Top

International Journal of Colorectal Disease

Published in:

01-04-2018 | Original Article

Selective association of nonaspirin NSAIDs with risk of diverticulitis

Authors: Matthias C. Reichert, Marcin Krawczyk, Beate Appenrodt, Markus Casper, Bettina Friesenhahn-Ochs, Frank Grünhage, Christoph Jüngst, Vincent Zimmer, Frank Lammert, Marc Dauer

Published in: International Journal of Colorectal Disease | Issue 4/2018

Abstract

Purpose

The purpose of this study is to investigate the association of intake of nonsteroidal anti-inflammatory drugs (NSAIDs) and in particular nonaspirin NSAIDs and compare it with other risk factors for the progression of diverticulosis to diverticulitis in patients who underwent colonoscopy.

Methods

A total of 194 patients who underwent complete colonoscopy in our center between 2012 and 2016 were recruited: 144 with diverticulosis without prior diverticulitis (median age 71 years, 59.7% men) and 50 with diverticulitis (median age 64 years, 54.0% men). Data concerning current and previous medication as well as concomitant diseases were collected using a structured questionnaire and by revision of patients medical charts.

Results

Patients with diverticulitis were significantly (p < 0.001) younger as compared to individuals with plain diverticulosis (median age 64 versus 71 years, respectively). The intake of NSAIDs significantly (p = 0.002) increased the risk of prior diverticulitis (OR 3.2, 95% CI 1.5–6.9). In the multivariate model, both age (p < 0.001) and NSAIDs (p = 0.03) proved to be independent determinants of diverticulitis. When analyzing aspirin intake, it was not associated with diverticulitis.

Conclusions

Our study demonstrates, in line with previous reports, that intake of NSAIDs is associated with diverticulitis. We show in particular that nonaspirin NSAIDs might be selectively associated with diverticulitis. These results point to divergent role of aspirin and nonaspirin NSAIDs in the development of diverticulitis.

Tursi A, Brandimarte G, MarioF D, Andreoli A, Annunziata ML, Astegiano M, Bianco MA, Buri L, Cammarota G, Capezzuto E, Chilovi F, Cianci M, Conigliaro R, del Favero G, di Cesare L, di Fonzo M, Elisei W, Faggiani R, Farroni F, Forti G, Germanà B, Giorgetti GM, Giovannone M, Lecca PG, Loperfido S, Marmo R, Morucci P, Occhigrossi G, Penna A, Rossi AF, Spadaccini A, Zampaletta C, Zilli M, Zullo A, Scarpignato C, Picchio M (2015) Development and validation of an endoscopic classification of diverticular disease of the colon: the DICA classification. Dig Dis 33(1):68–76. https://doi.org/10.1159/000366039 CrossRefPubMed

Hinchey EJ, Schaal PG, Richards GK (1978) Treatment of perforated diverticular disease of the colon. Adv Surg 12:85–109PubMed

Hansen O, Graupe F, Stock W (1998) Prognostic factors in perforating diverticulitis of the large intestine. Der Chirurg 69(4):443–449. https://doi.org/10.1007/s001040050436 CrossRef

Kruis W, Germer CT, Leifeld L (2014) Diverticular disease: guidelines of the german society for gastroenterology, digestive and metabolic diseases and the german society for general and visceral surgery. Digestion 90(3):190–207. https://doi.org/10.1159/000367625 CrossRefPubMed

Golder M, Ster IC, Babu P, Sharma A, Bayat M, Farah A (2011) Demographic determinants of risk, colon distribution and density scores of diverticular disease. World J Gastroenterol 17(8):1009–1017. https://doi.org/10.3748/wjg.v17.i8.1009 PubMedPubMedCentral

Everhart JE, Ruhl CE (2009) Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology 136(3):741–754. https://doi.org/10.1053/j.gastro.2009.01.015 CrossRefPubMed

Kang JY, Melville D, Maxwell JD (2004) Epidemiology and management of diverticular disease of the colon. Drugs Aging 21(4):211–228. https://doi.org/10.2165/00002512-200421040-00001 CrossRefPubMed

Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C, Gemmen E, Shah S, Avdic A, Rubin R (2002) The burden of selected digestive diseases in the United States. Gastroenterology 122(5):1500–1511. https://doi.org/10.1053/gast.2002.32978 CrossRefPubMed

Delvaux M (2003) Diverticular disease of the colon in Europe: epidemiology, impact on citizen health and prevention. Aliment Pharmacol Ther 18(Suppl 3):71–74. https://doi.org/10.1046/j.0953-0673.2003.01720.x CrossRefPubMed

10.

