The Impact of Aspirin, Non Steroidal Anti-Inflammatory Drugs and Warfarin on Acute Lower Gastrointestinal Bleeding: Ten Year Study From a Dedicated Bleeding Unit

Prospective Study of Urgent Endoscopic Diagnosis and Treatment of Patients with Diverticulosis and Severe Hematochezia Dennis M. Jensen, Thomas O. Kovacs, Gareth Dulai, Rome Jutabha, Ian M. Gralnek, Gustavo A. Machicado Severe hematochezia is frequent in the elderly & diverticulosis is considered the most prevalent cause. Unlike severe UGI hemorrhage where emergency endoscopy is used for diagnosis, hemostasis & triaging, this approach is uncommon for severe hematochezia. Our purposes were: 1) to document whether diverticulosis was the bleeding site based on stigmata of hemorrhage & exclusion of other lesions, 2) to present a classification of diverticulosis & severe hematochezia, & 3) to report cumulative results of all patients with definitive diverticular hemorrhage treated to date by medical-colonoscopic hemostasis or medical-surgical therapy. Methods: 215 new hospitalized patients with severe hematochezia & diverticulosis were prospectively studied. After resuscitation & purge, urgent colonoscopy was performed within 12 hrs of GI consultation. Anoscopy & enteroscopy were performed in patients without a colonic diagnosis. For major stigmata, focal lesions, or angioma syndromes, the choice of therapy was the attending’s. For the cumulative report of definitive diverticular hemorrhage, we combined individual data of all previous & new patients & re-analyzed by therapy (Med-Surg vs. MedColonoscopic). Results: For the 215 new patients, 29 (13.5%) had ‘‘definitive diverticular hemorrhage’’ – major stigmata seen on a single colonic diverticulum; 69 (32.1%) had ‘‘presumed diverticular hemorrhage’’ – no stigmata identified but no other GI source by colonoscopy, anoscopy & enteroscopy; & 117 (54.4%) had ‘‘incidental diverticulosis’’ – a non-diverticular source was identified. Triaging patients to level of care was feasible with this approach. For all 46 patients with definitive diverticular bleeding (means G SEM), ages for Med-Surg (vs. MedColonoscopic) were 66 G 3 (68 G 4); initial U RBC’s transfused were 5.5 G 1.2 (5.0 G 1.4); recent NSAID/aspirin in 25% (32%); & all patients had severe comorbidities. See Table. Conclusions: For patients with diverticulosis & severe hematochezia: 1) At least half had non-diverticular sources of hemorrhage. 2) For those with true diverticular bleeding, about 60% had presumptive & 30% had definitive diverticular hemorrhage. 3) For the latter group, colonoscopic hemostasis significantly decreased recurrent bleeding, need for surgery, & hospital stay.