GASTROİNTESTİNAL ANJİYODİSPLAZİLİ HASTALARDA KANAMAYI ETKİLEYEN KLİNİK ÖZELLİKLER VE RİSK FAKTÖRLERİNİN DEĞERLENDİRİLMESİ

Year 2022, Volume: 55 Issue: 2, 120 - 124, 31.08.2022

Berrin Yalınbaş , Hayrettin Dizen , İsmail Yenilmez

https://doi.org/10.20492/aeahtd.1088748

Abstract

AMAÇ: Bu çalışmanın amacı, anjiyodisplazili hastalarda kanamayı etkileyen klinik özellikleri ve risk faktörlerini değerlendirmektir.
GEREÇ VE YÖNTEM: Bu retrospektif çalışma Ocak 2016 ile Aralık 2019 tarihleri arasında yapılmış olup, iki kurumda herhangi bir nedenle endoskopi/kolonoskopi tetkiki yapılan hastalar dahil edilmiştir. Anjiyodisplazili hastalar kanama durumlarına göre iki gruba ayrılarak klinik özellikleri ve kanamayı etkileyen risk faktörleri incelendi.
BULGULAR: Endoskopi ve kolonoskopi yapılan 44 (%2,02) hastada anjiyodisplazi tespit edildi. Anjiyodisplazili hastaların %25'inde (n=11) kanama tespit edildi. Kanamalı anjiyodisplazi hastalarında varfarin kullanım sıklığı (p=0,016) ve kalp hastalığı sıklığı (p=0,008) daha yüksekti. Kanamalı anjiyodisplazi hastalarında hemoglobin (p=0,001), hematokrit (p < 0,001), trombosit düzeyleri (p=0,009) ve toplam demir bağlama kapasitesi (p=0,036) anlamlı olarak daha düşük bulundu. Varfarin kullanan hastaların, kullanmayanlara göre 12.917 kat daha yüksek kanama riskine sahip olduğu bulundu (OR:12,917, %95 GA: 2,014-82,830, p=0,007). Kanama yaş (p=0,196), cinsiyet (p=0,326), lezyon sayısı (p=0,063), mide lezyonu (p=0,880), duodenum lezyonu (p=0,472), kolon lezyonu (p=0,947), lezyon boyutu (p=0,789), nonsteroid antiinflamatuar ilaç kullanımı (p=0,631), hipertansiyon (p=0,163), siroz (p=0,179), koroner arter hastalığı (p=0,448) ve kalp hastalıkları (p=0.207) ile ilişkili değildi.
SONUÇ: Varfarin kullanımı gastrointestinal anjiyodisplazili hastalarda kanama riskini artırmaktadır. Gastrointestinal anjiyodisplazili hastalarda kanamayı etkileyen risk faktörlerinin kapsamlı prospektif çalışmalarla değerlendirilmesi gerekmektedir.

Keywords

Arteriovenöz Malformasyonlar, Anjiyodisplazi, Endoskopi, Kolonoskopi, Gastrointestinal Kanama, Risk Faktörleri

EVALUATION OF CLINICAL FEATURES AND RISK FACTORS AFFECTING BLEEDING IN PATIENTS WITH GASTROINTESTINAL ANGIODYSPLASIA

Abstract

AIM: The aim of the study was to evaluate the clinical features and risk factors affecting bleeding in patients with angiodysplasia.
MATERIA L AND METHOD: This retrospective study was conducted between January 2016 and December 2019, and included patients who underwent endoscopy/colonoscopy examination for any reason at two institutions (n=2177). Patients with angiodysplasia were divided into two groups according to their bleeding status, and their clinical features and risk factors affecting bleeding were analyzed.
RESULTS: Angiodysplasia was detected in 44 (2.02%) patients who underwent endoscopy and colonoscopy. Bleeding was detected in 25% (n=11) of patients with angiodysplasia. Warfarin use frequency (p=0.016) and heart disease frequency (p=0.008) were higher in patients with angiodysplasia with bleeding. Hemoglobin (p=0.001), hematocrit (p < 0.001), platelet levels (p=0.009) and total iron binding capacity (p=0.036) were found to be significantly lower in patients with bleeding angiodysplasia. It was found that patients using warfarin had a 12.917-fold higher risk of bleeding than nonusers (OR:12.917, 95%CI: 2.014-82.830, p=0.007). Bleeding was not associated with age (p=0.196), gender (p=0.326), number of lesions (p=0.063), gastric lesion (p=0.880), duodenal lesion (p=0.472), colonic lesion (p=0.947), size of lesion (p=0.789), nonsteroidal anti-inflammatory drugs use (p=0.631), hypertension (p=0.163), cirrhosis (p=0.179), coronary artery disease (p=0.448) and heart diseases (p=0.207).
CONCLUSION: The use of warfarin increases the risk of bleeding in patients with gastrointestinal angiodysplasia. Risk factors affecting bleeding in patients with gastrointestinal angiodysplasia need to be evaluated in comprehensive prospective studies.

