references: Osteoarthritis Cartilage. 2007 Jun;15(6):605-14
references: 17448700
references: Dis Colon Rectum. 2008 Jan;51(1):116-20
references: 18085336
references: Ann Intern Med. 2010 Jan 5;152(1):1-9
references: 19949136
references: Gastroenterology. 2011 May;140(5):1427-33
references: 21320500
references: J Gastroenterol Hepatol. 2011 Jun;26(6):1047-52
references: 21198829
references: Colorectal Dis. 2012 Mar;14(3):302-5
references: 21692963
references: Int J Colorectal Dis. 2012 Sep;27(9):1137-43
references: 22354135
references: Int J Colorectal Dis. 2012 Sep;27(9):1161-6
references: 22584295
references: Arch Intern Med. 2012 Oct 22;172(19):1484-91
references: 22987143
references: Acta Gastroenterol Belg. 2013 Mar;76(1):20-4
references: 23650778
references: Gastroenterology. 2013 Oct;145(4):895-7; discussion 897
references: 23973676
references: J Gastroenterol Hepatol. 2014 Oct;29(10):1786-93
references: 24720424
references: N Engl J Med. 2000 Jan 13;342(2):78-82
references: 10631275
references: Arch Intern Med. 2003 Apr 14;163(7):838-43
references: 12695275