A Risk Assessment of Factors for the Presence of Angiodysplasias During Endoscopy and Factors Contributing to Symptomatic Bleeding and Rebleeds
Background Few studies have assessed factors associated with angiodysplasias during endoscopy or factors associated with symptomatic disease. Aims To evaluate risk factors for the presence of and contribution to symptomatic disease in patients with angiodysplasias. Methods We performed a systematic...
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Published in | Digestive diseases and sciences Vol. 64; no. 10; pp. 2923 - 2932 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
01.10.2019
Springer Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Few studies have assessed factors associated with angiodysplasias during endoscopy or factors associated with symptomatic disease.
Aims
To evaluate risk factors for the presence of and contribution to symptomatic disease in patients with angiodysplasias.
Methods
We performed a systematic MEDLINE, EMBASE and Cochrane Library search according to the PRISMA guidelines for studies assessing risk factors involved in angiodysplasias detected during endoscopy and factors that lead to anemia or overt bleeding. Study quality was assessed with the Newcastle–Ottawa scale. A risk assessment was performed by selecting risk factors identified by two independent studies and/or by a large effect size.
Results
Twenty-three studies involving 92,634 participants were included. The overall quality of the evidence was moderate. Risk factors for the diagnosis of angiodysplasias during endoscopy confirmed by at least two studies were increasing age (OR 1.09 per year, 95% CI 1.04–1.1), chronic kidney disease (OR 4.5, 95% CI 1.9–10.5) and cardiovascular disease (2.9, 95% CI 1.4–6.2). The risk of rebleeds was higher in the presence of multiple lesions (OR 4.2, 95% CI 1.1–16.2 and 3.8, 95% CI 1.3–11.3 and 8.6, 95% CI 1.4–52.6), liver cirrhosis (OR 4.0, 95% 1.1–15.0) and prothrombin time < 30% (OR 4.2, 95% 1.1–15.4) with a moderate effect size. Multiple comorbidities were associated with an increased in-hospital mortality (OR 2.29, 95% CI 1.2–4.3).
Conclusions
This systematic review identified age, chronic kidney disease and cardiovascular disease as the most important risk factors for the diagnosis of angiodysplasias during endoscopy. Multiple lesions increase the risk of recurrent bleeding. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 |
ISSN: | 0163-2116 1573-2568 |
DOI: | 10.1007/s10620-019-05683-7 |