Nationwide cohort study identifies clinical outcomes of angioectasia in patients with acute hematochezia.
Acute hematochezia
Clipping therapy
Coagulation therapy
Colonic angioectasia
Rebleeding
Journal
Journal of gastroenterology
ISSN: 1435-5922
Titre abrégé: J Gastroenterol
Pays: Japan
ID NLM: 9430794
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
received:
17
10
2022
accepted:
18
12
2022
medline:
30
3
2023
pubmed:
24
12
2022
entrez:
23
12
2022
Statut:
ppublish
Résumé
While angioectasia is an important cause of acute hematochezia, relevant clinical features remain unclear. This study aims to reveal risk factors, clinical outcomes, and the effectiveness of therapeutic endoscopy for patients with acute hematochezia due to angioectasia. This retrospective cohort study was conducted at 49 Japanese hospitals between January 2010 and December 2019, enrolling patients hospitalized for acute hematochezia (CODE BLUE-J study). Baseline factors and clinical outcomes for angioectasia were analyzed. Among 10,342 patients with acute hematochezia, 129 patients (1.2%) were diagnosed with angioectasia by colonoscopy. The following factors were significantly associated with angioectasia: chronic kidney disease, liver disease, female, body mass index < 25, and anticoagulant use. Patients with angioectasia were at a significant increased risk of blood transfusions compared to those without angioectasia (odds ratio [OR] 2.61; 95% confidence interval [CI] 1.69-4.02). Among patients with angioectasia, 36 patients (28%) experienced rebleeding during 1-year follow-up. The 1-year cumulative rebleeding rates were 37.0% in the endoscopic clipping group, 14.3% in the coagulation group, and 32.8% in the conservative management group. Compared to conservative management, coagulation therapy significantly reduced rebleeding risk (P = 0.038), while clipping did not (P = 0.81). Multivariate analysis showed coagulation therapy was an independent factor for reducing rebleeding risk (hazard ratio [HR] 0.40; 95% CI 0.16-0.96). Our data showed patients with angioectasia had a greater comorbidity burden and needed more blood transfusions in comparison with those without angioectasia. To reduce rebleeding risk, coagulation therapy can be superior for controlling hematochezia secondary to angioectasia.
Sections du résumé
BACKGROUND
While angioectasia is an important cause of acute hematochezia, relevant clinical features remain unclear. This study aims to reveal risk factors, clinical outcomes, and the effectiveness of therapeutic endoscopy for patients with acute hematochezia due to angioectasia.
METHODS
This retrospective cohort study was conducted at 49 Japanese hospitals between January 2010 and December 2019, enrolling patients hospitalized for acute hematochezia (CODE BLUE-J study). Baseline factors and clinical outcomes for angioectasia were analyzed.
RESULTS
Among 10,342 patients with acute hematochezia, 129 patients (1.2%) were diagnosed with angioectasia by colonoscopy. The following factors were significantly associated with angioectasia: chronic kidney disease, liver disease, female, body mass index < 25, and anticoagulant use. Patients with angioectasia were at a significant increased risk of blood transfusions compared to those without angioectasia (odds ratio [OR] 2.61; 95% confidence interval [CI] 1.69-4.02). Among patients with angioectasia, 36 patients (28%) experienced rebleeding during 1-year follow-up. The 1-year cumulative rebleeding rates were 37.0% in the endoscopic clipping group, 14.3% in the coagulation group, and 32.8% in the conservative management group. Compared to conservative management, coagulation therapy significantly reduced rebleeding risk (P = 0.038), while clipping did not (P = 0.81). Multivariate analysis showed coagulation therapy was an independent factor for reducing rebleeding risk (hazard ratio [HR] 0.40; 95% CI 0.16-0.96).
CONCLUSIONS
Our data showed patients with angioectasia had a greater comorbidity burden and needed more blood transfusions in comparison with those without angioectasia. To reduce rebleeding risk, coagulation therapy can be superior for controlling hematochezia secondary to angioectasia.
Identifiants
pubmed: 36564578
doi: 10.1007/s00535-022-01945-w
pii: 10.1007/s00535-022-01945-w
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
367-378Subventions
Organisme : Grants-in-Aid for Research from the National Center for Global Health and Medicine
ID : 29-2001
Organisme : Grants-in-Aid for Research from the National Center for Global Health and Medicine
ID : 29-2004
Organisme : Grants-in-Aid for Research from the National Center for Global Health and Medicine
ID : 19A1011
Organisme : Grants-in-Aid for Research from the National Center for Global Health and Medicine
ID : 19A1022
Organisme : Grants-in-Aid for Research from the National Center for Global Health and Medicine
ID : 19A-2015
Organisme : Grants-in-Aid for Research from the National Center for Global Health and Medicine
ID : 29-1025
Organisme : Grants-in-Aid for Research from the National Center for Global Health and Medicine
ID : 30-1020
Organisme : Ministry of Health, Labour and Welfare
ID : 19HB1003
Organisme : JSPS KAKENHI
ID : JP17K09365
Organisme : JSPS KAKENHI
ID : 20K08366
Informations de copyright
© 2022. Japanese Society of Gastroenterology.
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