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Lower Gastrointestinal Bleeding in Patients With Cirrhosis-Etiology and Outcomes
1Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina.
Insights
Lower gastrointestinal bleeding (LGIB) in cirrhosis patients is uncommon but serious. Hemorrhoids and portal hypertensive enteropathy were common causes, with a significant mortality rate of 17% in this study.
Area of Science:
- Gastroenterology
- Hepatology
- Internal Medicine
Background:
- Lower gastrointestinal bleeding (LGIB) is a common issue, potentially more frequent in cirrhosis patients due to portal hypertension and coagulopathy.
- Limited data exists on LGIB specifically within the cirrhotic population.
- This study addresses the gap in understanding the causes and outcomes of LGIB in hospitalized cirrhosis patients.
Purpose of the Study:
- To investigate the etiology of lower gastrointestinal bleeding (LGIB) in patients with cirrhosis.
- To determine the clinical outcomes and mortality associated with LGIB in this patient group.
- To analyze the characteristics of cirrhotic patients hospitalized with LGIB.
Main Methods:
- Retrospective analysis of 3,735 cirrhotic patients admitted between January 2011 and September 2018.
- Identification of patients with a primary diagnosis of hematochezia or bright red blood per rectum.
- Inclusion of 30 cirrhotic patients with LGIB for detailed cohort analysis.
Main Results:
- The most frequent causes of LGIB were hemorrhoids (37%) and portal hypertensive enteropathy/colopathy (23%).
- Significant bleeding requiring transfusion occurred in 33% of patients.
- The mortality rate was 17% (5 deaths) among the 30 patients studied, with a mean hospital stay of 9 days.
Conclusions:
- Lower gastrointestinal bleeding (LGIB) in patients with cirrhosis, though infrequent, carries a high mortality risk.
- Understanding the specific causes and risk factors is crucial for managing this vulnerable population.
- Further research is warranted to improve outcomes for cirrhotic patients experiencing LGIB.
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.
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