Acute lower gastrointestinal bleeding management in Portugal

Arroja, Bruno; Cremers, Isabelle; Ramos, R. dos S.; Cardoso, Cláudia; Rego, Ana Catarina; Caldeira, Ana Teresa; Eliseu, Liliana; Dinis, Maria de Lurdes; Glória, L; Rosa, Isadora; Pedrosa, Jose A.

doi:10.1097/meg.0b013e328344ccb5

Cited by 46 publications

(40 citation statements)

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“…Given the frequently benign nature of this disease, a significant portion of those with CI never present to medical attention, and estimates of disease incidence are hospitalbased, frequently with colonoscopic confirmation; therefore, only the more severe presentations are included in studies to ensure accurate diagnosis. Despite this systematic bias, CI is remarkably common with an estimated 16 to 24 % of affected patients presenting to the Emergency Department (ED) with lower GI bleeding and subsequent colonoscopy confirming this diagnosis [9,10]. The incidence was poorly characterized prior to the drug alosetron (a 5-HT 3 antagonist used to treat women with severe diarrhea-predominant irritable bowel syndrome (IBS)) being identified as an etiology.…”

Section: Disease Incidencementioning

confidence: 99%

Update on Colon Ischemia: Recent Insights and Advances

Feuerstadt

Brandt

2015

Curr Gastroenterol Rep

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Colon ischemia (CI) is the most common manifestation of ischemic injury to the gastrointestinal (GI) tract. This usually self-limited disease is being diagnosed more frequently, and the list of known causes is increasing. Local hypoperfusion and reperfusion injury are both thought to contribute to the disease process, which manifests with a wide spectrum of injury including reversible colopathy (subepithelial hemorrhage and edema), transient colitis, chronic colitis, stricture, gangrene, and fulminant universal colitis. The distribution is usually segmental with left-sided disease (e.g., inferior mesenteric artery distribution) being more frequently observed than right-sided involvement (e.g., superior mesenteric artery distribution). Any portion of the colon can be affected, but the anatomic distribution of CI recently has been shown to be associated with outcome. Patients with isolated-right colon ischemia (IRCI) have a different presentation and worse outcomes than other distributions of disease. Although somewhat variable depending on disease location, CI presents with cramping abdominal pains over the segment of colon involved followed by a short course of bloody diarrhea. Diagnosis is usually made clinically and is supported with serologic, radiologic, and colonoscopic findings. Colonoscopy is the most accurate diagnostic study. Most patients respond to conservative supportive therapy although some with more severe disease require antimicrobials and/or surgical intervention.

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Section: Disease Incidencementioning

confidence: 99%

Update on Colon Ischemia: Recent Insights and Advances

Feuerstadt

Brandt

2015

Curr Gastroenterol Rep

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“…Gastrointestinal bleeding can be classified into upper- or lower-gastrointestinal bleeding (UGIB or LGIB) on the basis of anatomical location (3456). Risk factors for clinical outcomes for patients with UGIB have been widely investigated (78910); however, little is known about the risk factors for clinical outcomes in patients with LGIB, despite a rising incidence (68). …”

Section: Introductionmentioning

confidence: 99%

The Clinical Outcomes of Lower Gastrointestinal Bleeding Are Not Better than Those of Upper Gastrointestinal Bleeding

et al. 2016

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The incidence of lower gastrointestinal bleeding (LGIB) is increasing; however, predictors of outcomes for patients with LGIB are not as well defined as those for patients with upper gastrointestinal bleeding (UGIB). The aim of this study was to identify the clinical outcomes and the predictors of poor outcomes for patients with LGIB, compared to outcomes for patients with UGIB. We identified patients with LGIB or UGIB who underwent endoscopic procedures between July 2006 and February 2013. Propensity score matching was used to improve comparability between LGIB and UGIB groups. The clinical outcomes and predictors of 30-day rebleeding and mortality rate were analyzed between the two groups. In total, 601 patients with UGIB (n = 500) or LGIB (n = 101) were included in the study, and 202 patients with UGIB and 101 patients with LGIB were analyzed after 2:1 propensity score matching. The 30-day rebleeding and mortality rates were 9.9% and 4.5% for the UGIB group, and 16.8% and 5.0% for LGIB group, respectively. After logistic regression analysis, the Rockall score (P = 0.013) and C-reactive protein (CRP; P = 0.047) levels were significant predictors of 30-day mortality in patients with LGIB; however, we could not identify any predictors of rebleeding in patients with LGIB. The clinical outcomes for patients with LGIB are not better than clinical outcomes for patients with UGIB. The clinical Rockall score and serum CRP levels may be used to predict 30-day mortality in patients with LGIB.

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“…Common causes of acute LGIB include colonic diverticulosis, vascular ectasias, ischemic colitis, colorectal polyps and neoplasms, inflammatory bowel disease, anorectal conditions, and postpolypectomy bleeding [2, 4–5]. …”

Section: Introductionmentioning

confidence: 99%

Endoscopic hemostasis is rarely used for hematochezia: a population-based study from the Clinical Outcomes Research Initiative National Endoscopic Database

Fisher

Gralnek

Eisen

et al. 2014

Gastrointestinal Endoscopy

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Background Data on use of endoscopic hemostasis performed during colonoscopy for hematochezia are primarily derived from expert opinion and case series from tertiary care settings. Objective To characterize patients with hematochezia who underwent in-patient colonoscopy and compare those who received endoscopic hemostasis with those who did not receive endoscopic hemostasis. Design Retrospective analysis Setting Clinical Outcomes Research Initiative (CORI) National Endoscopic Database 2002 – 2008 Patients Adults with hematochezia Interventions None Main Outcome Measurements Demographics, co-morbidity, practice setting, adverse events, and colonoscopy procedural characteristics and findings. Results We identified 3,151 persons who underwent in-patient colonoscopy for hematochezia. Endoscopic hemostasis was performed in 144 patients (4.6%). Of those who received endoscopic hemostasis, the majority were male (60.3%), White (83.3%), older (mean age 70.9 ± 12.3 years), had a low risk ASA Score (53.9%), and underwent colonoscopy in a community setting (67.4%). The hemostasis-receiving cohort was significantly more likely to be White (83.3% vs. 71.0%, p=0.02), have more co-morbidities (ASA Score III and IV 46.2% vs. 36.0%, p=0.04), and have the cecum reached (95.8% vs. 87.7%, p=0.003). Those receiving hemostasis were significantly more likely to have an endoscopic diagnosis of AVM’s (32.6% vs. 2.6%) p=0.0001or solitary ulcer (8.3% vs. 2.1%), p<0.0001. Limitations Retrospective database analysis. Conclusions Less than five percent of persons presenting with hematochezia and undergoing inpatient colonoscopy received endoscopic hemostasis. These findings differ from published tertiary care setting data. These data provide new insights on in-patient colonoscopy performed primarily in a community practice setting for patients with hematochezia.

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Acute lower gastrointestinal bleeding management in Portugal

Cited by 46 publications

References 0 publications

Update on Colon Ischemia: Recent Insights and Advances

Update on Colon Ischemia: Recent Insights and Advances

The Clinical Outcomes of Lower Gastrointestinal Bleeding Are Not Better than Those of Upper Gastrointestinal Bleeding

Endoscopic hemostasis is rarely used for hematochezia: a population-based study from the Clinical Outcomes Research Initiative National Endoscopic Database

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