Acute Lower Gastrointestinal Bleeding: Characteristics and Clinical Outcome of Patients Treated With an Intensive Protocol

Διαμαντοπούλου, Γεωργία; Konstantakis, Christos; Κοττόρου, Αναστασία; Skroubis, G; Theocharis, Georgios; Theopistos, Vasileios; Triantos, Christos; Nikolopoulou, V.; Thomopoulos, Konstantinos

doi:10.14740/gr914w

Cited by 11 publications

(10 citation statements)

References 26 publications

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“…A study from USA showed that divericular bleeding (37%) was the most common cause of severe LGIB followed by ischemic colitis (13.2%), delayed post polypectomy induced bleeding (11.1%), rectal ulcer (8.9%), internal hemorrhoids (6.4%) and colon angiomas (6.4%) (Camus et al, 2017). Another study from western country discovered that the most common causes of LGIB were diverticulosis and ischemic colitis (Diamantopoulou et al, 2017). Study from Middle East indicated that the most common colonoscopic findings of LGIB were hemorrhoids followed by diverticulosis, neoplasm, rectal ulcer, colitis and polyps respectively, and colon was normal in 14.6% patients (Alruzug et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Colonoscopic Finding of Patients with Lower Gastrointestinal Bleeding at Different Age Group in Eastern Part of India – An Observational Study

Paul

2020

Prague Med. Rep.

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Incidence of lower gastrointestinal (GI) bleeding (LGIB) is increasing over time. It can be seen in all age group patients, commonly associated with pre-existing comorbidities and is one of the common indications of colonoscopy. This study was done to identify common causes of LGIB in eastern part of India, because there is no previous study from Eastern India to identify the common causes of lower GI bleeding diagnosed by colonoscopy in different age group patients. Consecutive 64 patients with LGIB were included in this study from June 2018 to March 2019. We divided our study population into three groups, such as group A (20 years to 40 years), group B (41 years to 60 years), and group C (more than 60 years). Data were entered into Excel and then transferred into SPSS version 22 for statistical analysis. Mean age of study population was 49.83 ± 19.06 years. Normal colonoscopic finding was seen in 7 patients (10.9%). Most common colonoscopic findings of our study population were hemorrhoids (n=32; 50%), anal fissure (n=11; 17.2%) and isolated rectal ulcer (n=9; 14.1%). Colorectal growth was seen in 6 patients (9.4%), among them female patients were more commonly affected than male patients. Therefore, most common causes of LGIB in eastern part of India are hemorrhoids, anal fissure and isolated rectal ulcer. Male individuals are more commonly affected by LGIB.

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Section: Introductionmentioning

confidence: 99%

Colonoscopic Finding of Patients with Lower Gastrointestinal Bleeding at Different Age Group in Eastern Part of India – An Observational Study

Paul

2020

Prague Med. Rep.

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“…The higher incidence of haemorrhoidal bleeding may account for the shorter median length of stay of 3 days which in turn may result from selection bias in our local context with easier access to tertiary healthcare, as compared to other jurisdictions. Small bowel bleeding remains relatively uncommon (0.3%) but may be as high as 2–9% of LGIB in the literature, with angiodysplastic lesions being most prominent [ 29 , 30 ]. It is an important differential to consider in LGIB patients with normal endoscopic findings necessitating further investigation with video capsule endoscopy or double balloon enteroscopy.…”

Section: Discussionmentioning

confidence: 99%

A clinical predictive model for risk stratification of patients with severe acute lower gastrointestinal bleeding