Keywords

Arteriovenous Malformations, Angiodysplasia, Endoscopy, Colonoscopy, Gastrointestinal Hemorrhage, Risk Factors

References

• 1.) Gordon FH, Watkinson A, Hodgson H. Vascular malformations of the gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2001;15(1):41-58.
• 2.) García-Compeán D, Del Cueto-Aguilera ÁN, Jiménez-Rodríguez AR, González-González JA, Maldonado-Garza HJ. Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: A critical review and view points. World J Gastroenterol. 2019;25(21):2549-2564.
• 3.) Sami SS, Al-Araji SA, Ragunath K. Review article: gastrointestinal angiodysplasia - pathogenesis, diagnosis and management. Aliment Pharmacol Ther. 2014;39(1):15-34.
• 4.) Boley S, Sammartano R, Brandt L. Vascular ectasias of the colon. Surg Gynecol Obstet. 1979;149(3):353-359.
• 5.) Becq A, Rahmi G, Perrod G, Cellier C. Hemorrhagic angiodysplasia of the digestive tract: pathogenesis, diagnosis, and management. Gastrointest Endosc. 2017;86(5):792-806.
• 6.) Beg S, Ragunath K. Review on gastrointestinal angiodysplasia throughout the gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2017;31(1):119-125.
• 7.) Jackson CS, Strong R. Gastrointestinal angiodysplasia: diagnosis and management. Gastrointest Endosc Clin N Am. 2017;27(1):51-62.
• 8.) Höög CM, Broström O, Lindahl TL, Hillarp A, Lärfars G, Sjöqvist U. Bleeding from gastrointestinal angioectasias is not related to bleeding disorders - a case control study. BMC Gastroenterol. 2010;10(1):113.
• 9.) Tsai Y-Y, Chen B-C, Chou Y-C, et al. Clinical characteristics and risk factors of active bleeding in colonic angiodysplasia among the Taiwanese. J Formos Med Assoc. 2019;118(5):876-882.
• 10.) Nishimura N, Matsueda K, Hamaguchi K, et al. Clinical features and endoscopic findings in patients with actively bleeding colonic angiodysplasia. Indian J Gastroenterol. 2015;34(1):73-76.
• 11.) Diggs NG, Holub JL, Lieberman DA, Eisen GM, Strate LL. Factors That Contribute to Blood Loss in Patients With Colonic Angiodysplasia From a Population-Based Study. Clin Gastroenterol Hepatol. 2011;9(5):415-420.
• 12.) Nishimura N, Mizuno M, Shimodate Y, et al. Risk factors for active bleeding from colonic angiodysplasia confirmed by colonoscopic observation. Int J Colorectal Dis. 2016;31(12):1869-1873.
• 13.) Holleran G, Hall B, Hussey M, Mcnamara D. Small bowel angiodysplasia and novel disease associations: a cohort study. Scand J Gastroenterol. 2013;48(4):433-438.
• 14.) Tariq T, Karabon P, Irfan FB, et al. Secondary angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease: Results from the nationwide inpatient sample. World J Gastrointest Endosc. 2019;11(10):504-514.
• 15.) Lanas Á, Carrera-Lasfuentes P, Arguedas Y, et al. Risk of Upper and Lower Gastrointestinal Bleeding in Patients Taking Nonsteroidal Anti-inflammatory Drugs, Antiplatelet Agents, or Anticoagulants. Clin Gastroenterol Hepatol. 2015;13(5):906-912.e902.
• 16.) Grooteman KV, Dalloyaux S, Van Den Bemt MC, et al. Risk factors for incidentally detected and symptomatic angiodysplasias: a case–control study with the general population as reference. Eur J Gastroenterol Hepatol. 2019;31(4):458-462.
• 17.) Sekino Y, Endo H, Yamada E, et al. Clinical associations and risk factors for bleeding from colonic angiectasia: a case‐controlled study. Colorectal Dis. 2012;14(10):e740-e746.
• 18.) Jehangir A, Pathak R, Ukaigwe A, Donato AA. Association of aortic valve disease with intestinal angioectasia: data from the Nationwide Inpatient Sample. Eur J Gastroenterol Hepatol. 2018;30(4):438-441.
• 19.) Neu B, Moessmer G, Bajbouj M, et al. Risk factors for bleeding from gastrointestinal angiodysplasia: a case-control study in patients with bleeding and non-bleeding angiodysplasia. Z Gastroenterol. 2020;58(03):234-240.