Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 6, 2016; 7(3): 440-446
Published online Aug 6, 2016. doi: 10.4292/wjgpt.v7.i3.440
Increase in colonic diverticular hemorrhage and confounding factors
Ken Kinjo, Toshiyuki Matsui, Takashi Hisabe, Hiroshi Ishihara, Shinichiro Maki, Kenta Chuman, Akihiro Koga, Kensei Ohtsu, Noritaka Takatsu, Fumihito Hirai, Kenshi Yao, Masakazu Washio
Ken Kinjo, Toshiyuki Matsui, Takashi Hisabe, Hiroshi Ishihara, Shinichiro Maki, Kenta Chuman, Akihiro Koga, Kensei Ohtsu, Noritaka Takatsu, Fumihito Hirai, Kenshi Yao, Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan
Masakazu Washio, Department of Community Health and Clinical Epidemiology, St. Mary’s College, Fukuoka 818-8502, Japan
Author contributions: Kinjo K collected and analyzed the data, and drafted the manuscript; Matsui T designed and supervised the study; Washio M performed the statistical analysisl; Hisabe T, Ishihara H, Maki S, Chuman K, Koga A, Ohtsu K, Takatsu N, Hirai F and Yao K performed the colonoscopy and revised the manuscript for important intellectual content; all authors have read and approved the final version to be published.
Institutional review board statement: This study was approved by the institutional review board of Fukuoka University Chikushi Hospital (R15-024) and was conducted in accordance with the Declaration of Helsinki.
Informed consent statement: In this study, we do not necessarily need the individual agreement from a study subject. Because this study is retrospective study and based on the ethical guidelines for medical studies in which human body samples are not used informed consent procedure No.12 was applied. Information about the implementation of this research was presented on Fukuoka University Chikushi Hospital clinical research support center home page.
Conflict-of-interest statement: In connection with this manuscript, there is no Conflict of Interest to be disclosed with any companies.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at matsui@fukuoka-u.ac.jp. Participants gave informed consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toshiyuki Matsui, MD, PhD, Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan. matsui@fukuoka-u.ac.jp
Telephone: +81-92-9211011 Fax: +81-92-9292630
Received: March 13, 2016
Peer-review started: March 14, 2016
First decision: April 5, 2016
Revised: April 17, 2016
Accepted: May 7, 2016
Article in press: May 9, 2016
Published online: August 6, 2016
Processing time: 141 Days and 11.1 Hours
Abstract

AIM: To classify changes over time in causes of lower gastrointestinal bleeding (LGIB) and to identify factors associated with changes in the incidence and characteristics of diverticular hemorrhage (DH).

METHODS: A total of 1803 patients underwent colonoscopy for overt LGIB at our hospital from 1995 to 2013. Patients were divided into an early group (EG, 1995-2006, n = 828) and a late group (LG, 2007-2013, n = 975), and specific diseases were compared between groups. In addition, antithrombotic drug (ATD) use and nonsteroidal anti-inflammatory drug (NSAID) use were compared between patients with and without DH.

RESULTS: Older patients (≥ 70 years old) and those with colonic DH were more frequent in LG than in EG (P < 0.01). Patients using ATDs as well as NSAIDs, male sex, obesity (body mass index ≥ 25 kg/m2), smoking, alcohol drinking, and arteriosclerotic diseases were more frequent in patients with DH than in those without.

CONCLUSION: Incidence of colonic DH seems to increase with aging of the population, and factors involved include use of ATDs and NSAIDs, male sex, obesity, smoking, alcohol drinking, and arteriosclerotic disease. These factors are of value in handling DH patients.

Keywords: Lower gastrointestinal bleeding; Colonic diverticular hemorrhage; Increase of incidence; Aging

Core tip: Colonic diverticular hemorrhage (DH) is the most frequent cause of lower gastrointestinal bleeding. A rapid increase in the incidence of colonic DH has been seen with the aging population. One reason is the widespread adoption of antithrombotic drugs (ATDs) since the early 2000s, based on guidelines to prevent ischemic heart disease and ischemic cerebrovascular disease. DH is more likely in patients who are older, are men, obesity, use nonsteroidal anti-inflammatory drugs or ATDs, and have hypertension and diabetes associated with arteriosclerotic disease. These factors are of value in handling DH patients.