Crowe FL, Appleby PN, Allen NE, Key TJ (2011) Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians. BMJ 19:343:d4131. https://doi.org/10.1136/bmj.d4131

11.

Hjern F, Wolk A, Hakansson N (2011) Smoking and the risk of diverticular disease in women. Br J Surg 98(7):997–1002. https://doi.org/10.1002/bjs.7477 CrossRefPubMed

12.

Turunen P, Wikstrom H, Carpelan-Holmstrom M, Kairaluoma P, Kruuna O, Scheinin T (2010) Smoking increases the incidence of complicated diverticular disease of the sigmoid colon. Scand J Surg 99:14–17. https://doi.org/10.1177/145749691009900104 CrossRefPubMed

13.

Usai P, Ibba I, Lai M, Boi MF, Savarese MF, Cuomo R, D’Alia G, Gemini S, Diaz G, Contu P (2011) Cigarette smoking and appendectomy: effect on clinical course of diverticulosis. Dig Liv Dis 43(2):98–101. https://doi.org/10.1016/j.dld.2010.05.008 CrossRef

14.

Tonnesen H, Engholm G, Moller H (1999) Association between alcoholism and diverticulitis. Br J Surg 86(8):1067–1068. https://doi.org/10.1046/j.1365-2168.1999.01171.x CrossRefPubMed

15.

Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC (1995) A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men. Ann Epidemiol 5(3):221–228. https://doi.org/10.1016/1047-2797(94)00109-7 CrossRefPubMed

16.

Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC (1994) A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr 60(5):757–764. https://doi.org/10.1093/ajcn/60.5.757 CrossRefPubMed

17.

Rosemar A, Angeras U, Rosengren A (2008) Body mass index and diverticular disease: a 28-year follow-up study in men. Dis Colon Rectum 51(4):450–455. https://doi.org/10.1007/s10350-007-9172-5 CrossRefPubMed

18.

Strate LL, Liu YL, Aldoori WH, Syngal S, Giovannucci EL (2009) Obesity increases the risks of diverticulitis and diverticular bleeding. Gastroenterology 136(1):115. https://doi.org/10.1053/j.gastro.2008.09.025 CrossRefPubMed

19.

Morris CR, Harvey IM, Stebbings WS, Speakman CT, Kennedy HJ, Hart AR (2003) Anti-inflammatory drugs, analgesics and the risk of perforated colonic diverticular disease. Br J Surg 90(10):1267–1272. https://doi.org/10.1002/bjs.4221 CrossRefPubMed

20.

Morris CR, Harvey IM, Stebbings WS, Speakman CT, Kennedy HJ, Hart AR (2003) Do calcium channel blockers and antimuscarinics protect against perforated colonic diverticular disease? A case control study. Gut 52(12):1734–1737. https://doi.org/10.1136/gut.52.12.1734 CrossRefPubMedPubMedCentral

21.

Humes DJ, Fleming KM, Spiller RC, West J (2011) Concurrent drug use and the risk of perforated colonic diverticular disease: a population-based case-control study. Gut 60(2):219–224. https://doi.org/10.1136/gut.2010.217281 CrossRefPubMed

22.

Strate LL, Liu YL, Huang ES, Giovannucci EL, Chan AT (2011) Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology 140(5):1427–1433. https://doi.org/10.1053/j.gastro.2011.02.004 CrossRefPubMedPubMedCentral

23.

