Risk of recurrence and long-term outcomes after colonic diverticular bleeding

Aytaç, Erman; Stocchi, Luca; Görgün, Emre; Özüner, Gökhan

doi:10.1007/s00384-013-1804-8

Cited by 59 publications

(58 citation statements)

References 22 publications

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“…We identified 74 patients of advanced age, mainly males, who presented several co-morbidities and use of multiple medications. The dimension and characteristics of this group are similar to previous studies with similar designs and objectives (8,12,17,(24)(25)(26). The high number of co-morbidities and subsequent medication is in accordance with patient age.…”

Section: Discussionsupporting

confidence: 78%

“…This was expected since transfusion needs, which is one of our criteria for severe bleeding, are determined mainly by low hemoglobin levels. Older age has been associated with the development of diverticulosis (6,9,(33)(34)(35)(36) and also with increased risk for LGIB (16) and CDB recurrence (26). As mentioned above, in the present study older age was also a predictive factor for severe CDB.…”

Section: Discussionsupporting

confidence: 74%

“…Even though previous studies addressed several risk factors for CDB recurrence (12,(23)(24)(25)(26), none of the factors we tested were predictive of a higher likelihood of rebleeding in our series, including bleeding severity in the index episode. Similar results were reported by Anthony et al (39) for LGIB, where no risk factors for rebleeding were identified.…”

Section: Discussionmentioning

confidence: 81%

“…This may have limited the identification of risk factors in this population. However, it is important to state that the dimension of this study population is similar to that of other studies with similar approaches (12,17,(23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 87%

“…Although reports concerning the risk factors for rebleeding of colonic diverticula are scarce, old-er age, non-steroidal anti-inflammatory drugs, antiplatelet drugs, history of hypertension, peripheral vascular disease, renal deficiency, diverticulitis and shock at presentation have been associated with recurrence (12,(23)(24)(25)(26). However, results are inconsistent and additional studies are needed to better understand the factors implicated in repeated bleeding episodes.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for severity and recurrence of colonic diverticular bleeding

Joaquim¹,

Caldeira²,

Antunes³

et al. 2016

Rev Esp Enferm Dig

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Background: Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Risk factors related to severity and repeated bleeding episodes are not completely clearly defined.Objective: To characterize a Portuguese population hospitalized due to colonic diverticular bleeding and to identify the clinical predictors related to bleeding severity and rebleeding.Methods: Retrospective analysis of all hospitalized patients diagnosed with colonic diverticular bleeding from January 2008 to December 2013 at our institution. The main outcomes evaluated were bleeding severity, defined as any transfusion support requirements and/or signs of hemodynamic shock, and 1-year recurrence rate.Results: Seventy-four patients were included, with a mean age of 75.7 ± 9.5 years; the majority were male (62.2%). Thirty-six patients (48.6%) met the criteria for severe bleeding; four independent risk factors for severe diverticular bleeding were identified: low hemoglobin level at admission (≤ 11 g/dL; OR 18.8), older age (≥ 75 years; OR 4.7), bilateral diverticular location (OR 14.2) and chronic kidney disease (OR 5.6). The 1-year recurrence rate was 12.9%. We did not identify any independent risk factor for bleeding recurrence in this population.Conclusion: In this series, nearly half of the patients hospitalized with diverticular bleeding presented with severe bleeding. Patients with low hemoglobin levels, older age, bilateral diverticular location and chronic kidney disease had a significantly increased risk for severe diverticular bleeding. In addition, a small number of patients rebled within the first year after the index episode, although we could not identify independent risk factors associated with the recurrence of diverticular bleeding.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Risk factors for severity and recurrence of colonic diverticular bleeding

Joaquim¹,

Caldeira²,

Antunes³

et al. 2016

Rev Esp Enferm Dig

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Risk factors of interventional radiology/surgery for colonic diverticular bleeding

et al. 2021

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Background and Aim Colonic diverticular bleeding (CDB) stops spontaneously, but sometimes, excessive bleeding does not allow hemostasis and requires interventional radiology (IR)/surgery. We examined risk factors in patients who required IR/surgery for CDB and late recurrent bleeding rate after IR/surgery. Methods This retrospective case–control study was conducted at a tertiary center. We included 608 patients who required hospitalization for CDB. Patients were investigated for risk factors using logistic regression analysis. We also investigated early and late recurrent bleeding rates following IR/surgery. Results In 261 patients (42.9%), the bleeding source was identified, and endoscopic hemostasis was performed; 23 (3.8%) required IR/surgery. In multivariate analysis, shock state with a blood pressure of ≤90 mmHg (P < 0.001; odds ratio [OR], 20.1; 95% confidence interval [CI], 5.08–79.5), positive extravasation on contrast‐enhanced computed tomography (P < 0.001; OR 9.5, 95% CI 2.85–31.4), two or more early recurrent bleeding episodes (P = 0.002; OR 7.4, 95% CI 2.14–25.4), and right colon as the source of bleeding (P = 0.023; OR 4.1, 95% CI 1.25–14.0) were independent risk factors requiring IR/surgery. Early recurrent bleeding was observed in 0% and 28.0% patients (P < 0.001) in the IR/surgery and no IR/surgery groups, respectively, whereas late recurrent bleeding rate was observed in 43.4% and 30.7% patients (P = 0.203) in the IR/surgery and no IR/surgery groups, respectively. Four patients who required surgery experienced late recurrent bleeding at a site different from the initial CDB. Conclusions Although IR/surgery is an effective hemostatic treatment wherein endoscopic treatment is unsuccessful, late recurrent bleeding cannot be prevented.

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