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Background and Purpose: Serious complications of colonic diverticula, namely bleeding and perforation, are a source of morbidity and mortality. A variety of drugs have been implicated in these complications. We present a systemic review of the literature to assess the importance of this relationship.
Data Sources: A systematic review of articles using PubMed and Cochrane Reviews was undertaken in August 2012. Search terms included ‘diverticulitis, diverticulum, diverticulosis, diverticular perforation, diverticular bleed, OR ‘lower GI bleed' AND ‘acetaminophen, anti-thrombotic, cyclooxygenase-2 inhibitors, cox-2, aspirin, amino salicylic acid, ASA, nonsteroidal anti-inflammatory drugs, NSAID, steroid, corticosteroid, OR calcium channel'.
Study selection and Data Extraction: An initial search yielded 853 results that were assessed for study design and topicality. A total off 23 articles were included in the review, including 74 subgroup analyses, where drug usage and specific complications were clearly documented. Data were extracted on these topics, as well as effect measures found.
Data Synthesis: We performed a qualitative data synthesis with a forest plot when five or more studies compared a single medication and similar patient complications.
Results: There were increased odds of bleeding with the use of NSAIDs (range 2.01-12.6), acetaminophen (0-3.75), aspirin (1.14-3.70), and steroids (0.57-5.40). There were increased odds of perforation and abscess formation with NSAIDs (1.46-10.3), aspirin (0.66-2.40), steroids (2.17-31.9), and opioids (1.80-4.51).
Limitations: Most studies did not describe duration or dosage of medications used, nor did they systematically describe the severity of diverticular complications.
Conclusions: A variety of common medications are implicated in colonic diverticular complications, rare, but occasionally devastating outcome in the many patients with diverticular disease.