Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 10, Number 6, December 2017, pages 352-358

Acute Lower Gastrointestinal Bleeding: Characteristics and Clinical Outcome of Patients Treated With an Intensive Protocol

**Table 1.** Clinical and Epidemiological Characteristics of Patients With ALGIB
Clinicoepidemiological characteristics	N = 528	% or range
SD: standard deviation; Hb: hemoglobin.
Sex
Male	271	51.3
Female	257	48.7
Age (mean ± SD in years)	70.2 ± 14.8	17 - 101
Clinical presentation
Hematochezia	447	84.7
Melena with red clots	73	13.8
Melena	8	1.5
In-hospital presentation	12	2.3
Comorbidities existing	464	87.9
Cardiovascular disease	266	50.4
Gastrointestinal surgery history	41	7.8
History of ALGIB	64	12.1
Use of anticoagulant drugs	96	18.2
Use of antiplatelet drugs	158	30
Use of NSAIDS (non-aspirin)	22	4.2
Hb on admission (mean ± SD) (g/dL)	11.6 ± 2.6	4.2 - 17.1
Platelets (mean ± SD) (10³/µL)	228,931.4 ± 93,746.8	32,000 -1,036,000
Blood urea nitrogen (BUN) (mean ± SD) (mg/dL)	50.30 ± 34.69	14 - 283
Creatinine (mean ± SD) (mg/dL)	1.01 ± 0.7	0.5 - 10.2

Table 1. Clinical and Epidemiological Characteristics of Patients With ALGIB

Clinicoepidemiological characteristics

N = 528

% or range

SD: standard deviation; Hb: hemoglobin.

Sex

Male

271

51.3

Female

257

48.7

Age (mean ± SD in years)

70.2 ± 14.8

17 - 101

Clinical presentation

Hematochezia

447

84.7

Melena with red clots

13.8

Melena

1.5

In-hospital presentation

2.3

Comorbidities existing

464

87.9

Cardiovascular disease

266

50.4

Gastrointestinal surgery history

7.8

History of ALGIB

12.1

Use of anticoagulant drugs

18.2

Use of antiplatelet drugs

158

Use of NSAIDS (non-aspirin)

4.2

Hb on admission (mean ± SD) (g/dL)

11.6 ± 2.6

4.2 - 17.1

Platelets (mean ± SD) (10³/µL)

228,931.4 ± 93,746.8

32,000 -1,036,000

Blood urea nitrogen (BUN) (mean ± SD) (mg/dL)

50.30 ± 34.69

14 - 283

Creatinine (mean ± SD) (mg/dL)

1.01 ± 0.7

0.5 - 10.2

**Table 2.** Diagnostic Tools in Patients With ALGIB
Diagnostic procedures	Νo.	%
CTA: computed tomography angiography; GI: gastrointestinal.
Colonoscopy	509	96.4
Upper GI endoscopy	111	21
CTA	46	8.7
Capsule enteroscopy	41	7.8
Push enteroscopy	10	1.9
Scintigraphy with red blood cells labeled	2	0.4
Intraoperative enteroscopy	1	0.2

Table 2. Diagnostic Tools in Patients With ALGIB

Diagnostic procedures

Νo.

CTA: computed tomography angiography; GI: gastrointestinal.

Colonoscopy

509

96.4

Upper GI endoscopy

111

CTA

8.7

Capsule enteroscopy

7.8

Push enteroscopy

1.9

Scintigraphy with red blood cells labeled

0.4

Intraoperative enteroscopy

0.2

**Table 3.** Localization of Bleeding and Diagnostic Examinations
Localization of bleeding	No.	%
CTA: computed tomography angiography; CE: capsule endoscopy.
Large bowel	465	88
Colonoscopy findings only	462
CΤΑ findings only	3
Small bowel	36	6.9
CE only	14
CE and push enteroscopy	8
CΤΑ only	9
Push enteroscopy only	2
Intraoperative enteroscopy	1
Scintigraphy only	1
Scintigraphy and CTA	1
No findings	27	5.1
Total	528	100

Table 3. Localization of Bleeding and Diagnostic Examinations

Localization of bleeding

No.

CTA: computed tomography angiography; CE: capsule endoscopy.

