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Risk factors for recurrence of acute gastrointestinal bleeding from angiodysplasia

Saperas, Esteve; Videla, Sebastián; Dot, Joan; Bayarri, Carolina; Lobo, Beatriz; Abu-Suboh, Monder; Armengol, Jose Ramón; Malagelada, Juan R.

European Journal of Gastroenterology & Hepatology: December 2009 - Volume 21 - Issue 12 - p 1333-1339
doi: 10.1097/MEG.0b013e32830e491c
Original Articles: Gastrointestinal Haemorrhage

Background and aims Recurrent bleeding from gastrointestinal (GI) angiodysplasia remains a therapeutic challenge. Identification of factors predicting poor outcome of haemorrhage from angiodysplasia would help us to select the patients who may likely benefit from further therapy. Thus, we analysed risk factors for recurrence of acute GI haemorrhage from angiodysplasia.

Patients and methods 62 patients admitted consecutively with acute GI bleeding from angiodysplasia, between June 2002 and June 2006, were included. Bivariate, multivariate and survival analysis were performed to identify risk factors for recurrence of bleeding after hospital discharge.

Results Recurrence of acute haemorrhage after hospital discharge occurred in 17 of 57 (30%) patients (38 men; mean age: 74±6 years), after a mean follow-up (33±40 months). On Cox analysis, earlier history of bleeding with a high bleeding rate, over anticoagulation and the presence of multiple lesions were predictive factors of recurrence in a multivariate analysis. In contrast, endoscopic argon plasma coagulation (APC) therapy was not associated with lower rates of recurrent bleeding.

Conclusion In patients with acute GI haemorrhage from angiodysplasia, earlier bleeding with a high bleeding rate, over anticoagulation and multiple angiodisplasic lesions predict an increased risk of recurrent bleeding. Although there is a trend towards better management with endoscopic APC therapy for the prevention of recurrence of bleeding, endoscopic APC therapy is not predictive of a lower rate of recurrence.

Gastroenterology Department and Endoscopy Unit, University Hospital Vall d'Hebron, Barcelona, Spain

Correspondence to Dr Esteve Saperas, MD, Digestive System Research Unit, University Hospital Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain

Tel/fax: +34 93 428 18 83; e-mail:esaperas@vhebron.net

This study was presented at the annual meeting of the American Gastroenterological Association, May 2007, Washington, DC.

Received 22 April 2008 Accepted 26 June 2008

© 2009 Lippincott Williams & Wilkins, Inc.