Risk factors for recurrence of acute gastrointestinal bleeding from angiodysplasia.
OBJECTIVE
Recurrent bleeding from gastrointestinal (GI) angiodysplasia remains a therapeutic challenge. Identification of factors predicting poor outcome of haemorrhage from angiodysplasia would help us to select the patients who may likely benefit from further therapy. Thus, we analysed risk factors for recurrence of acute GI haemorrhage from angiodysplasia.


METHODS
62 patients admitted consecutively with acute GI bleeding from angiodysplasia, between June 2002 and June 2006, were included. Bivariate, multivariate and survival analysis were performed to identify risk factors for recurrence of bleeding after hospital discharge.


RESULTS
Recurrence of acute haemorrhage after hospital discharge occurred in 17 of 57 (30%) patients (38 men; mean age: 74+/-6 years), after a mean follow-up (33+/-40 months). On Cox analysis, earlier history of bleeding with a high bleeding rate, over anticoagulation and the presence of multiple lesions were predictive factors of recurrence in a multivariate analysis. In contrast, endoscopic argon plasma coagulation (APC) therapy was not associated with lower rates of recurrent bleeding.


CONCLUSIONS
In patients with acute GI haemorrhage from angiodysplasia, earlier bleeding with a high bleeding rate, over anticoagulation and multiple angiodisplasic lesions predict an increased risk of recurrent bleeding. Although there is a trend towards better management with endoscopic APC therapy for the prevention of recurrence of bleeding, endoscopic APC therapy is not predictive of a lower rate of recurrence.
Saperas
Esteve
E
Gastroenterology Department, University Hospital Vall d'Hebron, Barcelona, Spain. esaperas@vhebron.net
Videla
Sebastián
S
Dot
Joan
J
Bayarri
Carolina
C
Lobo
Beatriz
B
Abu-Suboh
Monder
M
Armengol
Jose Ramón
JR
Malagelada
Juan R
JR
D000208:Acute Disease; D000368:Aged; D016888:Angiodysplasia / Q000150:complications* / Q000601:surgery; D057908:Argon Plasma Coagulation / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome