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Non‐steroidal anti‐inflammatory drugs and complicated diverticular disease: A case‐control study

R. Wilson,A. Smith,I. MacIntyre,R. Steele

Published 1991 in British Journal of Surgery

ABSTRACT

Sir We read with interest the paper by Campbell and Steele (Br J Surg 1991: 78: 190-1). As in the previous retrospective case control study of Langman rt a / . ’ , the authors describe a strong association between ingestion of NSAIDs (non-steroidal anti-inflammatory drugs) and serious complications of diverticular disease. Langman and collaborators associated NSAID intake with bleeding from diverticular disease in addition to septic complications, while the present report recorded both bleeding and perforation as a complication. It would be helpful to know if the Aberdeen data demonstrated a higher incidence of bleeding in those patients presenting with complications of diverticular disease who were taking NSAIDs compared with those who were not. In our own recently reported prospective study2 we defined a strong association between serious septic complications and NSAID intake, but patients on these drugs did not present more frequently with bleeding. This point is relevant as we have suggested that the possible mechanism for the NSAID effect in diverticular disease is related to an inhibition of the inflammatory response resulting in failure to localize the disease process. Corticosteroids have also been related to the septic complications of diverticular disease3. As these drugs are commonly prescribed in combination with NSAIDs, it is also important to establish whether the Aberdeen data corrected for this possible source of bias. None the less, this study, in conjunction with the previous ones’-3. underlines the strong association between NSAIDs and complications of diverticular disease. Perhaps given this clear association, the time has come to consider known diverticular disease as a relative contraindication to prescription of these agents.

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