How to Differentiate Sites of Gastrointestinal Bleeding in Patients with Hematochezia by Using Clinical Factors?

Yuwares Sittichanbuncha,Theerayut Thongkrau,Kittisak Sawanyawisuth,Suthasinee Senasu,Chaiyapon Keeratikasikorn

doi:10.1155/2013/265076

Yuwares Sittichanbuncha, Theerayut Thongkrau + Show 3 more

Open Access

https://doi.org/10.1155/2013/265076

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Abstract

Hematochezia is one of common gastrointestinal complaint at the Emergency Department (ED). Causes may be due to upper (UGIB) or lower (LGIB) gastrointestinal tract bleeding. Here, clinical factors were studied to differentiate sites of bleeding in patients with hematochezia. All patients with an age of more than 18 years who were diagnosed with GIB at the ED, Ramathibodi Hospital, Thailand were enrolled. Patients who presented with hematochezia and received complete workups to identify causes of bleeding were studied and categorized as being in the UGIB or LGIB groups. There were 1,854 patients who presented with GIB at the ED. Of those, 76 patients presented with hematochezia; 30 patients were in the UGIB group, while 43 patients were in the LGIB group. Clinical variables between both groups were mostly comparable. Three clinical factors were significantly associated with UGIB causes in patients with hematochezia including systolic blood pressure, hematocrit level, and BUN/Cr ratio. The adjusted odds ratios for all three factors were 0.725 (per 5 mmHg increase), 0.751 (per 3% increase), and 1.11 (per unit increase). Physicians at the ED could use these clinical factors as a guide for further investigation in patients who presented with hematochezia.

Highlights

Gastrointestinal bleeding (GIB) is a common complaint at the Emergency Department (ED)
Gastroscopy is indicated in UGIB patients to identify causes of UGIB, while colonoscopy and/or vascular scans are investigations of choice for LGIB
There were 1,854 patients presented with GIB at the ED

Summary

Introduction

Further investigations or management strategies are different between UGIB and LGIB patients. Not all of patients with UGIB, present with hematemesis or melena [1]. Hematochezia is a presenting symptom of LGIB. Patients with UGIB may present with hematochezia. Nasogastric lavage may not be a useful procedure if the patients do not have hematemesis [2]. Clinical factors such as the history of alcohol consumption, smoking, or NSAID use were found to be related to UGIB in previous studies [3].

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