Lower gastrointestinal bleeding: incidence, etiology, and outcomes in a population-based setting
Lower gastrointestinal bleeding: incidence, etiology, and outcomes in a population-based setting
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DOI：
10.1097/meg.0b013e32835948e3
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发表时间：
2013-01-01
影响因子：
2.1
通讯作者：
Bjoernsson, Einar S.
中科院分区：
文献类型：
--
作者：
Hreinsson, Johann P.;Gudmundsson, Sveinn;Bjoernsson, Einar S.
目的探讨急性下消化道出血(ALGIB)在人群中的发生率和转归，以及可能与GIB相关的药物的作用。队列包括2010年在冰岛国立大学医院接受结肠镜检查的所有患者。系统地记录内窥镜检查的适应症和用药史。纳入标准为导致住院或发生在住院患者中的明显出血。在GIB之前非类固醇抗炎药、小剂量阿司匹林、华法林、选择性5-羟色胺受体抑制剂和双膦酸盐的使用情况也在涵盖该国所有药物处方的药物数据库中进行了检查。对照组包括在研究期间接受结肠镜检查且没有GIB的患者。结果总共有1134名患者接受了1275次结肠镜检查。总体而言，163名患者患有ALGIB。ALGIB的粗发病率为87/10万居民/年。最常见的发现是憩室病(23%)和缺血性结肠炎(16%)。总共有7.4%的人接受了内窥镜治疗，没有人接受过手术。2例(1.2%)患者死于ALGIB，均伴有严重的合并症。总体而言，19%的ALGIB患者服用非甾体抗炎药，而非出血者为9%(P=0.0096)；37%的ALGIB患者服用小剂量阿司匹林，而非出血者为25%(P=0.0222)。ALGIB最常见的原因是憩室病和缺血性结肠炎。住院期间的死亡率很低。非甾体抗炎药和小剂量阿司匹林似乎增加了ALGIB的风险。EURJ胃肠病肝素25：37-43(C)2012沃尔特斯·克鲁沃健康垂直条Lippincott Williams&Wilkins。欧洲胃肠病与肝病杂志2013，25：37-43
Objectives To investigate the incidence and outcomes of acute lower gastrointestinal bleeding (ALGIB) in a population-based setting and examine the role of drugs potentially associated with GIB.Methods The study was prospective and population based. The cohort included all patients who underwent colonoscopy during the year 2010 at the National University Hospital of Iceland. Indications for endoscopies and drug history were recorded in a systematic manner. The inclusion criteria were overt bleeding leading to hospitalization or occurring in hospitalized patients. The use of NSAIDs, low-dose aspirin, warfarin, selective serotonin receptor inhibitors, and bisphosphonates before GIB was also checked in a Pharmaceutical Database covering all drug prescriptions in the country. A control group included patients who underwent colonoscopy during the study period and did not have GIB.Results Altogether, 1134 patients underwent 1275 colonoscopies. Overall, 163 patients had ALGIB. The crude incidence for ALGIB was 87/100 000 inhabitants/year. The most common findings were diverticulosis (23%) and ischemic colitis (16%). A total of 7.4% of individuals had endoscopic therapy and none had undergone surgery. Two (1.2%) patients died because of ALGIB, both with severe comorbidities. Overall, 19% with ALGIB were on NSAIDs versus 9% in nonbleeders (P=0.0096); 37% with ALGIB were on low-dose aspirin versus 25% in nonbleeders (P=0.0222).Conclusion The incidence for ALGIB is the highest reported to date. The most common reasons for ALGIB were diverticulosis and ischemic colitis. Mortality during hospitalization was very low. NSAIDs and low-dose aspirin seem to increase the risk for ALGIB. Eur J Gastroenterol Hepatol 25:37-43 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2013, 25:37-43