Suh Seungchul, Seo Pyoung Ju, Park Hyunkyung, Shin Cheol Min, Jo Hyun Jin, Kim Hyun Young, Lee Sang Hyub, Park Young Soo, Hwang Jin Hyeok, Kim Jin Wook, Jeong Sook Hyang, Kim Nayoung, Lee Dong Ho, Song In Sung, Jung Hyun Chae
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea.
Korean J Gastroenterol. 2012 Dec;60(6):349-54. doi: 10.4166/kjg.2012.60.6.349.
BACKGROUND/AIMS: Colonic diverticular bleeding cases account for 30-40% of the lower gastrointestinal bleeding, among which, 3-5% appear to be massive bleeding. The purpose of this study was to evaluate the risk factors for colonic diverticular bleeding diagnosed by colonoscopic examination.
Among the 1,003 patients, who were identified to have colonic diverticulosis including sleeding by diverticulitis and diverticular bleeding coding search, 216 patients had diverculosis, and they were divided into two groups: one with diverticular bleeding, and the other without bleeding. We evaluated the potential risk factors for diverticular bleeding, based on age, gender, location of diverticulum, comorbidities related to atherosclerosis, smoking, alcohol and medications, and compared them between both groups.
Among the 216 patients, we observed colonic diverticular bleeding in 35 patients (16.2%). The mean age of the bleeding group was significantly older than that of non-bleeding group. No difference was observed regarding gender ratio. Right colonic diverticula were common in both groups, but there were higher proportion of patients with bleeding in bilateral diverticuosis. Old age, bilateral diverticulosis, presence of atherosclerosis related diseases (hypertension, diabetes mellitus, ischemic heart disease, obesity), use of aspirin, NSAIDs and calcium channel blocker, increased the risk of bleeding. In a multivariate analysis, use of aspirin and bilateral diverticulosis were identified as independent risk factors for colonic diverticular bleeding.
Since the patients who took aspirin and/or had bilateral colonic diverticulosis increased the risk of bleeding from divertuculi. As such, caution and education of patients are required.
背景/目的：结肠憩室出血病例占下消化道出血的30%-40%，其中3%-5%似乎为大量出血。本研究的目的是评估经结肠镜检查诊断的结肠憩室出血的危险因素。
在1003例经编码搜索确定患有结肠憩室病（包括憩室炎出血和憩室出血）的患者中，216例患有憩室病，他们被分为两组：一组有憩室出血，另一组无出血。我们基于年龄、性别、憩室位置、与动脉粥样硬化相关的合并症、吸烟、饮酒和用药情况评估憩室出血的潜在危险因素，并在两组之间进行比较。
在216例患者中，我们观察到35例（16.2%）发生结肠憩室出血。出血组的平均年龄显著高于非出血组。性别比例无差异。右结肠憩室在两组中都很常见，但双侧憩室病患者中出血患者的比例更高。老年、双侧憩室病、存在动脉粥样硬化相关疾病（高血压、糖尿病、缺血性心脏病、肥胖）、使用阿司匹林、非甾体抗炎药和钙通道阻滞剂会增加出血风险。在多变量分析中，使用阿司匹林和双侧憩室病被确定为结肠憩室出血的独立危险因素。
由于服用阿司匹林和/或患有双侧结肠憩室病的患者憩室出血风险增加。因此，需要对患者进行谨慎处理和教育。
