title: Risk factors and the role of bedside colonoscopy for lower gastrointestinal hemorrhage in critically ill patients.
abstract: OBJECTIVE
  We designed this study to determine the clinical characteristics of critically ill patients with lower gastrointestinal hemorrhage (LGIH) and to evaluate the effectiveness of bedside colonoscopy in diagnosing and managing LGIH in the intensive care unit (ICU) setting.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients who underwent bedside colonoscopy for LGIH that developed while in the ICU at Severance Hospital from January 1999 to June 2006. The control group was a random sampling of patients hospitalized in the ICU without GIH.
  
  
  RESULTS
  A total of 28,101 patients were hospitalized in ICU during the study period. Of these, 43 patients were included in each group. There were no significant differences in age, sex, and primary and underlying diseases between the two groups. Hypoalbuminemia and high BUN levels were found to be risk factors for LGIH in ICU patients. Bleeding focus was recognized in 28 patients (65.1%) through bedside colonoscopy. Major endoscopic diagnoses were ischemic colitis (13, 30.2%), rectal ulcer (7, 20.9%), and hemorrhoids (6, 13.9%). Primary endoscopic hemostasis was achieved in 11 of 28 diagnosed patients (39.3%).
  
  
  CONCLUSIONS
  Our data suggest that patients' underlying conditions may affect LGIH in the ICU setting. Moreover, urgent bedside colonoscopy may be effective in diagnosing and guiding appropriate treatments for LGIH in critically ill patients.
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Byung Chang
authors.initials: BC
authors.lastname: Kim
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
authors.forename: Tao Il
authors.initials: TI
authors.lastname: Kim
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods; D016638:Critical Illness; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors