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Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit
  1. Kathryn Oakland1,
  2. Richard Guy2,
  3. Raman Uberoi3,
  4. Rachel Hogg4,
  5. Neil Mortensen2,
  6. Michael F Murphy1,5,
  7. Vipul Jairath6,7,8
  8. on behalf of the UK Lower GI Bleeding Collaborative
  1. 1Clinical Research, NHS Blood and Transplant, Oxford, UK
  2. 2Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
  3. 3Department of Interventional Radiology, Oxford University Hospitals, Oxford, UK
  4. 4Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
  5. 5National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals and the University of Oxford, Oxford, UK
  6. 6Division of Gastroenterology, Department of Medicine, University Hospital, London Health Sciences Centre, London, Ontario, Canada
  7. 7Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
  8. 8Nuffield Department of Medicine, University of Oxford, Oxford, UK
  1. Correspondence to Dr Vipul Jairath, Department of Medicine, University of Western Ontario, London, Ontario, Canada N6A 5A5; vjairath{at}uwo.ca

Abstract

Objective Lower GI bleeding (LGIB) is a common reason for emergency hospital admission, although there is paucity of data on presentations, interventions and outcomes. In this nationwide UK audit, we describe patient characteristics, interventions including endoscopy, radiology and surgery as well as clinical outcomes.

Design Multicentre audit of adults presenting with LGIB to UK hospitals over 2 months in 2015. Consecutive cases were prospectively enrolled by clinical teams and followed for 28 days.

Results Data on 2528 cases of LGIB were provided by 143 hospitals. Most were elderly (median age 74 years) with major comorbidities, 29.4% taking antiplatelets and 15.9% anticoagulants. Shock was uncommon (58/2528, 2.3%), but 666 (26.3%) received a red cell transfusion. Flexible sigmoidoscopy was the most common investigation (21.5%) but only 2.1% received endoscopic haemostasis. Use of embolisation or surgery was rare, used in 19 (0.8%) and 6 (0.2%) cases, respectively. 48% patients underwent no inpatient investigations. The most common diagnoses were diverticular bleeding (26.4%) and benign anorectal conditions (16.7%). Median length of stay was 3 days, 13.6% patients rebled during admission and 4.4% were readmitted with bleeding within 28 days. In-hospital mortality was 85/2528 (3.4%) and was highest in established inpatients (17.8%, p<0.0001) and in patients experiencing rebleeding (7.1%, p<0.0001).

Conclusions Patients with LGIB have a high burden of comorbidity and frequent antiplatelet or anticoagulant use. Red cell transfusion was common but most patients were not shocked and required no endoscopic, radiological or surgical treatment. Nearly half were not investigated. In-hospital mortality was related to comorbidity, not severe haemorrhage.

  • GASTROINTESTINAL BLEEDING
  • ENDOSCOPY
  • GASTROINTESTINAL SURGERY
  • INTERVENTIONAL RADIOLOGY

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Footnotes

  • Twitter Follow Kathryn Oakland @LGIBaudit

  • Collaborators UK Lower GI Bleeding Collaborative: full names listed in the online supplementary appendix.

  • Contributors KO designed and conducted the study, performed the analysis, interpreted the data and wrote the paper. RG, NM, MFM and RU designed the study, interpreted the data and critically revised the paper. RH performed the statistical analysis and critically revised the paper. VJ designed the study, interpreted the data and wrote the paper.

  • Funding This project was funded by the NHS Blood and Transplant and the Bowel Disease Research Foundation. KO is supported by a research fellowship from the Royal College of Surgeons of England.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional unpublished data on the organisation of services for lower GI bleeding has been provided to all hospitals that participated and are available at www.hospital.blood.co.uk.

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