Baba Yuki, Kawano Seiji, Kono Yoshiyasu, Inokuchi Toshihiro, Kanzaki Hiromitsu, Iwamuro Masaya, Harada Keita, Hiraoka Sakiko, Kawahara Yoshiro, Okada Hiroyuki
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
Intern Med. 2020 Jun 1;59(11):1345-1350. doi: 10.2169/internalmedicine.3628-19. Epub 2020 Feb 5.
Objective With the advent of capsule endoscopy (CE) and double-balloon endoscopy (DBE), the diagnosis and treatment of obscure gastrointestinal bleeding (OGIB) have markedly progressed. However, rebleeding sometimes occurs and is difficult to diagnose and treat. The aim of the present study was to investigate the clinical features of OGIB and risk factors for rebleeding in our hospital. Methods A total of 195 patients who underwent CE and/or DBE for OGIB in our hospital from January 2009 to July 2016 were included in the present study. We analyzed 168 cases of small intestinal OGIB, after excluding 27 cases of extra small intestinal bleeding. The clinical characteristics and risk factors related to rebleeding were retrospectively studied. Results Among the 168 patients who were included in the analysis, 95 patients (56.5%) were male. The mean age was 64.5 years (range, 8 to 87 years). Hypertension (31.0%) was the most frequent comorbidity, followed by chronic kidney disease (19.0%). The final diagnoses were ulcerative lesions (n=50, 29.8%), vascular lesions (n=30, 17.9%), tumors (n=7, 4.2%), and diverticula (n=2, 1.2%). The bleeding source was undetermined in the remaining 79 cases (47.0%). Rebleeding was confirmed in 29 cases (17.3%). In a univariate analysis, chronic kidney disease, vascular lesions, and overt previous bleeding were significantly associated with the risk of rebleeding. A multivariate analysis showed that chronic kidney disease, vascular lesion, and overt previous bleeding were significantly associated with the risk of rebleeding. Conclusion Patients with OGIB with overt previous bleeding, vascular lesions, and/or chronic kidney disease had a higher risk of rebleeding.
目的 随着胶囊内镜（CE）和双气囊小肠镜（DBE）的出现，不明原因消化道出血（OGIB）的诊断和治疗有了显著进展。然而，再出血有时会发生，且难以诊断和治疗。本研究的目的是探讨我院OGIB的临床特征及再出血的危险因素。方法 纳入2009年1月至2016年7月在我院因OGIB接受CE和/或DBE检查的195例患者。排除27例小肠外出血后，分析168例小肠OGIB病例。回顾性研究与再出血相关的临床特征和危险因素。结果 在纳入分析的168例患者中，95例（56.5%）为男性。平均年龄为64.5岁（范围8至87岁）。高血压（31.0%）是最常见的合并症，其次是慢性肾脏病（19.0%）。最终诊断为溃疡性病变（n = 50，29.8%）、血管性病变（n = 30，17.9%）、肿瘤（n = 7，4.2%）和憩室（n = 2，1.2%）。其余79例（47.0%）出血来源未明确。29例（17.3%）确认有再出血。单因素分析显示，慢性肾脏病、血管性病变和既往明显出血与再出血风险显著相关。多因素分析表明，慢性肾脏病、血管性病变和既往明显出血与再出血风险显著相关。结论 既往有明显出血、血管性病变和/或慢性肾脏病的OGIB患者再出血风险较高。
