Introduction Nicorandil is widely used in the treatment of ischaemic heart disease, but over the last ten years there has been a growing body of literature reporting the association between nicorandil and ulceration of the gastrointestinal tract. In the setting of diverticulosis/diverticulitis, any superimposed ulceration may lead to significant complications, but data on whether or not nicorandil contributes to this is scanty and limited to one study which only investigated intestinal fistulae.1 Our aim is to identify if any potential association between all forms of complicated diverticulitis and nicorandil exists.
Methods We reviewed 100 reports of colonic resections with diverticular disease received in a single institution over a 6 month period (from June 2013 to January 2014) and divided them into those with complicated diverticulitis (defined as active diverticulitis in combination with perforation, fistulation, abscess formation or structuring)2 and those with uncomplicated diverticulitis or uninflamed diverticulosis. The age, sex, surgical indication and use of nicorandil were recorded for both groups.
Results 51 patients had complicated diverticulitis and 45 had uncomplicated diverticulitis or diverticular disease (7 diverticulosis only, 3 diverticulitis, 4 diverticular stricture/fibrosis, 3 ischaemia + diverticulosis, 24 colorectal cancer + diverticulosis, 3 Crohn’s disease + diverticulosis, 1 prolapse + diverticulosis, 1 ovarian cancer + diverticulosis). 4 were excluded because no drug history was available. The age range in the complicated diverticulitis group was 26 to 89 years with a mean age of 62 years with a male to female ratio of 23:28. The age range in the uncomplicated group was 46 to 89 years with a mean age of 72 years with a male to female ratio of 6:9.
In the complicated diverticulitis disease group, 6 patients (12%) were on nicorandil therapy, compared to 0 in the other group, a significant difference (p = 0.019, Fisher’s exact Test). The use of nicorandil was not stated on any of the pathology request forms. It was raised as a possible contributing factor in only one pathology report.
Conclusion We have shown that there is an association between nicorandil use and complicated diverticulitis. In addition, we have also demonstrated that nicorandil-associated perforation, fistulation and abscess formation in diverticular disease is under reported.
McDaid J, Reichl C, Hamzah I, Fitter S, Harbach L, Savage AP. Diverticular fistulation is associated with nicorandil usage. Ann R Coll Surg Engl. 2010;92(6):463–5
Commissioning guide: Colonic diverticular disease. The Royal College of Surgeons of England. 2013 (available at http://www.rcseng.ac.uk/healthcare-bodies/docs/CommissioningGuideforColonicdiverticulardiseaseouttoconsultationfrom27November201310January2014.pdf accessed 24/1/2014)
Disclosure of Interest None Declared.
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