Impact of discontinuing non-steroidal antiinflammatory drugs on long-term recurrence in colonic diverticular bleeding.

Abstract

AIM:

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.

CONCLUSION:

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, Takuro Shimbo, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Masashi Mizokami, Naomi Uemura
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 21 Issue 4 Pg. 1292-8 (Jan 28 2015) ISSN: 2219-2840 [Electronic] United States
• PMID: 25632204 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal

Topics

• Aged
• Aged, 80 and over
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage, adverse effects)
• Colonoscopy
• Diverticulum, Colon (complications, diagnosis, therapy)
• Drug Administration Schedule
• Female
• Gastrointestinal Hemorrhage (chemically induced, diagnosis, prevention & control)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Proportional Hazards Models
• Prospective Studies
• Recurrence
• Risk Assessment
• Risk Factors
• Time Factors