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

Toshihiko Komai,Fumio Omata,Yasutoshi Shiratori,Hiroko Arioka,Daiki Kobayashi

doi:10.1155/2018/8179890

Abstract

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.

Highlights

Rectal ulcer, unrelated to malignancy, inflammatory bowel diseases (IBD), or infectious colitis includes two distinct disease entities: solitary rectal ulcer syndrome (SRUS) [1, 2] and acute hemorrhagic rectal ulcer syndrome (AHRUS) [3]
Gender, comorbidities, laboratory values, hospitalization, and antithrombotic use were associated with AHRUS
In multivariate logistic regression analyses, hospitalization, antithrombotic drug use, and one gram decrease of serum albumin were significantly associated with AHRUS

Summary

Introduction

Rectal ulcer, unrelated to malignancy, inflammatory bowel diseases (IBD), or infectious colitis includes two distinct disease entities: solitary rectal ulcer syndrome (SRUS) [1, 2] and acute hemorrhagic rectal ulcer syndrome (AHRUS) [3]. AHRUS is characterized by sudden massive rectal bleeding, most often in elderly patients with underlying comorbidities [6, 7]. AHRUS has been reported to be the most common cause of acute lower gastrointestinal bleeding in hospitalized patients with comorbidities [3, 6, 7]. There have been few studies investigating risk factors and prophylactic interventions of life-threatening AHRUS. This lack of information may contribute to delay in making the diagnosis and in instituting preventive measures. There has been no report of survival analysis of the patients suffering from AHRUS. The aims of our study were to determine risk factors of AHRUS and to predict its oneyear survival

Objectives

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Conclusion