Kvasnovsky CL, Papagrigoriadis S, Bjarnason I (2014) Increased diverticular complications with nonsteriodal anti-inflammatory drugs and other medications: a systematic review and meta-analysis. Colorectal Dis 16(6):O189–O196. https://doi.org/10.1111/codi.12516 CrossRefPubMed

24.

Hjern F, Mahmood MW, Abraham-Nordling M, Wolk A, Hakansson N (2015) Cohort study of corticosteroid use and risk of hospital admission for diverticular disease. Br J Surg 102(1):119–124. https://doi.org/10.1002/bjs.9686 CrossRefPubMed

25.

Strate LL, Peery AF, Neumann I (2015) American Gastroenterological Association Institute technical review on the management of acute diverticulitis. Gastroenterology 149(7):1950–1976. https://doi.org/10.1053/j.gastro.2015.10.001 CrossRefPubMed

26.

Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39(6):681–685. https://doi.org/10.1007/BF02056950 CrossRefPubMed

27.

Mpofu S, Mpofu CM, Hutchinson D, Maier AE, Dodd SR, Moots RJ (2004) Steroids, non-steroidal anti-inflammatory drugs, and sigmoid diverticular abscess perforation in rheumatic conditions. Ann Rheum Dis 63(5):588–590. https://doi.org/10.1136/ard.2003.010355 CrossRefPubMedPubMedCentral

28.

Campbell K, Steele RJ (1991) Non-steroidal anti-inflammatory drugs and complicated diverticular disease: a case-control study. Br J Surg 78(2):190–191. https://doi.org/10.1002/bjs.1800780218 CrossRefPubMed

29.

Mathews SN, Lamm R, Yang J, Kang L, Telem D, Pryor AD, Talamini M, Genua J (2017) Factors associated with repeated health resource utilization in patients with diverticulitis. J Gastrointest Surg 21(1):112–120. https://doi.org/10.1007/s11605-016-3245-5 CrossRefPubMed

30.

Okayama M, Hayashi S, Aoi Y, Nishio H, Kato S, Takeuchi K (2007) Aggravation by selective COX-1 and COX-2 inhibitors of dextran sulfate sodium (DSS)-induced colon lesions in rats. Dig Dis Sci 52(9):2095–2103. https://doi.org/10.1007/s10620-006-9597-z CrossRefPubMed

31.

Shahedi K, Fuller G, Bolus R, Cohen E, Vu M, Shah R, Agarwal N, Kaneshiro M, Atia M, Sheen V, Kurzbard N, van Oijen MGH, Yen L, Hodgkins P, Erder MH, Spiegel B (2013) Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol 11(12):1609–1613. https://doi.org/10.1016/j.cgh.2013.06.020 CrossRefPubMedPubMedCentral

32.

Martel J, Raskin JB (2008) History, incidence, and epidemiology of diverticulosis. J Clin Gastroenterol 42(10):1125–1127. https://doi.org/10.1097/MCG.0b013e3181865f18 CrossRefPubMed

33.

Chabok A, Pahlman L, Hjern F, Haapaniemi S, Smedh K (2012) Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg 99(4):532–539. https://doi.org/10.1002/bjs.8688 CrossRefPubMed

Title: Selective association of nonaspirin NSAIDs with risk of diverticulitis
Authors: Matthias C. Reichert
Marcin Krawczyk
Beate Appenrodt
Markus Casper
Bettina Friesenhahn-Ochs
Frank Grünhage
Christoph Jüngst
Vincent Zimmer
Frank Lammert
Marc Dauer
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 4/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-018-2968-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Selective association of nonaspirin NSAIDs with risk of diverticulitis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2018

Fecal incontinence after transanal endoscopic microsurgery

Trends in the treatment of rectal prolapse: a population analysis

Local excision for ypT2 rectal cancer following preoperative chemoradiation therapy: it should not be justified

Are we doing too much?: local excision before radical surgery in early rectal cancer

Bacterial culture and antibiotic susceptibility in patients with acute appendicitis

Extralevator versus standard abdominoperineal excision in locally advanced rectal cancer: a retrospective study with long-term follow-up