Large bowel

465

Colonoscopy findings only

462

CΤΑ findings only

Small bowel

6.9

CE only

CE and push enteroscopy

CΤΑ only

Push enteroscopy only

Intraoperative enteroscopy

Scintigraphy only

Scintigraphy and CTA

No findings

5.1

Total

528

100

**Table 4.** Etiology of Bleeding in the Small and Large Bowel
Localization	Causes	No.	%
Large bowel		465	88
	Diverticulosis	104	19.7
	Ischemic colitis	102	19.3
	Post-polypectomy bleeding	44	8.3
	Hemorrhoids	43	8.1
	Malignancy	42	8.0
	Polyp	28	5.3
	Vascular ectasia	27	5.1
	Colitis other than ischemic	23	4.4
	Ulcers	20	3.8
	Inflammatory bowel disease	15	2.8
	Anal fissure	12	2.3
	Other	5	0.9
Small bowel		36	6.9
	Meckel diverticulum	2	0.4
	Ulcers	5	0.9
	Vascular ectasia	11	2.1
	Neoplasia	3	0.6
	Diverticulum	1	0.2
	Ectopic varices	4	0.8
	Blood only	10	1.9
No findings	Unknown	27	5.1
Total	Total	528	100

Table 4. Etiology of Bleeding in the Small and Large Bowel

Localization

Causes

No.

Large bowel

465

Diverticulosis

104

19.7

Ischemic colitis

102

19.3

Post-polypectomy bleeding

8.3

Hemorrhoids

8.1

Malignancy

8.0

Polyp

5.3

Vascular ectasia

5.1

Colitis other than ischemic

4.4

Ulcers

3.8

Inflammatory bowel disease

2.8

Anal fissure

2.3

Other

0.9

Small bowel

6.9

Meckel diverticulum

0.4

Ulcers

0.9

Vascular ectasia

2.1

Neoplasia

0.6

Diverticulum

0.2

Ectopic varices

0.8

Blood only

1.9

No findings

Unknown

5.1

Total

528

100

**Table 5.** Clinical Outcome of Patients With ALGIB
Outcome	No.	% or range
SD: standard deviation; APC: argon plasma coagulation.
Days of hospitalization ± SD	4.3 ± 3.2	1 - 20
Need of blood transfusion	158	30
Units of blood transfusion ± SD	0.94 ± 1.9	0 - 14
Presence of blood in colonoscopy	162	31.8
Active bleeding	117	22.2
Recurrence of bleeding	44	8.3
Therapeutic intervention
Endoscopic	82	15.6
Clips only	16	3
Adrenaline only	7	1.3
Adrenaline + clips	25	4.7
Adrenaline + APC	2	0.4
APC only	31	5.8
Polypectomy	1	0.2
Radiological embolization	10	1.9
Surgery	6	1.1
Death	13	2.5

Table 5. Clinical Outcome of Patients With ALGIB

Outcome

No.

% or range

SD: standard deviation; APC: argon plasma coagulation.

Days of hospitalization ± SD

4.3 ± 3.2

1 - 20

Need of blood transfusion

158

Units of blood transfusion ± SD

0.94 ± 1.9

0 - 14

Presence of blood in colonoscopy

162

31.8

Active bleeding

117

22.2

Recurrence of bleeding

8.3

Therapeutic intervention

Endoscopic

15.6

Clips only

Adrenaline only

1.3

Adrenaline + clips

4.7

Adrenaline + APC

0.4

APC only

5.8

Polypectomy

0.2

Radiological embolization

1.9

Surgery

1.1

Death

2.5

**Table 6.** Factors Associated With Death in Patients With ALGIB
Outcome correlation	No death, N = 515	Death, N = 13	P
In-hospital presentation	10	2	0.032
Cardiovascular disease	256	10	0.047
Cirrhosis	8	2	0.023
Antiplatelet agents	153	5	0.049
Anticoagulant agents	91	5	0.053
Active bleeding	111	6	0.046
Angiographic embolization	7	3	0.001
Surgery	5	1	0.024
Small bowel bleeding	32	4	0.008

Table 6. Factors Associated With Death in Patients With ALGIB

Outcome correlation

No death, N = 515

Death, N = 13

In-hospital presentation

0.032

Cardiovascular disease

256

0.047

Cirrhosis

0.023

Antiplatelet agents

153

0.049

Anticoagulant agents

0.053

Active bleeding

111

0.046

Angiographic embolization

0.001

Surgery

0.024

Small bowel bleeding

0.008

**Table 7.** Factors Associated With Recurrence of Bleeding in Patients With ALGIB
Outcome correlation	No recurrence, N = 484	Recurrence, N = 44	P value
Male sex	241/484	30/44	0.027
Presence of blood	142/469	20/42	0.025
Active bleeding	99/483	18/44	0.004
Vascular ectasia	22/473	5/43	0.064
Anticoagulant drugs	81/484	15/44	0.007
Non-presence of ischemic colitis	375/473	39/43	0.047

Table 7. Factors Associated With Recurrence of Bleeding in Patients With ALGIB

Outcome correlation

No recurrence, N = 484

Recurrence, N = 44

P value

Male sex

241/484

30/44

0.027

Presence of blood

142/469

20/42

0.025

Active bleeding

99/483

18/44

0.004

Vascular ectasia

22/473

5/43

0.064

Anticoagulant drugs

81/484

15/44

0.007

Non-presence of ischemic colitis

375/473

39/43

0.047