Lower Gastrointestinal Bleeding in Patients With Cirrhosis-Etiology and Outcomes

Abstract

Background: Lower gastrointestinal bleeding (LGIB) is a common clinical problem, and may be more prevalent among patients with cirrhosis, especially in the setting of portal hypertension and coagulopathy. However, there is extremely little data available on the subject of LGIB in patients with cirrhosis. Therefore, the primary objective of this study was to better understand the etiology and outcomes of cirrhotic patients hospitalized with LGIB.

Materials and methods: We analyzed 3,735 cirrhotic patients admitted to the Medical University of South Carolina between January 2011 and September 2018, and identified patients admitted with a primary diagnosis of hematochezia or bright red blood per rectum.

Results: Thirty patients with cirrhosis and LGIB were included in the cohort. The mean age was 56 ± 13 years, with 30% women. The mean model of end stage liver disease score was 22, and Child-Pugh (CP) scores were C: 41%, B: 33% and A: 26%. The mean Charlson Comorbidity Index was 5.6. Twenty-four (80%) patients had a clinical decompensating event (hepatic encephalopathy, ascites, esophageal varices); the mean hepatic venous pressure gradient was 14.1 mm Hg (n = 8). In 33% of patients, LGIB was considered significant bleeding that necessitated blood transfusion. The most common cause of LGIB was hemorrhoids (11 patients, 37%), followed by portal hypertensive enteropathy or colopathy (7 patients, 23%). Hemoglobin levels on admission were lower in patients with CP B/C cirrhosis than in those with CP A (P < 0.001). The length of stay was 9 ± 10 days, and 5 patients died (mortality, 17%).

Conclusions: Despite being uncommon, LGIB in cirrhotic patients is associated with a high mortality rate.

Keywords: Bright red bleeding per rectum; Hematochezia; Outcome.

Figure 1.

Consort diagram of the study cohort. The numbers of patients included in the study are shown. 562 patients with GI bleeding and cirrhosis were admitted to the hospital. Of these, 30 patients had hematochezia/BRBPR and no evidence of upper GI bleeding. See also the methods section. Abbreviations - GI: gastrointestinal; UGIB: upper gastrointestinal bleeding; BRBPR: bright red bleeding per rectum; IDA: iron deficiency anemia.