Marine Camus1,2,3, Vandana Khungar4, Dennis M Jensen5,6,7, Gordon V Ohning5,6,7, Thomas O Kovacs5,6,7, Rome Jutabha5,6, Kevin A Ghassemi5,6, Gustavo A Machicado5,6,7, Gareth S Dulai5,6,7. 1. Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA. marine.camus@gmail.com. 2. CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, Los Angeles, CA, USA. marine.camus@gmail.com. 3. Department of Gastroenterology, Cochin Hospital, APHP, University Paris 5, 27 rue du Faubourg St. Jacques, 75014, Paris, France. marine.camus@gmail.com. 4. Department of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA. 5. Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA. 6. CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, Los Angeles, CA, USA. 7. Gastroenterology Section at VA GLAHC, Los Angeles, CA, USA.
Abstract
BACKGROUND: The sites of origin, causes and outcomes of severe hematochezia have not been compared between cirrhotics and non-cirrhotics. In cirrhotics versus non-cirrhotics presenting with severe hematochezia, we aimed at (1) identifying the site and etiology of gastro-intestinal bleeding and independent predictors of bleeding from the upper gastrointestinal tract versus small bowel or the colon, (2) comparing 30-day clinical outcomes, and (3) proposing an algorithm for management of severe hematochezia. METHODS: In this cohort study from two university-based medical centers, 860 consecutive patients with severe hematochezia admitted from 1995 to 2011 were prospectively enrolled with 160 (18.6 %) cirrhotics. We studied (a) general clinical and laboratory characteristics of cirrhotics versus non-cirrhotics, (b) predictors of bleeding sites in each patient group by multiple variable regression analysis, and compared (c) 30-day outcomes, including rebleeding, surgery and deaths. RESULTS: Cirrhosis independently predicted an upper gastrointestinal source of bleeding (OR 3.47; 95 % CI 2.01-5.96) as well as history of hematemesis, melena in the past 30 days, positive nasogastric aspirate, prior upper gastrointestinal bleeding or use of aspirin or non-steroidal anti-inflammatory. The most prevalent diagnoses were esophageal varices (20 %) in cirrhotics and colon diverticular bleeding (27.1 %) in non-cirrhotics. Thirty-day rates of rebleeding, surgical interventions and deaths were 23.1 versus 15 % (P = 0.01), 14.4 versus 6.4 % (P < 0.001), and 17.5 versus 4.1 % (P < 0.001), in cirrhotics versus non-cirrhotics, respectively. CONCLUSIONS: Cirrhosis predicted an upper gastrointestinal site of bleeding in patients presenting with severe hematochezia. The 30-day rates of rebleeding, surgery, and death were significantly higher in cirrhotics than in non-cirrhotics.
BACKGROUND: The sites of origin, causes and outcomes of severe hematochezia have not been compared between cirrhotics and non-cirrhotics. In cirrhotics versus non-cirrhotics presenting with severe hematochezia, we aimed at (1) identifying the site and etiology of gastro-intestinal bleeding and independent predictors of bleeding from the upper gastrointestinal tract versus small bowel or the colon, (2) comparing 30-day clinical outcomes, and (3) proposing an algorithm for management of severe hematochezia. METHODS: In this cohort study from two university-based medical centers, 860 consecutive patients with severe hematochezia admitted from 1995 to 2011 were prospectively enrolled with 160 (18.6 %) cirrhotics. We studied (a) general clinical and laboratory characteristics of cirrhotics versus non-cirrhotics, (b) predictors of bleeding sites in each patient group by multiple variable regression analysis, and compared (c) 30-day outcomes, including rebleeding, surgery and deaths. RESULTS:Cirrhosis independently predicted an upper gastrointestinal source of bleeding (OR 3.47; 95 % CI 2.01-5.96) as well as history of hematemesis, melena in the past 30 days, positive nasogastric aspirate, prior upper gastrointestinal bleeding or use of aspirin or non-steroidal anti-inflammatory. The most prevalent diagnoses were esophageal varices (20 %) in cirrhotics and colon diverticular bleeding (27.1 %) in non-cirrhotics. Thirty-day rates of rebleeding, surgical interventions and deaths were 23.1 versus 15 % (P = 0.01), 14.4 versus 6.4 % (P < 0.001), and 17.5 versus 4.1 % (P < 0.001), in cirrhotics versus non-cirrhotics, respectively. CONCLUSIONS:Cirrhosis predicted an upper gastrointestinal site of bleeding in patients presenting with severe hematochezia. The 30-day rates of rebleeding, surgery, and death were significantly higher in cirrhotics than in non-cirrhotics.
Authors: Raquel E Davila; Elizabeth Rajan; Douglas G Adler; James Egan; William K Hirota; Jonathan A Leighton; Waqar Qureshi; Marc J Zuckerman; Robert Fanelli; Jo Wheeler-Harbaugh; Todd H Baron; Douglas O Faigel Journal: Gastrointest Endosc Date: 2005-11 Impact factor: 9.427
Authors: José Alberto González-González; Diego García-Compean; Genaro Vázquez-Elizondo; Aldo Garza-Galindo; Joel Omar Jáquez-Quintana; Héctor Maldonado-Garza Journal: Ann Hepatol Date: 2011 Jul-Sep Impact factor: 2.400
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