Increased diverticular complications with nonsteriodal antiinflammatory drugs and other medications: a systematic review and meta-analysis

Aim
Complications of colonic diverticula, perforation and bleeding are a source of morbidity and mortality. A variety of drugs have been implicated in these complications. We present a systemic review and meta-analysis of the literature to assess the importance of this relationship.

Method
A systematic review of articles in PubMed, Cochrane Reviews, Embase and Google Scholar was undertaken in February 2013. An initial literature search yielded 2916 results that were assessed for study design and topicality. Twenty-three articles were included in the review. A qualitative data synthesis was conducted using forest plots of studies comparing single medication with complications.

Results
Individual studies demonstrated the odds of perforation and abscess formation with nonsteridal anti-inflammatory drugs (NSAIDs) (1.46–10.30), aspirin (0.66–2.40), steroids (2.17–31.90) and opioids (1.80–4.51) and the odds of bleeding with NSAIDs (2.01–12.60), paracetamol (0–3.75), aspirin (1.14–3.70) and steroids (0.57–5.40). Pooled data showed significantly increased odds of perforation and abscess formation with NSAIDs (OR = 2.49), steroids (OR = 9.08) and opioids (OR = 2.52). They also showed increased odds of diverticular bleeding from NSAIDs (OR = 2.69), aspirin (OR = 3.24) and calcium-channel blockers (OR = 2.50). Most studies did not describe the duration or dosage of medication used and did not systematically describe the severity of diverticular complications.

Conclusion
Various common medications are implicated in complications of diverticular disease.