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Non-steroidal anti-inflammatory drugs and acetylsalicylic acid increase the risk of complications of diverticular disease: a meta-analysis of case–control and cohort studies

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Abstract

Background

The role of non-steroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid in the occurrence of diverticular bleeding (DB), complicated diverticulitis (CD), and acute diverticulitis (AD) is not yet defined.

Aim

Update a systematic review and meta-analyses of case–control and cohort studies to evaluate the association between NSAIDs or acetylsalicylic acid with DB, CD, or AD.

Methods

The study included were identified through MEDLINE, Scopus, Web of Science, and Cochrane Library databases. Sizes were pooled across studies to obtain the overall effect size. A random-effects model was used to account for different sources of variation among studies. Odds ratio (OR) with 95% confidence interval (CI) was used as a measure of effect size.

Results

Thirteen studies were included in the systematic review and meta-analysis. NSAIDs and acetylsalicylic acid use were associated with an increased risk of DB (OR: 6.90, 95% CI 3.86 to 12.35, P ˂ 0.00001, and OR 2.84, 95% CI 2.19 to 3.67, P < 0.00001, respectively). NSAIDs and acetylsalicylic acid use were also associated with increased risk of CD occurrence (OR 3.13, 95% CI 1.73 to 5.68, P = 0.0002, and OR 1.49, 95% CI 1.02 to 2.17, P = 0.04, respectively). The only study found about AD occurrence showed that NSAIDs use was not associated with AD and acetylsalicylic acid use had a low risk of AD.

Conclusion

NSAIDs and acetylsalicylic acid significantly increase the risk of DB and CD. Further studies are needed to clarify the role of NSAIDs and acetylsalicylic acid in AD. However, increasing evidence suggests caution in the use of such medications in patients with colonic diverticula.

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Authors and Affiliations

  1. Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy

    Salvatore Longo, Filippo Vernia, Marco Valvano, Marco Magistroni, Antonio Mancusi, Angelo Viscido & Giovanni Latella

  2. Epidemiology and Biostatistics Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy

    Emma Altobelli

  3. Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy

    Chiara Castellini

  4. Department of Medicine, Gastroenterology Division and Cancer Center, Howard University, Washington, DC, USA

    Hassan Ashktorab

Authors
  1. Salvatore Longo
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Contributions

Study concept and design: SL, EA, GL; acquisition of data: SL, FV, MV, MM, AM; analysis and interpretation of data: SL, EA, CC; drafting of the manuscript: SL, EA, GL; critical revision of the manuscript for important intellectual content: EA, CC, AV, HA, GL; study supervision: GL. All authors have approved the final draft of the manuscript.

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Correspondence to Giovanni Latella.

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Longo, S., Altobelli, E., Castellini, C. et al. Non-steroidal anti-inflammatory drugs and acetylsalicylic acid increase the risk of complications of diverticular disease: a meta-analysis of case–control and cohort studies. Int J Colorectal Dis 37, 521–529 (2022). https://doi.org/10.1007/s00384-021-04088-1

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