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Selective association of nonaspirin NSAIDs with risk of diverticulitis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to investigate the association of intake of nonsteroidal anti-inflammatory drugs (NSAIDs) and in particular nonaspirin NSAIDs and compare it with other risk factors for the progression of diverticulosis to diverticulitis in patients who underwent colonoscopy.

Methods

A total of 194 patients who underwent complete colonoscopy in our center between 2012 and 2016 were recruited: 144 with diverticulosis without prior diverticulitis (median age 71 years, 59.7% men) and 50 with diverticulitis (median age 64 years, 54.0% men). Data concerning current and previous medication as well as concomitant diseases were collected using a structured questionnaire and by revision of patients medical charts.

Results

Patients with diverticulitis were significantly (p < 0.001) younger as compared to individuals with plain diverticulosis (median age 64 versus 71 years, respectively). The intake of NSAIDs significantly (p = 0.002) increased the risk of prior diverticulitis (OR 3.2, 95% CI 1.5–6.9). In the multivariate model, both age (p < 0.001) and NSAIDs (p = 0.03) proved to be independent determinants of diverticulitis. When analyzing aspirin intake, it was not associated with diverticulitis.

Conclusions

Our study demonstrates, in line with previous reports, that intake of NSAIDs is associated with diverticulitis. We show in particular that nonaspirin NSAIDs might be selectively associated with diverticulitis. These results point to divergent role of aspirin and nonaspirin NSAIDs in the development of diverticulitis.

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Funding

This study was supported by a grant from the Faculty of Medicine, Saarland University (HOMFOR grant T201000747), to Matthias C Reichert.

Author information

Authors and Affiliations

  1. Department of Medicine II, Saarland University Medical Center, 66421, Homburg, Germany

    Matthias C. Reichert, Marcin Krawczyk, Beate Appenrodt, Markus Casper, Bettina Friesenhahn-Ochs, Frank Grünhage, Christoph Jüngst, Vincent Zimmer, Frank Lammert & Marc Dauer

  2. Laboratory of Metabolic Liver Diseases, Centre for Preclinical Research, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland

    Marcin Krawczyk

  3. Department Medicine 2, Klinikum St. Marien, Amberg, Germany

    Marc Dauer

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  1. Matthias C. Reichert
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Contributions

MCR and MD designed the study; MCR, BA, FG, CJ, VZ, MC, and BF participated in acquisition of data; MCR collected the data and drafted the manuscript and together with FL, MK, and MD analyzed the data and finalized the manuscript, which was then critically revised by all authors. The final draft of the manuscript has been approved by all authors. The contents of this manuscript are our original work and have not been published, in whole or in part, prior to or simultaneous with our submission of the manuscript.

Corresponding author

Correspondence to Matthias C. Reichert.

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Conflict of interest

The authors declare that they have no conflict of interest

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Terminology

The following definitions are used in this article, since they are not applied coherently in the literature: diverticulosis is the mere presence of colonic diverticula without evidence of inflammation. The term diverticular disease (DD) is used to summarize all possible impact on a patient’s health that could be caused by colonic diverticula, such as symptomatic diverticulosis, complicated and uncomplicated diverticulitis, as well as diverticular bleeding. Currently, no widely accepted classification for diverticulitis exists. Recently the DICA classification has been proposed [1]. The classification was not available at the initiation of our study and could therefore not be applied. Other commonly applied classifications include the predominantly in the USA used Hinchey classification, it could not be applied as it uses intraoperative findings [2], and the Hansen-Stock classification [3], which is used predominantly in Europe. The recent diverticulitis classification from the guidelines of the German Gastroenterological Association (DGVS) [4] is an extension of the Hansen-Stock classification. As our cohort included only patients treated in Germany and currently no other widely accepted suitable classification is available, diagnosis of diverticulosis and diverticulitis was based on these guidelines in this study.

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Reichert, M.C., Krawczyk, M., Appenrodt, B. et al. Selective association of nonaspirin NSAIDs with risk of diverticulitis. Int J Colorectal Dis 33, 423–430 (2018). https://doi.org/10.1007/s00384-018-2968-z

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