Rebleeding Risk of Acute Hemorrhagic Rectal Ulcer: A Multicenter Retrospective Study
Takahiro Muramatsu1, Masakatsu Fukuzawa1, Akira Madarame1
1Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan.
Internal Medicine (Tokyo, Japan)
|February 12, 2024
Summary
Risk factors for rebleeding in acute hemorrhagic rectal ulcers (AHRU) include poor performance status, blood transfusions, low kidney function, and specific endoscopic findings. Identifying these factors aids in managing AHRU patients and preventing recurrence.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Internal Medicine
Background:
- Acute hemorrhagic rectal ulcer (AHRU) presents with sudden, massive rectal bleeding.
- Limited research exists on risk factors for AHRU rebleeding.
- Effective management requires understanding predictors of recurrent bleeding.
Purpose of the Study:
- To identify risk factors for rebleeding after initial hemostasis in patients with AHRU.
- To analyze clinical, endoscopic, and treatment-related factors associated with AHRU recurrence.
- To inform clinical practice and improve outcomes for AHRU patients.
Main Methods:
- Retrospective multicenter study of 149 AHRU patients (January 2015 - May 2020).
- Data collected included patient demographics, comorbidities, medications, laboratory results, endoscopic findings, hemostasis methods, and clinical course.
- Multivariate analysis was used to determine significant risk factors for rebleeding.
Main Results:
- Rebleeding occurred in 23% (35/149) of patients.
- Significant predictors of rebleeding included poor performance status (PS 4), history of blood transfusion, low estimated glomerular filtration rate (eGFR), poor visualization of the entire rectum during endoscopy, and use of monopolar hemostatic forceps.
Conclusions:
- Poor performance status (PS 4) is a key risk factor for AHRU rebleeding.
- Blood transfusion history, low eGFR, and inadequate endoscopic visualization are associated with increased rebleeding risk.
- The choice of hemostasis method, specifically monopolar forceps, may also influence rebleeding rates.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
67
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
67
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
185
Introduction
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
185
01:24Esophageal Varices-I: Introduction
137
Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
137
01:30Peptic Ulcer Disease I: Introduction
168
Peptic Ulcer Disease (PUD) is characterized by mucosal excavation in the esophagus, stomach, pylorus, or duodenum. It can manifest as acute or chronic based on the extent and duration of mucosal involvement.
An acute ulcer, marked by superficial erosion and minimal inflammation, swiftly resolves upon identifying and addressing the underlying cause. In contrast, a chronic ulcer persists, potentially eroding through the muscular wall and forming fibrous tissue.
Peptic ulcers can also be...
An acute ulcer, marked by superficial erosion and minimal inflammation, swiftly resolves upon identifying and addressing the underlying cause. In contrast, a chronic ulcer persists, potentially eroding through the muscular wall and forming fibrous tissue.
Peptic ulcers can also be...
168