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Risk Factors for Late Rebleeding of Colonic Diverticular Bleeding in Elderly Individuals
Yoshinori Sato1, Hiroshi Yasuda1, Yusuke Nakamoto1
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.
Insights
Elderly patients with colonic diverticular bleeding (CDB) face higher rates of late rebleeding. Discontinuing non-steroidal anti-inflammatory drugs (NSAIDs) may help prevent recurrence in this vulnerable population.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Epidemiology
Background:
- Colonic diverticular bleeding (CDB) is a significant cause of lower gastrointestinal bleeding.
- Elderly individuals represent a growing demographic with unique clinical challenges related to CDB.
Purpose of the Study:
- To investigate the clinical characteristics of CDB in elderly patients.
- To compare rebleeding rates between elderly and non-elderly patients.
- To identify risk factors for late rebleeding in elderly individuals with CDB.
Main Methods:
- Retrospective case-control study at a single tertiary center.
- Analysis of 519 patients with CDB hospitalized between January 2004 and May 2019.
- Division of patients into elderly (≥75 years) and non-elderly (<75 years) groups.
Main Results:
- Late rebleeding rates were significantly higher in the elderly group (42.3%) compared to the non-elderly group (30.6%) (p=0.005).
- 3-year recurrence-free survival was lower in the elderly (63.6%) versus non-elderly (75.6%) (p<0.001).
- Independent risk factors for late rebleeding in the elderly included NSAID use (OR, 3.55), chronic kidney disease (OR, 2.89), and bilateral diverticula (OR, 1.83).
Conclusions:
- Elderly patients with CDB necessitate vigilant post-discharge monitoring.
- Discontinuation of NSAIDs should be strongly considered to mitigate the risk of recurrent bleeding in elderly CDB patients.
Objectives:
This study aimed to examine the clinical characteristics of colonic diverticular bleeding (CDB) in elderly individuals.
Methods:
This retrospective case-control study was conducted at a single tertiary center. A total of 519 patients (356 men and 163 women; mean age of 73.1 ± 12.5 years) with CDB and hospitalized between January 2004 and May 2019 were analyzed. The subjects were divided into two groups: the elderly (274 individuals aged ≥75 years; mean age, 82.1 ± 5.3 years) and non-elderly (245 individuals aged <75 years; mean age, 63.0 ± 10.3 years) groups. Primary outcomes were early and late rebleeding rates, and secondary outcomes were the risk factors for late rebleeding in elderly individuals. Rebleeding occurring within 30 days of hospitalization was defined as early rebleeding, whereas rebleeding occurring after 31 days was defined as late rebleeding.
Results:
The early rebleeding rates were 30.6% and 33.1% (p = 0.557) in the elderly and non-elderly groups, respectively. The late rebleeding rates were 42.3% and 30.6% (p = 0.005) in the elderly and non-elderly groups, respectively. The 3-year recurrence-free survival was 63.6% in the elderly group and 75.6% in the non-elderly group (log-rank test: p < 0.001). Multivariate analysis revealed the use of non-steroidal anti-inflammatory drugs (NSAIDs) [odds ratio (OR), 3.55], chronic kidney disease (OR, 2.89), and presence of bilateral diverticula (OR, 1.83) as the independent risk factors for late rebleeding in elderly individuals.
Conclusions:
Elderly individuals with CDB require careful follow-up even after discharge. Furthermore, it is important to consider discontinuing NSAIDs to prevent rebleeding.
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