Santos Thais Abaurre Haig, Wahle Raul Carlos, Milani Luciane Reis, de Oliveira Leite Milena Arruda, Waisberg Jaques, Poletti Paula Bechara, Pinto Fernando Campos Gomes
Department of Gastroenterology, "Francisco Morato de Oliveira" State Government Employee Hospital (HSPE-FMO), São Paulo, Brazil.
Faculty of Medicine of ABC (FMABC), São Paulo, Brazil.
Transl Gastroenterol Hepatol. 2025 Jul 18;10:44. doi: 10.21037/tgh-25-6. eCollection 2025.
Recurrent bleeding from small bowel angiodysplasia (SBA) is common, and identifying risk factors for rebleeding can help identify high-risk patients who may benefit from further therapy. The pathophysiology of SBA is linked to an imbalance of angiogenic factors such as angiopoietin 1 (Ang-1) and angiopoietin 2 (Ang-2), as well as higher serum levels of Ang-2. Additionally, murine models of steatohepatitis showed elevated serum and hepatic Ang-2 levels, which directly promote pathological angiogenesis. The present study aimed to evaluate risk factors for rebleeding in symptomatic patients with SBA.
Upon review of the medical records and application of the inclusion and exclusion criteria, 109 cases were determined to be affected by SBAs. Five patients were ineligible for the study because of a shorter than one-year follow-up period or early use of a specific treatment. Thus, in a retrospective observational study of 104 patients with gastrointestinal bleeding from SBA between 2012 and 2016 who were conservatively managed at the beginning of follow-up, we obtained clinical features and risk factors for rebleeding, and we analyzed potential predictors of rebleeding through univariate and multivariable analysis.
We found that 57 of 104 patients (54.8%) experienced rebleeding during a follow-up of more than one year. The majority were females (71.2%), and we noted that hypertension (70.2%) and dyslipidemia (43.3%) were the most common comorbidities. Multiple regression analysis indicated that waist circumference (WC) (odds ratio for each 1 cm increment =1.04; 95% confidence interval: 1.01-1.08; P=0.02) was a significant risk factor for rebleeding.
In patients with symptomatic SBAs, an increase in WC positively correlated with the risk of rebleeding.
小肠血管发育异常（SBA）导致的反复出血很常见，识别再出血的危险因素有助于确定可能从进一步治疗中获益的高危患者。SBA的病理生理学与血管生成素1（Ang-1）和血管生成素2（Ang-2）等血管生成因子的失衡以及血清Ang-2水平升高有关。此外，脂肪性肝炎的小鼠模型显示血清和肝脏Ang-2水平升高，这直接促进病理性血管生成。本研究旨在评估有症状的SBA患者再出血的危险因素。
在查阅病历并应用纳入和排除标准后，确定109例患者患有SBA。5例患者因随访期短于1年或早期使用特定治疗而不符合研究条件。因此，在一项对2012年至2016年间104例因SBA导致胃肠道出血且随访开始时接受保守治疗的患者的回顾性观察研究中，我们获得了再出血的临床特征和危险因素，并通过单变量和多变量分析来分析再出血的潜在预测因素。
我们发现，104例患者中有57例（54.8%）在超过1年的随访期间出现再出血。大多数为女性（71.2%），我们注意到高血压（70.2%）和血脂异常（43.3%）是最常见的合并症。多元回归分析表明，腰围（WC）（每增加1厘米的比值比=1.04；95%置信区间：1.01-1.08；P=0.02）是再出血的一个显著危险因素。
在有症状的SBA患者中，WC的增加与再出血风险呈正相关。
