Abstract
Colonic diverticular disease, especially diverticulitis constitutes a major cause of hospitalization and an economic burden in developed countries. Proton pump inhibitors (PPIs) are among the commonest drugs used to treat several diseases affecting the upper gastrointestinal tract. A few studies have reported that the use of Proton Pump Inhibitors PPIs caused dysbiosis. In this study, we searched for a relationship between PPI use and the onset and severity of diverticulitis in patients with colonic diverticulosis. In a retrospective study, patients who were hospitalized for documented diverticulitis were enrolled as cases and compared with a control group of patients with uncomplicated diverticulosis. Overall, 613 patients who had a diagnosis of diverticulosis were included in the study, 217 of whom had diverticulitis. After multivariate analysis, the non-modifiable risk factors associated with diverticulitis included: age (p < 0.0001), hypertension (p < 0.0001), chronic renal failure (p = 0.007), diabetes mellitus (p < 0.0001), and left colon location (p = 0.02). However, among the modifiable factors, only PPI use (p < 0.0001) showed a significant association. Advanced disease severity (according to Hinchey classification of diverticulitis stages II–IV) was associated with aspirin use (p = 0.0004) and pan-colonic location (p = 0.02). PPI use was the only modifiable factor significantly associated with diverticulitis, but not with its severity, among patients with diverticulosis. This observation should be confirmed in future multicenter prospective studies.
Highlights
Colonic diverticular disease, especially when complicated by diverticulitis and bleeding, constitutes a major cause of hospitalization and an economic burden in developed countries [1,2]
A second search was performed among these patients to detect patients who had been hospitalized at a later time, with the clinical diagnosis of diverticulitis that had been confirmed by computed tomography (CT) scan, during the study period when they were eligible for enrollment in the study
We showed a possible association between pump inhibitors (PPIs) use and the risk of diverticulitis that remained significant in multivariate analysis (p > 0.001, odds ratios (OR) 3.94, 95% confidence intervals (CI) 2.26–6.86)
Summary
Especially when complicated by diverticulitis and bleeding, constitutes a major cause of hospitalization and an economic burden in developed countries [1,2]. The main pathogenetic mechanism seems to involve inspissated fecal material that leads to mucus secretion and eventual bacterial overgrowth within the diverticulum inducing inflammation, focal necrosis, and micro- or macroperforation [7]. Due to their high efficacy and low toxicity, proton pump inhibitors (PPIs) are the most common drug used to treat gastroesophageal reflux disease, peptic ulcer disease (PUD), and to prevent NSAID and aspirin associated peptic ulcer disease [8]. PPI-induced dysbiosis can increase the risk of bacterial enteric infections and translocation [9,15]
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