Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1292-1298
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1292
Impact of discontinuing non-steroidal antiinflammatory drugs on long-term recurrence in colonic diverticular bleeding
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
Naoyoshi Nagata, Ryota Niikura, Tomonori Aoki, Katsunori Sekine, Hidetaka Okubo, Kazuhiro Watanabe, Toshiyuki Sakurai, Chizu Yokoi, Junichi Akiyama, Mikio Yanase, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Takuro Shimbo, Department of Clinical Research and Informatics, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Masashi Mizokami, Naomi Uemura, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba 272-8516, Japan
Author contributions: Nagata N designed the study and was the main author of the manuscript; Shimbo T performed the statistical analysis; Niikura R, Aoki T, Sekine K and Watanabe K collected clinical information; Okubo H, Sakurai T, Yokoi C, and Akiyama J performed the colonoscopy; and Shimbo T, Mizokami M and Uemura N edited the manuscript; all authors approved the final draft.
Supported by A Grant-in-Aid for Research from the National Center for Global Health and Medicine No. 26A-201.
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: Naoyoshi Nagata, MD, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan. nnagata_ncgm@yahoo.co.jp
Telephone: +81-3-32027181 Fax: +81-3-32071038
Received: June 3, 2014
Peer-review started: June 3, 2014
First decision: July 21, 2014
Revised: August 3, 2014
Accepted: September 18, 2014
Article in press: September 19, 2014
Published online: January 28, 2015
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.

Keywords: Non-steroidal anti-inflammatories, Drug withdrawal, Diverticular hemorrhage, Hemodialysis, Antithrombotic drugs

Core tip: The probability of recurrence of diverticular bleeding at 1, 12, and 24 mo was 3.1%, 27%, and 38%, respectively. Of the 41 non-steroidal antiinflammatory drugs (NSAIDs) users on admission, 26 (63%) discontinued NSAID use at discharge. 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. This study provides new information on risk reduction strategies for diverticular bleeding.