• Internal medicine · Sep 2024

    Multicenter Study

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

    • Takahiro Muramatsu, Masakatsu Fukuzawa, Akira Madarame, Yasuyuki Kagawa, Miho Kikuchi, Sho Taniguchi, Satoshi Shimai, Sho Matsumoto, Fumito Yamanishi, Yuka Suzuki, Daiki Nemoto, Hirokazu Shinohara, Taisuke Matsumoto, Yohei Koyama, Kumiko Uchida, Hayato Yamaguchi, Takashi Morise, Akihiko Sugimoto, Yoshiya Yamauchi, Shin Kono, Sakiko Naito, Hironori Nakamura, Daisuke Nutahara, Yuubu Matsue, Yoshiko Kishimoto, Kei Yamamoto, Takashi Kawai, and Takao Itoi.
    • Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Japan.
    • Intern. Med. 2024 Sep 15; 63 (18): 248124902481-2490.

    AbstractObjective 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 (PS 4), blood transfusion, a low eGFR, poor view of the whole rectum on endoscopy, and the use of monopolar hemostatic forceps.

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