Intest Res  
Risk factors for severity of colonic diverticular hemorrhage
Ken Kinjo1, Toshiyuki Matsui1, Takashi Hisabe1, Hiroshi Ishihara1, Toshiki Kojima2, Kenta Chuman2, Shigeyoshi Yasukawa1, Tsuyoshi Beppu1, Akihiro Koga1, Satoshi Ishikawa1, Masahiro Kishi1, Noritaka Takatsu1, Fumihito Hirai1, Kenshi Yao2, Toshiharu Ueki1, Masakazu Washio3
Departments of 1Gastroenterology and 2Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, 3Department of Community Health and Clinical Epidemiology, St. Mary’s College, Kurume, Japan
Correspondence to: Toshiyuki Matsui, Department of Gastroenterology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino 818-8502, Japan. Tel: +81-92-921-1011, Fax: +81-92-929-2630, E-mail: matsui@fukuoka-u.ac.jp
Received: September 5, 2017; Revised: April 5, 2018; Accepted: April 11, 2018; Published online: July 11, 2018.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: Colonic diverticular hemorrhage (DH) was a rare disease until the 1990s, and its incidence has increased rapidly since 2000 in Japan. In recent years, colonic DH has been the most frequent cause of lower gastrointestinal bleeding (LGIB). Nearly all cases of DH are mild, with the bleeding often stopping spontaneously. Some cases, however, require surgery or arterial embolization. In this study, using a cohort at Fukuoka University Chikushi Hospital, we investigated factors associated with severe colonic DH. Methods: Among patients with LGIB who underwent colonoscopy at our hospital between 1995 and 2013, DH was identified in 273 patients. Among them, 62 patients (22.7%) were defined as having severe colonic DH according to recurrence of bleeding in a short period, and/or the necessity of transfusion, arterial embolization, or surgery. We then evaluated risk factors for severe DH among DH patients in this retrospective cohort. Results: Among the 273 patients with DH, use of nonsteroidal anti-inflammatory drugs (NSAIDs) (odds ratio [OR], 2.801; 95% confidence interval [CI], 1.164–6.742), Charlson Risk Index (CRI) ≥2 (OR, 3.336; 95% CI, 1.154–7.353), right-sided colonic DH (OR, 3.873; 95% CI, 1.554–9.653), and symptoms of cerebral hypoperfusion (such as light-headedness, dizziness, or syncope) (OR, 2.926; 95% CI, 1.310–6.535) showed an increased risk of severe DH even after controlling for other factors. Conclusions: Severe DH occurred in 23% of DH patients, and NSAID use, CRI ≥2, right-sided colonic DH, and symptoms of cerebral hypoperfusion are suggested to be predictors of severe DH.
Keywords: Colonic diverticular hemorrhage; Severity risk factors; Anti-inflammatory agents, non-steroidal; Right-sided colonic diverticular hemorrhage


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