Use of Aspirin or Nonsteroidal Anti-inflammatory Drugs Increases Risk for Diverticulitis and Diverticular Bleeding
Use of Aspirin or Nonsteroidal Anti-inflammatory Drugs Increases Risk for Diverticulitis and Diverticular Bleeding
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DOI：
10.1053/j.gastro.2011.02.004
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发表时间：
2011-05-01
期刊：
影响因子：
29.4
通讯作者：
Chan, Andrew T.
中科院分区：
文献类型：
--
作者：
Strate, Lisa L.;Liu, Yan L.;Chan, Andrew T.
背景与目的：包括阿司匹林在内的非甾体抗炎药（NSAID）与憩室并发症有关。我们在一个大型前瞻性队列中研究了阿司匹林和NSAID的使用对憩室炎和憩室出血风险的影响。方法：我们研究了47,210名健康专业人员随访研究队列中的美国男性，他们在1986年基线时年龄为40-75岁。我们每两年评估一次阿司匹林、非阿司匹林非甾体抗炎药和其他危险因素的使用情况。我们根据对两年期和补充问卷的回答确定了患有憩室炎或憩室出血的男性。结果：在22年的随访评估中，我们记录了939例憩室炎和256例憩室出血。校正危险因素后，与不使用阿司匹林和NSAID的男性相比，定期使用阿司匹林（≥ 2次/周）的男性憩室炎的多变量风险比（HR）为1.25（95%置信区间[CI]，1.05-1.47），憩室出血的HR为1.70（95% CI，1.21-2.39）。中等剂量（2-5.9标准，325 mg片剂/周）和频率（4-6天/周）使用阿司匹林与出血风险最高相关（多变量HR，2.32; 95% CI，1.34-4.02，多变量HR，3.13; 95% CI，1.82-5.38）。与拒绝使用这些药物的男性相比，经常使用非阿司匹林NSAID的男性发生憩室炎（多变量HR，1.72; 95%CI，1.40-2.11）和憩室出血（多变量HR，1.74; 95%CI，1.15-2.64）的风险也增加。结论：经常使用阿司匹林或非甾体抗炎药与憩室炎和憩室出血的风险增加有关。有憩室并发症风险的患者应仔细考虑使用这些药物的潜在风险和益处。
BACKGROUND & AIMS: Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, have been implicated in diverticular complications. We examined the influence of aspirin and NSAID use on risk of diverticulitis and diverticular bleeding in a large prospective cohort. METHODS: We studied 47,210 US men in the Health Professionals Follow-up Study cohort who were 40-75 years old at baseline in 1986. We assessed use of aspirin, nonaspirin NSAIDs, and other risk factors biennially. We identified men with diverticulitis or diverticular bleeding based on responses to biennial and supplementary questionnaires. RESULTS: We documented 939 cases of diverticulitis and 256 cases of diverticular bleeding during a 22-year period of follow-up evaluation. After adjustment for risk factors, men who used aspirin regularly (>= 2 times/wk) had a multivariable hazard ratio (HR) of 1.25 (95% confidence interval [CI], 1.05-1.47) for diverticulitis and a HR of 1.70 (95% CI, 1.21-2.39) for diverticular bleeding, compared with nonusers of aspirin and NSAIDs. Use of aspirin at intermediate doses (2-5.9 standard, 325-mg tablets/wk) and frequency (4-6 days/wk) were associated with the highest risk of bleeding (multivariable HR, 2.32; 95% CI, 1.34-4.02, and multivariable HR, 3.13; 95% CI, 1.82-5.38, respectively). Regular users of nonaspirin NSAIDs also had an increased risk of diverticulitis (multivariable HR, 1.72; 95% CI, 1.40-2.11) and diverticular bleeding (multivariable HR, 1.74; 95% CI, 1.15-2.64), compared with men who denied use of these medications. CONCLUSIONS: Regular use of aspirin or NSAIDs is associated with an increased risk of diverticulitis and diverticular bleeding. Patients at risk of diverticular complications should carefully consider the potential risks and benefits of using these medications.