Rebleeding Risk of Acute Hemorrhagic Rectal Ulcer: A Multicenter Retrospective Study

  • Muramatsu Takahiro
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Fukuzawa Masakatsu
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Madarame Akira
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Kagawa Yasuyuki
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Kikuchi Miho
    Department of Gastroenterology, Tokyo Medical University Hachioji Medical Center, Japan
  • Taniguchi Sho
    Department of Gastroenterology, Todachuo General Hospital, Japan
  • Shimai Satoshi
    Department of Gastroenterology, Todachuo General Hospital, Japan
  • Matsumoto Sho
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Yamanishi Fumito
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Suzuki Yuka
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Nemoto Daiki
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Shinohara Hirokazu
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Matsumoto Taisuke
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Koyama Yohei
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Uchida Kumiko
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Yamaguchi Hayato
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Morise Takashi
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Sugimoto Akihiko
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Yamauchi Yoshiya
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Kono Shin
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Naito Sakiko
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan
  • Nakamura Hironori
    Department of Gastroenterology, Tokyo Medical University Hachioji Medical Center, Japan
  • Nutahara Daisuke
    Department of Gastroenterology, Tokyo Medical University Hachioji Medical Center, Japan
  • Matsue Yuubu
    Department of Gastroenterology, Tokyo Medical University Hachioji Medical Center, Japan
  • Kishimoto Yoshiko
    Department of Gastroenterology, Todachuo General Hospital, Japan
  • Yamamoto Kei
    Department of Gastroenterology, Todachuo General Hospital, Japan
  • Kawai Takashi
    Endoscopy Center, Tokyo Medical University Hospital, Japan
  • Itoi Takao
    Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan

抄録

<p>Objective Acute hemorrhagic rectal ulcer (AHRU) is characterized by sudden, painless, and massive bleeding from rectal ulcers. To date, few studies have analyzed the risk factors for AHRU rebleeding. In this study, we clarified the risk factors of rebleeding after initial hemostasis of AHRU through a multicenter study. Methods A total of 149 patients diagnosed with AHRU between January 2015 and May 2020 at 3 medical centers were enrolled. We retrospectively investigated the following factors: age, sex, body mass index (BMI), performance status (PS), Charlson comorbidity index (CCI), comorbidities, medications, laboratory examinations, endoscopic findings, view of the entire rectum on endoscopy, hemostasis method, blood transfusion history, shock, instructions for posture change after initial hemostasis, and clinical course. Results Rebleeding was observed in 35 (23%) of 149 patients. A multivariate analysis showed that significant factors for rebleeding were PS 4 [odds ratio (OR), 5.23; 95% confidence interval (CI)], 1.97-13.9; p=0.001], a blood transfusion history (OR, 3.66; 95% CI, 1.41-9.51; p=0.008), low an estimated glomerular filtration rate (eGFR) levels (OR, 0.98; 95% CI, 0.97-0.99; p=0.001), poor view of the whole rectum on endoscopy (OR, 0.33; 95% CI, 0.12-0.90; p=0.030), and use of monopolar hemostatic forceps (OR, 4.89; 95% CI, 1.37-17.4; p=0.014). Conclusion Factors associated with rebleeding of AHRU were a poor PS (PS4), blood transfusion, a low eGFR, poor view of the whole rectum on endoscopy, and the use of monopolar hemostatic forceps. </p>

収録刊行物

  • Internal Medicine

    Internal Medicine advpub (0), 2024

    一般社団法人 日本内科学会

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