Outcome Of Lower Gastrointestinal Bleeding Research Articles

Clinical outcomes of lower gastrointestinal bleeding in patients managed with lower endoscopy: A tertiary center results.

Lower gastrointestinal bleeding (LGIB) is an urgent presentation with increasing prevalence and remains a common cause of hospitalization. The clinical outcome can vary based on several factors, including the cause of bleeding, its severity, and the effectiveness of management strategies. The aim of this study is to provide a comprehensive report on the clinical outcomes observed in patients with LGIB who underwent lower endoscopy. All patients who underwent emergency lower endoscopy for fresh bleeding per rectum, from May 2015 to December 2021, were included. The primary outcome was to identify the rate of rebleeding after initial control of bleeding. The second was to measure the clinical outcomes and the potential predictors leading to intervention and readmission. A total of 84 patients were included. Active bleeding was found in 20% at the time of endoscopy. Rebleeding within 90 days occurred in 6% of the total patients; two of which (2.38%) were within the same admission. Ninety-day readmission was reported in 19% of the cases. Upper endoscopy was performed in 32.5% of the total cases and was found to be a significant predictor for intervention (OR 4.1, P = 0.013). Personal history of inflammatory bowel disease (IBD) and initial use of sigmoidoscopy were found to be significant predictors of readmission [(OR 5.09, P = 0.008) and (OR 5.08, P = 0.019)]. LGIB is an emergency that must be identified and managed using an agreed protocol between all associated services to determine who needs upper GI endoscopy, ICU admission, or emergency endoscopy within 12 hours.

S790 Outcomes of Lower Gastrointestinal Bleeding Among Colorectal Cancers Patients: An Analysis from Nationwide Readmissions Database

S790 Outcomes of Lower Gastrointestinal Bleeding Among Colorectal Cancers Patients: An Analysis from Nationwide Readmissions Database

Anatomical location, risk factors, and outcomes of lower gastrointestinal bleeding in colorectal cancer patients: a national inpatient sample analysis (2009-2019).

This study aimed to investigate the incidence, predictors, and impact of lower gastrointestinal bleeding (LGIB) on inpatient mortality among colorectal cancer patients, due to its clinical significance and potential influence on patient outcomes. We conducted a retrospective analysis of data from the National Inpatient Sample database between 2009 and 2019, including 2,598,326 colorectal cancer patients with and without LGIB. Univariate and multivariate logistic regression analyses were performed to determine predictors of LGIB and its association with inpatient outcomes. The highest incidence of LGIB was observed in rectal cancer patients (3.8%), followed by distal colon cancer patients (1.4%) and proximal colon cancer patients (1.2%). Several factors were significantly associated with LGIB, including older age; male sex; certain racial such as Black, Hispanic, and Asia/Pacific Islander patients; or lower socioeconomic status. Multivariate analysis identified independent predictors of LGIB, such as severe sepsis, use of anticoagulants, long-term use of aspirin or antiplatelet drugs, palliative care, malnutrition, cachexia, chemotherapy or immunotherapy, metastasis, alcohol abuse, hypertension, obesity, and family history of digestive cancer. No significant difference in inpatient mortality was observed between patients with and without LGIB. Our study underscores the importance of considering colorectal cancer location and identified risk factors for LGIB assessment. Clinicians should address modifiable risk factors and healthcare disparities. Future research should explore underlying mechanisms, targeted interventions, and long-term outcomes beyond inpatient mortality.

Etiologies and outcome of lower gastrointestinal bleeding in patients presenting to a tertiary care Children's Hospital.

Objective:To determine etiology and outcome of children with lower gastrointestinal bleeding (LGIB).Methods:This was a prospective study conducted at the Department of Pediatric Gastroenterology and Hepatology, Children’s Hospital and The Institute of Child’s Heath, Multan, Pakistan, from July 2019 to March 2020. A total of 148 cases presented with bleeding per rectum and underwent colonoscopy, were included. Children of both genders and aged three month to 15 years were included. Detailed history, clinical examination, laboratory studies, colonoscopy and histopathology were done in all cases. Study information like demographics, complaints, general clinical examination, colonoscopy and histopathological findings were recorded.Results:Overall, mean age was noted to be 7.20±1.83 years. Abdominal pain was reported in 41 (27.7%), diarrhea 36 (24.3%), fever 12 (8.1%) and constipation in 4 (2.7%). Pallor was noted among 68 (45.9%), weight loss 39 (26.3%) and tachycardia 31 (20.9%). Colonoscopy revealed juvenile colonic / rectal polyps, infectious colitis and solitary rectal ulcer (SRU) as the most common etiologies found among 58 (39.2%), 20 (13.5%) and 19 (12.8%) cases respectively. Juvenile polyps and non-specific colitis were the commonest histopathological findings seen in 55 (37.2%) and 20 (13.5%) cases respectively. Colonoscopic polypectomy was used to remove all juvenile polyps.Conclusion:LGIB is presentation of various underlying causes. Children with LGIB commonly present with abdominal pain. Juvenile polyps were the most frequent cause of LGIB among children flowed by non-specific colitis. Most of the children having LGIB were diagnosed and treated successfully, few are in remission and very few were found resistant to treatment.

