ISSN 2148-4902
e-ISSN 2536-4553

Volume : 6 Issue : 2 Year : 2019

Factors Associated with Diverticular Bleeding and Re-Bleeding: A United States Hospital Study [North Clin Istanb]
North Clin Istanb. Ahead of Print: NCI-23540 | DOI: 10.14744/nci.2018.23540  

Factors Associated with Diverticular Bleeding and Re-Bleeding: A United States Hospital Study

Ala Abdel-jalil1, Robyn Gorski2, Salah Abdel Jalil3, Ryan Cronin4, Michael Comianos5, Moss Mann6, Hari Rajagopalan7, Asem Abdeljalil8, Veysel Tahan1
1University of Missouri-Columbia, Gastroenterology & Hepatology, Columbia, Missouri, USA
2Medical College of Wisconsin, Anesthesiology, Milwaukee, Wisconsin, USA
3Grand Strand Medical Center, General Surgery, Myrtle Beach, South Carolina, USA
4East Tennessee State University, General Surgery, Johnson City, Tennessee, USA
5Ohio Health Riverside Methodist Hospital, Internal Medicine, Columbus, Ohio, USA
6Carolinas Medical Center, Gastroenterology, Florence, South Carolina, USA
7Francis Marion University, School of Business, Florence, South Carolina, USA
8University of Missouri-Kansas City, Pulmonary, Critical Care & Sleep Medicine, Kansas, Missouri, USA

INTRODUCTION: Diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Arteriovascular disease, metabolic syndromes, non-steroidal anti-inflammatory drugs (NSAIDs), anti-thrombotics, and anticoagulants have been suggested as risk factors. The aim of this study is to evaluate factors associated with colonic diverticular bleeding and re-bleeding in a US community-based hospital.
METHODS: We conducted a retrospective, case-control study to analyze the factors associated with diverticular bleeding. Between January 2010 and July 2011, 93 patients were admitted to our hospital with a primary diagnosis of acute diverticular bleeding. We compared them to 152 patients who were admitted with a primary diagnosis of diverticulitis within the same period. We collected the data from the medical records of each patient in relation to the demographics, comorbidities, medications, social habits, location of diverticulosis, length of stay in hospital, and re-bleeding rate within two years of the first bleeding episode.
RESULTS: Cerebrovascular accident (P=0.009), coronary artery disease (P=0.037), diabetes mellitus (P=0.046), obstructive sleep apnea (P=0.033), NSAIDs (P=0.038), anti-thrombotics (P=0.001), anticoagulants (P=0.002), calcium channel blockers (P=0.009), and bilateral diverticulosis (P=0.001) were significantly associated with diverticular bleeding compared to diverticulitis. Recurrence of bleeding was noted in 26/93 (28%) of case group patients within 2 years of first bleeding episode (P=0.001). Bilateral colonic involvement, anti-coagulants and elderly age (≥65 year) were found as factors having closer relation to diverticular re-bleeding, although they did not reach statistical significance.
DISCUSSION AND CONCLUSION: This study reveals that arteriovascular disease, diabetes mellitus, NSAIDs, anti-thrombotics, anti-coagulants, calcium channel blockers and sleep apnea are factors significantly associated with diverticular bleeding. It also shows that bilateral colonic involvement, elderly age and anti-coagulants have closer relation to diverticular re-bleeding. Prospective studies in patients with diverticular bleeding remain a need to shed more light on the causality of these factors to this prevalent condition.

Keywords: Colonic Diverticulosis, Diverticulitis, Bleeding, Rebleeding, US Hospital, Outcome.

Corresponding Author: Ala Abdel-jalil, United States

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