Origin, Clinical Characteristics and 30-Day Outcomes of Severe Hematochezia in Cirrhotics and Non-cirrhotics.
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.



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.



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.



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.
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA. marine.camus@gmail.com.|CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, Los Angeles, CA, USA. marine.camus@gmail.com.|Department of Gastroenterology, Cochin Hospital, APHP, University Paris 5, 27 rue du Faubourg St. Jacques, 75014, Paris, France. marine.camus@gmail.com.
Marine
M
Camus
Department of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA.
Vandana
V
Khungar
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.|CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, Los Angeles, CA, USA.|Gastroenterology Section at VA GLAHC, Los Angeles, CA, USA.
Dennis M
DM
Jensen
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.|CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, Los Angeles, CA, USA.|Gastroenterology Section at VA GLAHC, Los Angeles, CA, USA.
Gordon V
GV
Ohning
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.|CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, Los Angeles, CA, USA.|Gastroenterology Section at VA GLAHC, Los Angeles, CA, USA.
Thomas O
TO
Kovacs
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.|CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, Los Angeles, CA, USA.
Rome
R
Jutabha
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.|CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, Los Angeles, CA, USA.
Kevin A
KA
Ghassemi
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.|CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, Los Angeles, CA, USA.|Gastroenterology Section at VA GLAHC, Los Angeles, CA, USA.
Gustavo A
GA
Machicado
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.|CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, Los Angeles, CA, USA.|Gastroenterology Section at VA GLAHC, Los Angeles, CA, USA.
Gareth S
GS
Dulai
D000368:Aged; D000369:Aged, 80 and over; D016888:Angiodysplasia / Q000150:complications; D001241:Aspirin / Q000627:therapeutic use; D016913:Blood Component Transfusion; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D017091:Colitis, Ischemic / Q000150:complications; D003108:Colonic Diseases / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D004238:Diverticulitis / Q000150:complications; D017707:Erythrocyte Transfusion; D004935:Esophageal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006396:Hematemesis / Q000453:epidemiology; D006400:Hematocrit; D006484:Hemorrhoids / Q000150:complications; D006801:Humans; D007421:Intestine, Small; D008103:Liver Cirrhosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010314:Partial Thromboplastin Time; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D010949:Plasma; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010976:Platelet Count; D017713:Platelet Transfusion; D012189:Retrospective Studies; D012307:Risk Factors; D013272:Stomach Diseases / Q000453:epidemiology* / Q000628:therapy; D014456:Ulcer / Q000150:complications
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
Cirrhosis; Hematochezia; Lower gastrointestinal bleeding; Upper gastrointestinal bleeding