Concurrent drug use and the risk of perforated colonic diverticular disease: a population-based case–control study
- 1NIHR Biomedical Research Unit, Nottingham Digestive Diseases Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
- 2Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
- Correspondence to Mr David J Humes, Nottingham Digestive Disease Centre and Biomedical Research Unit, Department of Surgery, QMC Campus, E Floor, West Block, Nottingham University Hospital NHS Trust, Derby Road, Nottingham NG7 2UH, UK;
Contributions DJH, RCS and JW: study design, analysis and writing of manuscript; KMF: analysis and writing of manuscript.
- Revised 16 August 2010
- Accepted 3 September 2010
- Published Online First 12 October 2010
Objective To determine the risk of diverticular perforation associated with current and ever use of corticosteroids, opiate analgesics, non-steroidal anti-inflammatory drugs, aspirin, cyclo-oxygenase-2 inhibitors, statins and calcium antagonists.
Design, setting and participants Case–control analysis using conditional logistic regression analysis of data from the UK General Practice Research Database. The study involved 899 cases of incident diverticular perforation and 8980 population controls from 1990 to 2005.
Main outcome measures Odds ratios (ORs) are presented for perforation associated with use of corticosteroids, opiate analgesics, non-steroidal anti-inflammatory drugs, aspirin, cyclo-oxygenase-2 inhibitors, statins and calcium antagonists. Data were adjusted for smoking, comorbidity, prior abdominal pain and body mass index.
Results A total of 899 patients with an incident diagnosis of perforated diverticular disease were identified. Current use of opiate analgesics (OR=2.16; 95% CI 1.55 to 3.01) and oral corticosteroids (OR=2.74; 95% CI 1.63 to 4.61) was associated with a two- and threefold increase in the risk of diverticular perforation, respectively. Current use of a calcium antagonist and aspirin were not associated with an increased risk of diverticular perforation. Current statin use was associated with a reduction in the risk of perforation (OR=0.44; 95% CI 0.20 to 0.95).
Conclusion Perforated diverticular disease is a serious surgical emergency with current opiate analgesics and oral corticosteroids being strongly associated with an increased risk of diverticular perforation.
Funding JW and KMF are funded by a National Institute of Health Research/Department of Health Clinician Scientist Fellowship for JW. The dataset was acquired through the Medical Research Council scheme for academic use of General Practice Research Database data. The validation study was funded in part by the Mason Medical Foundation and Institute of Clinical Research at Nottingham University. The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review, or approval of the manuscript.
Competing interests None.
Ethics approval This study was conducted with the approval of the Independent Scientific Advisory Committee approval board (ISAC) who provide scientific advice to the MHRA on study design and advise if further approval is required from the Multi-centre Research Ethics Committee outside the MHRA's current approval for observational studies.
Provenance and peer review Not commissioned; externally peer reviewed.