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. 2016 Sep;61(9):2732-40.
doi: 10.1007/s10620-016-4198-y. Epub 2016 Jun 10.

Origin, Clinical Characteristics and 30-Day Outcomes of Severe Hematochezia in Cirrhotics and Non-cirrhotics

Marine Camus  1   2   3 , Vandana Khungar  4 , Dennis M Jensen  5   6   7 , Gordon V Ohning  5   6   7 , Thomas O Kovacs  5   6   7 , Rome Jutabha  5   6 , Kevin A Ghassemi  5   6 , Gustavo A Machicado  5   6   7 , Gareth S Dulai  5   6   7
Affiliations

Origin, Clinical Characteristics and 30-Day Outcomes of Severe Hematochezia in Cirrhotics and Non-cirrhotics

Marine Camus et al. Dig Dis Sci. 2016 Sep.

Abstract

Background: The sites of origin, causes and outcomes of severe hematochezia have not been compared between cirrhotics and non-cirrhotics. In cirrhotics versus non-cirrhotics presenting with severe hematochezia, we aimed at (1) identifying the site and etiology of gastro-intestinal bleeding and independent predictors of bleeding from the upper gastrointestinal tract versus small bowel or the colon, (2) comparing 30-day clinical outcomes, and (3) proposing an algorithm for management of severe hematochezia.

Methods: In this cohort study from two university-based medical centers, 860 consecutive patients with severe hematochezia admitted from 1995 to 2011 were prospectively enrolled with 160 (18.6 %) cirrhotics. We studied (a) general clinical and laboratory characteristics of cirrhotics versus non-cirrhotics, (b) predictors of bleeding sites in each patient group by multiple variable regression analysis, and compared (c) 30-day outcomes, including rebleeding, surgery and deaths.

Results: Cirrhosis independently predicted an upper gastrointestinal source of bleeding (OR 3.47; 95 % CI 2.01-5.96) as well as history of hematemesis, melena in the past 30 days, positive nasogastric aspirate, prior upper gastrointestinal bleeding or use of aspirin or non-steroidal anti-inflammatory. The most prevalent diagnoses were esophageal varices (20 %) in cirrhotics and colon diverticular bleeding (27.1 %) in non-cirrhotics. Thirty-day rates of rebleeding, surgical interventions and deaths were 23.1 versus 15 % (P = 0.01), 14.4 versus 6.4 % (P < 0.001), and 17.5 versus 4.1 % (P < 0.001), in cirrhotics versus non-cirrhotics, respectively.

Conclusions: Cirrhosis predicted an upper gastrointestinal site of bleeding in patients presenting with severe hematochezia. The 30-day rates of rebleeding, surgery, and death were significantly higher in cirrhotics than in non-cirrhotics.

Keywords: Cirrhosis; Hematochezia; Lower gastrointestinal bleeding; Upper gastrointestinal bleeding.

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Conflict of interest statement

Conflict of interest The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Location in bleeding sites in cirrhotics versus non-cirrhotics presenting with severe hematochezia
Fig. 2
Fig. 2
Stigmata of recent hemorrhage in cirrhotics versus non-cirrhotics presenting with severe hematochezia
Fig. 3
Fig. 3
Algorithm recommended by the CURE Hemostasis Research Group for the management of severe hematochezia
See this image and copyright information in PMC

References

    1. Davila RE, Rajan E, Adler DG, et al. ASGE guideline: the role of endoscopy in the patient with lower-GI bleeding. Gastrointest Endosc. 2005;62:656–660. - PubMed
    1. Zuccaro G., Jr Management of the adult patient with acute lower gastrointestinal bleeding. American College of Gastroenterology. Practice Parameters Committee. Am J Gastroenterol. 1998;93:1202–1208. - PubMed
    1. Savides TJ, Jensen DM. GI bleeding. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10. Philadelphia: Saunders Elsevier Saunders; 2016. pp. 297–335.
    1. Jensen DM. Management of patients with severe hematochezia—with all current evidence available. Am J Gastroenterol. 2005;100:2403–2406. - PubMed
    1. González-González JA, García-Compean D, Vázquez-Elizondo G, Garza-Galindo A, Jáquez-Quintana JO, Maldonado-Garza H. Nonvariceal upper gastrointestinal bleeding in patients with liver cirrhosis. Clinical features, outcomes and predictors of in-hospital mortality. A prospective study. Ann Hepatol. 2011;10:287–295. - PubMed

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