Higher waist circumference as a risk factor for rebleeding of small bowel angiodysplasia

Recurrent bleeding from small bowel angiodysplasia (SBA) is common, and identifying risk factors for rebleeding can help identify high-risk patients who may benefit from further therapy. The pathophysiology of SBA is linked to an imbalance of angiogenic factors such as angiopoietin 1 (Ang-1) and angiopoietin 2 (Ang-2), as well as higher serum levels of Ang-2. Additionally, murine models of steatohepatitis showed elevated serum and hepatic Ang-2 levels, which directly promote pathological angiogenesis. The present study aimed to evaluate risk factors for rebleeding in symptomatic patients with SBA.

Upon review of the medical records and application of the inclusion and exclusion criteria, 109 cases were determined to be affected by SBAs. Five patients were ineligible for the study because of a shorter than one-year follow-up period or early use of a specific treatment. Thus, in a retrospective observational study of 104 patients with gastrointestinal bleeding from SBA between 2012 and 2016 who were conservatively managed at the beginning of follow-up, we obtained clinical features and risk factors for rebleeding, and we analyzed potential predictors of rebleeding through univariate and multivariable analysis.

We found that 57 of 104 patients (54.8%) experienced rebleeding during a follow-up of more than one year. The majority were females (71.2%), and we noted that hypertension (70.2%) and dyslipidemia (43.3%) were the most common comorbidities. Multiple regression analysis indicated that waist circumference (WC) (odds ratio for each 1 cm increment =1.04; 95% confidence interval: 1.01-1.08; P=0.02) was a significant risk factor for rebleeding.

In patients with symptomatic SBAs, an increase in WC positively correlated with the risk of rebleeding.