Evaluation of the causes and outcome of lower gastrointestinal bleeding: An endoscopic study

Evaluation of the causes and outcome of lower gastrointestinal bleeding: An endoscopic study

Incidence, Management, and Risk Factors for Lower Gastrointestinal Bleeding in Renal Transplant Recipients

BackgroundThere are limited convincing data regarding management and outcomes of lower gastrointestinal bleeding (LGB) in renal transplant recipients (RTR). The aim of this study was to evaluate incidence, management strategies, and risk factors associated with LGB in RTR. MethodsBetween January 2004 and December 2013, RTR with LGB were analyzed. LGB was defined as having clinical evidence of hemorrhage after upper gastrointestinal etiology was ruled out. ResultsThere were 1578 RTR with a mean age of 50 ± 14 years at the time of transplantation. Mean follow-up time after transplantation was 57 ± 45 months. Forty-five (2.9%) patients had a documented site of LGB. The most common causes of bleeding were colitis and angiodysplasia (n = 17). Mean time to LGB after transplantation was 43 ± 36 months. Twelve patients with LGB required intervention. Three underwent colectomy, endoscopic treatment was utilized in 8, and 1 patient had angiographic embolization to control bleeding. Recurrent LGB developed in 11 patients of 42 patients who did not have surgery at the time of index bleeding. Surgical (n = 1) or endoscopic intervention (n = 4) was required in 5 of recurrent bleeders. LGB was more commonly seen in RTRs who had development of a nonfunctioning kidney (P < .0001). RTR who had an LGB had an increased overall mortality rate (not directly related to the bleeding episode) compared with those who did not have a LGB (P = .001). We did not observe any increased risk of LGB bleeding among patients who were receiving anticoagulant or anti-aggregant treatment agents (P = .76). ConclusionsNonfunctioning kidney after transplant is a risk factor for LGB. Overall mortality rates increased after LGB in RTR. Strategies aiming to prolong transplanted kidney function may reduce the incidence of LGB and improve life expectancy in RTR.

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

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.

Etiology and outcome of lower gastrointestinal bleeding in patients with AIDS

Objective: The objective of the study was to investigate bleeding (LGIB) in patients with acquired immunodeficiency syndrome (AIDS). Methods: All hospitalized AIDS patients with LGIB evaluated by the gastroenterology service at a large city-county hospital during a 6 yr period were identified by database review and by endoscopy and consultation records. Results: Of the 691 AIDS patients seen during the study period, 18 (2.6%) (median age 41 ± 7 years) were evaluated for LGIB. In these patients, LGIB was caused by human immunodeficiency virus type 1 (HIV)-associated disorders in 72% including cytomegalovirus colitis in seven patients, idiopathic colonic ulcers in five patients, and intestinal Kaposi's sarcoma in one patient. HIV-associated thrombocytopenia contributed to substantial bleeding from hemorrhoidal disease in two patients. Rebleeding occurred in four patients (22%), including hemorrhoids in three and idiopathic colonic ulcers in one. Surgery was not performed in any patient. Following the institution of ganciclovir therapy, no patient with CMV colitis had recurrent bleeding. The in-hospital mortality was high (28%), although bleeding was the direct cause of death in only one patient. Conclusions: LGIB is infrequent in patients with AIDS and is usually caused by opportunistic diseases specifically related to immunodeficiency. Although some of these conditions are potentially treatable medically, in-hospital mortality is high and long-term prognosis is poor because of AIDS-related comorbidity.

Etiology and outcome of lower gastrointestinal bleeding in patients with AIDS.

The objective of the study was to investigate bleeding (LGIB) in patients with acquired immunodeficiency syndrome (AIDS). All hospitalized AIDS patients with LGIB evaluated by the gastroenterology service at a large city-county hospital during a 6 yr period were identified by database review and by endoscopy and consultation records. Of the 691 AIDS patients seen during the study period, 18 (2.6%) (median age 41+/-7 years) were evaluated for LGIB. In these patients, LGIB was caused by human immunodeficiency virus type 1 (HIV)-associated disorders in 72% including cytomegalovirus colitis in seven patients, idiopathic colonic ulcers in five patients, and intestinal Kaposi's sarcoma in one patient. HIV-associated thrombocytopenia contributed to substantial bleeding from hemorrhoidal disease in two patients. Rebleeding occurred in four patients (22%), including hemorrhoids in three and idiopathic colonic ulcers in one. Surgery was not performed in any patient. Following the institution of ganciclovir therapy, no patient with CMV colitis had recurrent bleeding. The in-hospital mortality was high (28%), although bleeding was the direct cause of death in only one patient. LGIB is infrequent in patients with AIDS and is usually caused by opportunistic diseases specifically related to immunodeficiency. Although some of these conditions are potentially treatable medically, in-hospital mortality is high and long-term prognosis is poor because of AIDS-related comorbidity.