Singh

Chiang

Seah³

et al. 2021

World J Emerg Surg

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Background Lower gastrointestinal bleeding (LGIB) is a common presentation of surgical admissions, imposing a significant burden on healthcare costs and resources. There is a paucity of standardised clinical predictive tools available for the initial assessment and risk stratification of patients with LGIB. We propose a simple clinical scoring model to prognosticate patients at risk of severe LGIB and an algorithm to guide management of such patients. Methods A retrospective cohort study was conducted, identifying consecutive patients admitted to our institution for LGIB over a 1-year period. Baseline demographics, clinical parameters at initial presentation and treatment interventions were recorded. Multivariate logistic regression was performed to identify factors predictive of severe LGIB. A clinical management algorithm was developed to discriminate between patients requiring admission, and to guide endoscopic, angiographic and/or surgical intervention. Results 226/649 (34.8%) patients had severe LGIB. Six variables were entered into a clinical predictive model for risk stratification of LGIB: Tachycardia (HR ≥ 100), hypotension (SBP < 90 mmHg), anaemia (Hb < 9 g/dL), metabolic acidosis, use of antiplatelet/anticoagulants, and active per-rectal bleeding. The optimum cut-off score of ≥ 1 had a sensitivity of 91.9%, specificity of 39.8%, and positive and negative predictive Values of 45% and 90.2%, respectively, for predicting severe LGIB. The area under curve (AUC) was 0.77. Conclusion Early diagnosis and management of severe LGIB remains a challenge for the acute care surgeon. The predictive model described comprises objective clinical parameters routinely obtained at initial triage to guide risk stratification, disposition and inpatient management of patients.

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“…Small bowel bleeding remains relatively uncommon (0.3%) but may be as high as 2-9% of LGIB in the literature, with angiodysplastic lesions being most prominent. (29,30) It is an important differential to consider in LGIB patients with normal endoscopic ndings necessitating further investigation with video capsule endoscopy or double balloon enteroscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Lower Gastrointestinal Bleeding (LGIB), de ned as bleeding distal to the ligament of Treitz, remains a common presenting symptom for emergency general surgical patients. The annual incidence (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) cases per 100,000 adults) rises 200-fold between the 3rd and 9th decade of life. (1, 2) Amongst the elderly, the morbidity secondary to LGIB is exacerbated due to the interplay of multiple comorbidities, use of antiplatelet and/or anticoagulants and poor functional reserves.…”

Section: Introductionmentioning

confidence: 99%

A Clinical Predictive Model for Risk Stratification of Patients with Severe Acute Lower Gastrointestinal Bleeding

Singh

Chiang

Seah

et al. 2021

Preprint

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Background: Lower Gastro-Intestinal Bleeding (LGIB) is a common presentation of surgical admissions, imposing a significant burden on healthcare costs and resources. There is a paucity of standardised clinical predictive tools available for the initial assessment and risk stratification of patients with LGIB. We propose a simple clinical scoring model to prognosticate patients at risk of severe LGIB and an algorithm to guide management of such patients.Methods: A retrospective cohort study was conducted, identifying consecutive patients admitted to our institution for LGIB over a 1-year period. Baseline demographics, clinical parameters at initial presentation and treatment interventions were recorded. Severe LGIB was the primary outcome measure. Multivariate logistic regression was performed to identify factors predictive of severe LGIB. A clinical management algorithm was developed to discriminate between patients requiring admission, and to guide endoscopic, angiographic and/or surgical intervention.Results: 226/649 (34.8%) patients had severe LGIB. Six variables were entered into a clinical predictive model for risk stratification of LGIB: Tachycardia (HR>100), hypotension (SBP<90mmHg), anemia (Hb<9g/dL), metabolic acidosis, use of antiplatelet/anticoagulants, and active per-rectal bleeding. The optimum cut-off score of >1 had a sensitivity of 91.9%, specificity of 39.8%, and Positive and Negative Predictive Values of 45% and 90.2% respectively for predicting severe LGIB. The Area Under Curve (AUC) was 0.77.BConclusion: Early diagnosis and management of severe LGIB remains a challenge for the acute care surgeon. The predictive model described comprises objective clinical parameters routinely obtained at initial triage to guide risk stratification, disposition and inpatient management of patients.

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Acute Lower Gastrointestinal Bleeding: Characteristics and Clinical Outcome of Patients Treated With an Intensive Protocol

Cited by 11 publications

References 26 publications

Colonoscopic Finding of Patients with Lower Gastrointestinal Bleeding at Different Age Group in Eastern Part of India – An Observational Study

Colonoscopic Finding of Patients with Lower Gastrointestinal Bleeding at Different Age Group in Eastern Part of India – An Observational Study

A clinical predictive model for risk stratification of patients with severe acute lower gastrointestinal bleeding

A Clinical Predictive Model for Risk Stratification of Patients with Severe Acute Lower Gastrointestinal Bleeding

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