The Clinical Risk Factors Analysis Of 81 Patients With Small Bowel Bleeding

Background Small bowel bleeding(SBB)refers intestinal bleeding from the Treitz ligament to the ileocecal valve.It belongs to the middle gastrointestinal bleeding which accounts for 5-10% of the whole gastrointestinal bleeding.It often presents obscure gastrointestinal bleeding.The etiology of small bowel bleeding is complex,the clinical manifestations are not specific,and its anatomical location is special,so it is difficult to accurately diagnose it.Patients often need to be hospitalized repeatedly.With the progress of capsule endoscopy(CE)and the instrument assisted enteroscopy,more and more causes of SBB have been identified.The application of CE and double balloon enteroscopy(DBE)in the field of SBB has emerged in an endless stream,but there is still no clear conclusion.At present,several scoring systems for non-variceal upper gastrointestinal bleeding has been reported,but there is no scoring system for SBB to predict its adverse outcome.Objective 1.Analyzing the etiology,clinical manifestation and prognosis of the hospitalized patients with SBB.To understand the disease situation and the etiological changes of SBB in recent years.Exploring the application value of CE and DBE in SBB,so that further enhancing the understanding of SBB.2.To study whether the CRS?GBS and AIMS65 scoring systems for non-variceal upper gastrointestinal bleeding have the same predictive value for SBB.And to explore the risk factors related to different clinical outcomes of patients with SBB.So that it will help to judge the initial treatment of the patients,improve the level of diagnosis and treatment,improve the prognosis and save the medical resources.Method 1.The study included 81 SBB patients in Tianjin Medical University General Hospital from June 2016 and December 2017.Date was retrospectively analyzed.2.Calculating the detection rate and diagnostic rate of CE and DBE to study their application value in SBB.3.Drawing the receiver-operating characteristic curve and calculating the area under the receiver-operating characteristic curve to evaluate whether the CRS?GBS and AIMS65 scoring systems for non-variceal upper gastrointestinal bleeding have the same predictive value for SBB.Using logistic regression analysis to identify the risk factors for clinical outcome.Result 1.Small intestinal vascular malformation(SIVMF),inflammatory disease and small intestinal tumor were the main causes of SBB,accounting for 29.63%,27.16%,11.11%,respectively.Of the 81 patients,the males were 1.8 times as greater as the females.They were with a mean age of 56.27±18.92 years,a mean disease course of 12.84±27.27 months and a mean length stay in hospital of 12.14±6.40 days.The mean hemoglobin level of these patients before admission was(86.43±28.42)g/L and the incidence of anemia was 85.2%.Overall,47.0% experienced rebleeding and 1.2% died in hospital.And 47.0% needed at least one clinical intervention,of whom 48.1% needed blood transfusion,9.9% needed endoscopic hemostasis and 2.5% needed surgery.2.The detection rates of CE and DBE for SBB lesions were 87,27% and 87.23% respectively.There was no significant difference between the two groups(P>0.05).The diagnostic rate of DBE for SBB was higher than that of CE,61.82% and 80.85% respectively,and the difference was statistically significant(P<0.05).3.The three scoring systems have a certain value for predicting the different clinical outcomes of SBB.The mean scores in patients with rebleeding,clinical intervention and long hospitalization were higher than the others without adverse outcomes.4.The age more than 50,the hemoglobin level before admission less than 70g/L,the albumin level less than 30g/L,the blood urea more than 6.5mmol/L and coagulation dysfunction were associated with rebleeding.The independent predictors for rebleeding was coagulation dysfunction and hemoglobin.The hemoglobin level before admission less than 70g/L,the albumin level lower than 30g/L,the blood urea more than 6.5mmol/L and coagulation dysfunction were associated with clinical intervention.Among them,hemoglobin was the independent risk factor.Conclusion 1.Small intestinal vascular malformation,inflammatory disease and small intestinal tumor were the main causes of SBB.2.CE and DBE are the effective means to diagnose SBB.They can be complementary.But at the same time,we should consider the economic benefits and choose the most effective diagnostic methods for the patients.3.The CRS,GBS and AIMS65 scoring system has a certain predictive value for different clinical outcomes of SBB patients,but it is not an ideal scoring model for SBB.4.The coagulation dysfunction and hemoglobin level lower than 70g/L before admission were independent risk factors for rebleeding;The independent predictor for clinical intervention was the lower hemoglobin level.