Acute hemorrhagic rectal ulcer (AHRU) syndrome: comparison with non-AHRU lower gastrointestinal bleeding

Aim Acute hemorrhagic rectal ulcer (AHRU) syndrome can cause massive, life-threatening rectal bleeding. Sigmoidoscopic hemostasis with enema can often be performed to effectively control rectal bleeding. Methods The medical records of AHRU patients were retrospectively reviewed. The baseline clinical characteristics were compared with those of non-AHRU lower gastrointestinal bleeding patients to identify predictive factors for AHRU. Results Among the 118 patients who underwent emergent endoscopy due to acute massive hematochezia from 2013 to 2015, 25 (21.2%) were diagnosed as having AHRU. Twenty-two patients (88%) were successfully managed endoscopically, and three (12%) underwent surgery. Six patients (24%) developed rebleeding within 1–9 days after initial bleeding, which was controlled by repeat endoscopy. Five patients (20%) died during follow-up. Compared to the non-AHRU patients, the AHRU patients had a worse Eastern Cooperative Oncology Group (ECOG) performance and lower serum albumin level (median [range], 2.4 g/dL [1.8-4.2] vs. 3.4 g/dL [1.9-4.6]; P < 0.001). Multivariable-adjusted logistic regression analysis revealed that a lower serum albumin level, worse ECOG status and history of constipation were significant factors for predicting AHRU. Hypoalbuminemia (<3.0 g/dL) had sensitivity, specificity, and positive/negative predictive values of 84%, 78.5%, 51.2%, and 94.8% for predicting AHRU, respectively. Conclusions Among patients with massive hematochezia, 21.2% had AHRU. The majority of the AHRU patients (88%) were managed endoscopically. Low serum albumin level, poor ECOG performance status, and prior constipation could be used in distinguishing AHRU from non-AHRU bleeding cases and could facilitate selection of the optimal bowel preparation method for massive hematochezia. Copyright © 2017 John Wiley & Sons, Ltd.