Acute hemorrhagic rectal ulcer syndrome: Comparison with non‐hemorrhagic rectal ulcer lower gastrointestinal bleeding

Jung, Joo Hyuk; Kim, Jong Wook; Lee, Hyun Woo; Park, Min Yong; Paik, Woo Hyun; Bae, Woo Kyung; Kim, Nam Hoon; Kim, Kyung-Ah; Lee, June Sung

doi:10.1111/1751-2980.12513

Cited by 13 publications

(23 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several studies have shown that serum hypoalbuminemia can be an independent risk factor for decreased microperfusion and pressure ulcers because albumin helps maintain oncotic pressure and vascular refilling [ 22 – 24 ]. Our results were compatible with the results of the previous observational study, which suggested that hypoalbuminemia and high blood urea nitrogen levels were risk factors for lower gastrointestinal bleeding, mainly due to ischemic colitis and rectal ulcer in critically ill patients [ 19 ].…”

Section: Discussionsupporting

confidence: 92%

“…Previous observational studies have reported the characteristics of AHRUS patients, such as older age, immobility, antithrombotic drug use, and comorbidities such as diabetes mellitus, coronary artery diseases, cerebrovascular attacks, sepsis, liver failure [ 3 ], hypoalbuminemia [ 17 – 19 ], and chronic renal failure with hemodialysis [ 15 ]. The characteristics of cases in our research were compatible with those in observational studies and supported etiological assumptions except for older age [ 17 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors for Acute Hemorrhagic Rectal Ulcer Syndrome and Its Prognosis: A Density Case-Control Study

Komai

Shiratori

Kobayashi

et al. 2018

Gastroenterology Research and Practice

View full text Add to dashboard Cite

Acute hemorrhagic rectal ulcer syndrome (AHRUS) can cause fatal gastrointestinal bleeding. However, there have been few epidemiological studies investigating risk factors of AHRUS. To determine the risk factors and predict one-year survival after onset of AHRUS, we conducted a retrospective density case-control study in a tertiary referral hospital. Patients with hematochezia, bloody stool, and rectal ulcer confirmed by colonoscopy between 2003 and 2011 were diagnosed as AHRUS (n = 38). Patients with malignancies, infectious colitis, ulcerative colitis, or solitary rectal ulcer syndrome were excluded. Control subjects (n = 123) without rectal ulcer were selected by risk set sampling for each AHRUS. Multivariate logistic regression analyses revealed that the significant adjusted odds ratio (95% confidence interval) of hospitalization, antithrombotic drug use, and one gram increase of serum albumin was 15.7 (2.25–108.9), 12.1 (1.53–94.4), and 0.11 (0.02–0.52), respectively. Endoscopic hemostasis for rectal bleeding was performed in 8 cases (21%). Seventeen percent of patients died within one year after the episode of AHRUS from non-AHRUS causes. This study revealed that hospitalization, antithrombotic drug use, and lower serum albumin value were significant risk factors for AHRUS, and that AHRUS was an unfavorable prognostic condition. This information could be helpful in recognizing high-risk patients of rectal bleeding and applying preventive measures.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Risk Factors for Acute Hemorrhagic Rectal Ulcer Syndrome and Its Prognosis: A Density Case-Control Study

Komai

Shiratori

Kobayashi

et al. 2018

Gastroenterology Research and Practice

View full text Add to dashboard Cite

show abstract

“…Most subsequent reports through 2018 emanated from the eastern world, primarily out of Japan and Taiwan. [ 2 – 11 ] Delaney and Hitch, in 1974 (3 patients), [ 12 ] and Duff and Wright, in 1981 (7/9 acute bleeding patients) [ 13 ] described in Western world what is now called AHRU although they did not use the term “AHRU”.…”

Section: Introductionmentioning

confidence: 99%

Acute hemorrhagic rectal ulcer: Experience in 11 patients at an urban acute care center in the USA

Sugawa

Culver²,

Diebel³

et al. 2020

Medicine

View full text Add to dashboard Cite

Introduction: Acute hemorrhagic rectal ulcer (AHRU) is a rare entity which has most frequently been described in Japan and Taiwan literature. This study characterizes 11 AHRUs identified and managed at an urban acute care hospital in the United States of America (USA). Methods: A total of 2253 inpatients underwent colonoscopy. In 1172 patients (52%), colonoscopy was performed for evaluation of lower gastrointestinal (LGI) bleeding. Eleven (0.9%) of the 1172 patients with LGI bleeding had AHRU. Results: AHRU is characterized by a sudden onset of painless and massive lower rectal bleeding in elderly, bedridden patients (pts) with major underlying diseases. The endoscopic findings were classified into 4 types. All 11 ulcers were located in the distal rectum within 10 cm of the dentate line. All 11 patients required blood transfusion (mean = 3.7 units; range 2–9 units). Seven patients responded to blood, plasma, and platelet transfusions. The other 4 patients required endoscopic hemostasis. Three patients died within a month of colonoscopy from comorbidities. None had bleeding as a cause of death. Eight surviving patients did not have recurrent bleeding. Conclusion: AHRU does exist in the USA and should be considered as an important cause of acute lower GI bleeding in elderly, critically ill, and bedridden patients. AHRU should be recognized and managed correctly.

