Factors that affect the development of acute hemorrhagic rectal ulcer syndrome and rebleeding

Natsumi Uehara; Kazuaki Inoue; Yuichiro Kuroki; Naoki Miyao; Kenta Iwahashi; Reika Suzuki; Toshiyuki Endo; Kunio Asonuma; Erika Yoshida; Naoko Koshibu; Akihiro Tabuchi; Misako Tohata; Shotaro Hanamura; Kuniyo Gomi; Yorimasa Yamamoto; Masatsugu Nagahama

doi:10.1002/deo2.184

Factors that affect the development of acute hemorrhagic rectal ulcer syndrome and rebleeding

DEN Open. 2022 Nov 22;3(1):e184. doi: 10.1002/deo2.184. eCollection 2023 Apr.

Authors

Natsumi Uehara^{1

2}, Kazuaki Inoue³, Yuichiro Kuroki⁴, Naoki Miyao², Kenta Iwahashi⁵, Reika Suzuki², Toshiyuki Endo², Kunio Asonuma², Erika Yoshida², Naoko Koshibu², Akihiro Tabuchi², Misako Tohata², Shotaro Hanamura⁶, Kuniyo Gomi², Yorimasa Yamamoto², Masatsugu Nagahama²

Affiliations

¹ Department of Gastroenterology Medical Topia Soka Hospital Saitama Japan.
² Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan.
³ Department of Gastroenterology International University of Health and Welfare Narita Hospital Chiba Japan.
⁴ Department of Gastroenterology St. Marianna University School of Medicine Yokohama City Seibu Hospital Kanagawa Japan.
⁵ Department of Internal medicine Honda Hospital Tokyo Japan.
⁶ Department of Gastroenterology Kikuna Memorial Hospital Kanagawa Japan.

Abstract

Objectives: Acute hemorrhagic rectal ulcer syndrome (AHRUS) causes massive bleeding and often recurrent rebleeding from rectal ulcers that form immediately above the dentate line. This study aimed to determine the clinical background and risk factors contributing to rebleeding in patients with AHRUS and the most appropriate method of hemostasis treatment.

Methods: This retrospective study included 93 patients diagnosed with AHRUS at Showa University Fujigaoka Hospital, Japan, between April 2009 and November 2018. Information on clinical background factors, endoscopic findings, and hemostasis was obtained from medical records. The relationship with episodes of rebleeding was analyzed by multivariate logistic regression analysis.

Results: The median age was 79 years, and 84 patients (90%) had a performance status of grade 2 or higher. The patients had multiple background factors, with a median number of 5 per patient. The background factors could be classified into two major factors: those related to arteriosclerosis and those related to delayed wound healing.In the multivariate analysis, significantly more rebleeding occurred in patients with active bleeding during the initial endoscopy (odds ratio 4.88, 95% confidence interval 1.80-14.46, p = 0.003); significantly less rebleeding occurred in patients for whom hemostasis was first performed by clipping (odds ratio 0.30, 95% confidence interval 0.09-0.88, p = 0.035).

Conclusions: In bedridden older individuals with poor general health, multiple combinations of arteriosclerosis-related factors and protracted wound healing factors can induce AHRUS. We strongly recommend performing hemostasis via the clipping method on suspected bleeding points, including active bleeding sites, in AHRUS.

Keywords: endoscopy; hemorrhage; hemostasis; rectum; ulcer.