Factors that contribute to blood loss in patients with colonic angiodysplasia from a population-based study

Abstract

Background & aims: Most studies of angiodysplasia are small and performed at a single center. We investigated the epidemiology and management of colonic angiodysplasia by using a national endoscopy database.

Methods: Colonoscopy reports (n = 229,727; generated from January 2000 to December 2002) from patients with documented angiodysplasia (n = 4159) were retrieved from the Clinical Outcomes Research Initiative. Predictors of occult or overt blood loss and endoscopic treatment were identified by using multivariate logistic regression.

Results: Most patients with documented angiodysplasia were older than 60 years (73%) or had right-sided lesions (62%). There was evidence of blood loss in 56% of patients with angiodysplasia. Predictors of blood loss included inpatient status (odds ratio [OR], 8.74; 95% confidence interval [CI], 5.42-14.10), 2-10 angiodysplasias (OR, 1.50; 95% CI, 1.29-1.75), more than 10 lesions (OR, 2.18; 95% CI, 1.69-2.80), black race (OR, 1.95; 95% CI, 1.46-2.62), severe illness (OR, 1.97; 95% CI, 1.62-2.41), Hispanic ethnicity (OR, 1.71; 95% CI, 1.32-2.22), and age older than 80 years (OR, 1.32; 95% CI, 1.06-1.63). Endoscopic therapy was given to 28% of patients with evidence of blood loss and in 68% with active bleeding. Endoscopic treatment increased among patients in a university practice setting (vs community setting, OR, 2.53; 95% CI, 1.96-3.27) and decreased in Northwest geographic locations (vs Southwest, OR, 0.60; 95% CI, 0.43-0.84).

Conclusions: Predictors of blood loss in patients with colonic angiodysplasia include inpatient status, comorbidities, age, race/ethnicity, and lesion number. Endoscopic therapy for angiodysplasia varied according to practice setting and region.