T1048 NSAIDs Accelerated a Risk of Colonic Diverticular Hemorrhage: A Case-Control Study

Background: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) could be a major risk factor for lower intestinal hemorrhage, in addition to the upper gastrointestinal bleeding. The aim of this study is to assess whether use of NSAIDs is a risk factor for ischemic colitis or colonic diverticular hemorrhage, which are well-known causes for lower intestinal hemorrhage. Methods: We enrolled consecutive 98 patients of hemorrhage caused by ischemic colitis (n=47) or colonic diverticulum (n=51), who visited Saga Medical School between January 2000 and December 2008. Gender and age matched control cases (n=196) were selected from patients of other diseases hospitalized during the same period. We evaluated influences of comorbidities (cerebrovascular disease, ischemic heart disease, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, and osteoporosis), medications including NSAIDs, duration of hospitalization, and habits (smoking, alcohol, chronic constipation) by using logistic regression analysis. Results: Regarding comorbidities, duration of hospitalization, smoking and alcohol, there was no significant difference between patients of ischemic colitis and of colonic diverticular hemorrhage. NSAIDs (odds ratio = 11.420, 95%CI: 2.222-58.705, p=0.0035), and hyperlipidemia (odds ratio = 2.393, 95%CI: 1.0425.497, p=0.0397) were significant risk factors in colonic diverticular hemorrhage, but not in ischemic colitis, compared to the selected case controls. The acceleration effect of NSAIDs for diverticular bleeding was not observed in patients with low dose aspirin. Use of NSAIDs and anticoagulant prolonged duration of hospitalization of patients of colonic diverticular hemorrhage (odds ratio = 1.1, 95%CI: 1.002-1.098, p=0.042). This study also indicated that use of NSAIDs was a risk factor for re-bleeding of diverticulum (odds ratio = 5.4, 95%CI: 1.01-28.78, p=0.048). Re-bleeding was increased in diverticulum patients with constipation (odds ratio = 10.22, 95%CI: 1.6-64.4, p=0.01). In cases of ischemic colitis patients,no risk factor including NSAIDs was not confirmed compared to the case-controls. Conclusion: This case-control study indicated that use of NSAIDs could be a significant risk factor in colonic diverticular hemorrhage and re-hemorrhage, but not in ischemic colitis.