show abstract

“…AHRU is a rare disease first reported by Delancy and Hitch ( 3 ). From 1994 to 2019, 38 ( 4 ), 25 ( 5 ), 19 ( 6 ), and 6 ( 7 ) cases in Japan, South Korea, Taiwan, and Thailand, respectively, have been reported. These studies summarized the clinical features of AHRU with acute rectal ulcers, painless, massive rectal bleeding, and negative blood and stool culture.…”

Section: Introductionmentioning

confidence: 99%

“…These studies summarized the clinical features of AHRU with acute rectal ulcers, painless, massive rectal bleeding, and negative blood and stool culture. The pathological features of AHRU present as necrosis with denudation of the covering epithelium, hemorrhage, and multiple thrombi in the vessels of the epithelium and underlying stroma ( 5 , 6 ). Hospitalization, antithrombotic drug use, and lower serum albumin value are risk factors for AHRU ( 4 ); however, the pathogenesis of AHRU remains largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus Infection in an Adult Patient With Neuromyelitis Optica and Acute Hemorrhagic Rectal Ulcer: Case Report and Literature Review

et al. 2020

View full text Add to dashboard Cite

Background: Previous infectious or inflammatory events may be involved in the pathogenesis of neuromyelitis optica (NMO), potentially by triggering an autoimmune response. Cytomegalovirus (CMV)-related NMO (CMV-NMO) is rarely reported. Acute hemorrhagic rectal ulcer (AHRU) is a rare disease with a largely unknown pathogenesis. Herein, we reported a co-NMO and AHRU case associated with CMV infection. In addition, we review previously reported cases of CMV-NMO and CMV-AHRU. Case presentation: A 40-year-old female diagnosed with aquaporin4 (AQP4)-IgG + NMO and a poor response to high-dose intravenous methylprednisolone and immunoglobulin, followed by three rounds of plasma exchange was transferred to Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. She developed repeated acute lower gastrointestinal hemorrhage from the third day of admission. Abdominal computed tomography angiography (CTA) and interventional angiography did not detect any bleeding vessel. Bedside colonoscopy revealed a large ulcer-like lesion at 10 cm above the anus. Rectal biopsy pathology confirmed a CMV infection on day 23 post-admission, and cerebrospinal fluid (CSF) pathogen gene sequencing detected CMV gene copies on day 25 post-admission. After 2 weeks of treatment with ganciclovir and sodium phosphinate, the patient's lower gastrointestinal bleeding stopped, and her limb muscle strength and visual acuity gradually improved. After 4 weeks of antiviral therapy, colonoscopy showed that the intestinal wall of the original lesion was smooth. Hematoxylin and eosin (HE) staining and immunohistochemistry (IHC) of a biopsy specimen was negative for CMV, her right eye vision was normal, and limb muscle strength had recovered. Serum AQP4-IgG was negative, and lesions on brain magnetic resonance imaging (MRI) manifested shrinkage. Conclusions: The benefits of antiviral therapy remain unclear; however, clinicians should be aware of the possibility of CMV-related NMO, if NMO was refractory to high-dose intravenous methylprednisolone, immunoglobulin, and plasma exchange. Moreover, clinicians should consider the possibility of CMV-related AHRU when recurrent acute lower gastrointestinal bleeding occurs in a patient.

show abstract

Acute hemorrhagic rectal ulcer syndrome: Comparison with non‐hemorrhagic rectal ulcer lower gastrointestinal bleeding

Cited by 13 publications

References 12 publications

Risk Factors for Acute Hemorrhagic Rectal Ulcer Syndrome and Its Prognosis: A Density Case-Control Study

Risk Factors for Acute Hemorrhagic Rectal Ulcer Syndrome and Its Prognosis: A Density Case-Control Study

Acute hemorrhagic rectal ulcer: Experience in 11 patients at an urban acute care center in the USA

Cytomegalovirus Infection in an Adult Patient With Neuromyelitis Optica and Acute Hemorrhagic Rectal Ulcer: Case Report and Literature Review

Contact Info

Product

Resources

About