Acute lower gastrointestinal bleeding/Akutna krvarenja iz donjih partija gastrointestinalnog trakta

• Published in: Medicinski pregled Vol. 67; no. 11-12; p. 361
• Main Authors: Jocic, Tatiana, Bosnjak, Olgica Latinovic, Hadnadev, Ljiljana, Damjanov, Dragomir, Savic, Zeljka, Orlic, Tihomir
• Format: Journal Article
• Language: English
• Published: Drustvo Lekara Vojvodine 01-11-2014
• Subjects: Care and treatment; Comorbidity; Development and progression; Diagnosis; Endoscopic surgery; Endoscopy; Gastrointestinal bleeding; Mortality; Patient outcomes; Risk factors; Serbia; Serbia
• ISSN: 0025-8105
• DOI: 10.2298/MPNS1412361J

Introduction. Acute lower gastrointestinal bleeding accounts for approximately 20% of all acute gastrointestinal hemorrhages, and they are the most common urgent cases in gastroenterology. The aim of this study was to determine the most common etiology, efficacy in diagnostics and therapy, and the outcome in patients with acute lower gastrointestinal bleeding. Material and Methods. Data were collected from the medical records of 86 patients who had been hospitalized for acute lower gastrointestinal bleeding in 2009 at the Ward of Gastroenterology and Hepatology, Clinical Centre of Vojvodina. Results. The average age of the patients was 70.4 years (ranging from 37 to 88), and the largest number of patients 41/86 (47.7%) were between the ages 71 and 80. Colon diverticulosis was the most common cause of bleeding, and it occurred in 21 patients from the study sample (24.4%), and the other causes were malignant tumors (12/86, i.e. 13.9%), polyps (10/86, i.e. 11.6%), anorectal diseases (7/86, i.e. 8.3%) and colitis (8/86, i.e. 9.3%). No diagnostic procedures were performed in 15 patients (17.4%) due to their poor medical condition and comorbidities. The total mortality rate was 6/86 (6.9%), and the largest number of deaths occurred (5/86 i.e. 5.8%) due to a multisystem organ failure and underlying diseases which were not associated with acute lower gastrointestinal bleeding. Uncontrolled bleeding was the cause of death in only 1 patient (1.2%). Conclusions. Acute lower gastrointestinal bleeding is most commonly found in the older population, whose age, comorbidities, and ongoing therapy have impact on bleeding lesions, diagnostic and therapeutic modalities and the outcomes of bleeding. Endoscopic procedures are still the gold standard in diagnostics. Key words: Gastrointestinal Hemorrhage; Lower Gastrointestinal Tract; Diagnosis; Treatment Outcome; Diverticulum; Colonoscopy Uvod. Akutna krvarenja iz donjih partija gastrointestinalnog trakta cine oko 20% uzroka svih akutnih gastrointestinalnih krvarenja koja predstavljaju najcesca urgentna stanja u gastroenterologiji. Cilj ove studije bio je da se utvrde najcesca etiologija, efikasnost u dijagnostici i terapiji, te ishod bolesti kod bolesnika sa akutnim krvarenjem iz donjih partija gastrointestinalnog trakta. Materijal i metode. Podaci su dobijeni iz istorija bolesti 86 bolesnika koji su bili hospitalizovani zbog akutnog krvarenja iz donjih partija gastrointestinalnog trakta u jednogodisnjem periodu, tokom 2009. godine, na Klinici za gastroenterologiju i hepatologiju, Klinickog centra Vojvodine. Rezultati. Prosecna starost bolesnika iznosila je 70,4 godina (od 37 do 88), a najveci broj bolesnika 41/86 (47,7%) pripada starosnoj grupi od 71 do 80 godina. Divertikuloza kolona predstavljala je najcesci uzrok krvarenja 21/86 (24,4%), a ostali uzroci bili su maligniteti kolona 12/86 (13,9%), polipi 10/86 (11,6%), bolesti anorektalne regije 7/86 (8,1%) i kolitisi 8/86 (9,3%). Kod 15/86 (17,4%) bolesnika nisu sprovodene nikakve dijagnosticke procedure sa ciljem identifikacije uzroka krvarenja zbog teskog opsteg stanja i komorbiditeta. Ukupan mortalitet kod bolesnika sa akutnim krvarenjem iz donjih partija gastrointestinalnog trakta iznosio je 6/86 (6,9%), a najveci broj smrtnih ishoda 5/86 (5,8%) posledica je multisistemske organske insuficijencije i pridru[]enih bolesti koji nisu povezani sa krvarenjem. Samo kod 1/86 (1,2%) bolesnika uzrok letalnog ishoda bio je recidiv krvarenja. Zakljucak. S obzirom da se akutna krvarenja iz donjih partija gastrointestinalnog trakta cesce javljaju kod starije populacije, samo []ivotno doba, prisutni komorbiditeti i terapija uticu na vrstu krvarece lezije, mogucnost dijagnostike i ishod bolesti. I dalje zlatni standard u dijagnostici predstavljaju endoskopske procedure. Kljucne reci: Gastrointestinalna krvarenja; Donji gastrointestinalni trakt; Dijagnoza; Ishod lecenja; Divertikulum; Kolonoskopija