Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland.
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
United European Gastroenterol J. 2019 Dec;7(10):1330-1336. doi: 10.1177/2050640619863517. Epub 2019 Jul 8.
Data on the natural history of acute lower gastrointestinal bleeding (ALGIB) are lacking. We evaluated five-year bleeding risk and mortality in ALGIB patients and controls. Furthermore, we aimed to find predictors of rebleeding.
This was a population-based retrospective case-control study conducted at the National University Hospital of Iceland, and included every individual who underwent endoscopy in 2010-2011. ALGIB was defined as rectal bleeding leading to hospitalisation or occurring in a hospitalised patient. Controls were randomly selected from those who underwent endoscopy in the same time period but who did not have GIB, and were matched for sex and age. Patients were followed up five years after index bleeding. Rebleeding was defined as ALGIB >14 days after index bleeding.
In total, 2294 patients underwent 2602 colonoscopies in 2010-2011. Of those, 319 (14%) had ALGIB. The mean age for cases and controls was 64 and 65 years (±19.3-20.7), respectively, and females accounted for 51-52% of the study population. For ALGIB patients, the five-year risk of a bleeding was 20% (95% confidence interval (CI) 15-24%) compared to 3% (95% CI 1-5%) in controls (log rank < 0.0001; co-morbidity-adjusted hazard ratio (HR) 6.9 (95% CI 3.4-14)). Only 37% of bleeders had the same cause of index bleeding and rebleeding. In ALGIB patients, age and inflammatory bowel disease (IBD) were predictors of rebleeding, with odds ratios per 10 years of 1.3 (95% CI 1.1-1.6) and 4.3 (95% CI 1.5-12), respectively. Bleeders did not have a higher risk of five-year mortality compared to controls (HR = 1.2; 95% CI 0.87-1.6).
One fifth of ALGIB patients had rebleeding during follow-up. Age and IBD were independent predictors of rebleeding. ALGIB was not associated with lower five-year survival.
急性下消化道出血（ALGIB）的自然病史数据尚不清楚。我们评估了 ALGIB 患者和对照者五年内出血风险和死亡率。此外，我们旨在寻找再出血的预测因素。
这是一项在冰岛国家大学医院进行的基于人群的回顾性病例对照研究，纳入了 2010-2011 年接受内镜检查的每一位个体。ALGIB 定义为导致住院或住院患者发生的直肠出血。对照者是从同一时期接受内镜检查但无 GIB 的患者中随机选择的，并按性别和年龄匹配。患者在指数性出血后随访五年。再出血定义为指数性出血后 14 天以上的 ALGIB。
总共 2294 例患者在 2010-2011 年进行了 2602 例结肠镜检查。其中 319 例（14%）患有 ALGIB。病例和对照组的平均年龄分别为 64 和 65 岁（±19.3-20.7），女性占研究人群的 51-52%。对于 ALGIB 患者，五年内出血风险为 20%（95%CI 15-24%），而对照组为 3%（95%CI 1-5%）（对数秩检验<0.0001；合并疾病调整后的危险比（HR）6.9（95%CI 3.4-14））。仅有 37%的出血者具有相同的指数性出血和再出血原因。在 ALGIB 患者中，年龄和炎症性肠病（IBD）是再出血的预测因素，每增加 10 岁，比值比分别为 1.3（95%CI 1.1-1.6）和 4.3（95%CI 1.5-12）。与对照组相比，出血者五年内死亡率没有更高的风险（HR=1.2；95%CI 0.87-1.6）。
1/5 的 ALGIB 患者在随访期间发生再出血。年龄和 IBD 是再出血的独立预测因素。ALGIB 与五年生存率降低无关。
