RT Journal Article
SR Electronic
T1 Concurrent drug use and the risk of perforated colonic diverticular disease: a population-based case–control study
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 219
OP 224
DO 10.1136/gut.2010.217281
VO 60
IS 2
A1 David J Humes
A1 Kate M Fleming
A1 Robin C Spiller
A1 Joe West
YR 2011
UL http://gut.bmj.com/content/60/2/219.abstract
AB 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.