High Risk for Recurrence After Acute Lower GI Bleeding


Adults who are discharged from the hospital following acute lower gastrointestinal bleeding (ALGIB) face a high risk for recurrence and increased mortality associated with rebleeding.


  • The data came from a retrospective analysis of 5048 patients urgently hospitalized for ALGIB at 49 hospitals in Japan.

  • The risk factors for long-term recurrence were analyzed using competing risk analysis.


  • Rebleeding occurred in 1304 (26%) patients during a mean follow-up of 31 months.

  • The cumulative incidences of rebleeding at 1 and 5 years were 15% and 25%, respectively.

  • In a multivariate analysis, factors significantly associated with an increased rebleeding risk were shock index ≥1 (subdistribution hazard ratio [SHR], 1.25), blood transfusion (SHR, 1.26), in-hospital rebleeding (SHR, 1.26), colonic diverticular bleeding (SHR, 2.38), and thienopyridine use (SHR, 1.24).

  • In a multivariate analysis of patients with colonic diverticular bleeding, blood transfusion (SHR, 1.20), in-hospital rebleeding (SHR, 1.30), and thienopyridine use (SHR, 1.32) significantly increased the rebleeding risk, while endoscopic hemostasis (SHR, 0.83) significantly decreased the risk.

  • The risk for death was significantly higher in patients with out-of-hospital rebleeding episodes (hazard ratio, 1.42).


“These large nationwide follow-up data highlighted the importance of endoscopic diagnosis and treatment during hospitalization and the assessment of the need for ongoing thienopyridine use to reduce the risk of out-of-hospital rebleeding. This information also aids in the identification of patients at high-risk of rebleeding,” the authors write.


The study was conducted by Yoshinori Sato, MD, with the Division of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan, and colleagues. It was published online June 3 in Clinical Gastroenterology & Hepatology. The study had no commercial funding. 


The follow-up period of 31 months may not capture long-term recurrence accurately. Missing data led to the exclusion of 1325 patients from the analysis, which may have influenced the results. It is not clear if the findings generalize to patients outside Japan.


The authors declared no conflicts of interest related to this study.

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