'Acute on chronic' gastrointestinal bleeding common, has lower mortality rate than acute bleeding — 3 insights

A study published in the Journal of Investigative Medicine examined acute on chronic gastrointestinal bleeding.

Researchers defined acute on chronic bleeding as acute bleeding that occurs in the setting of chronic bleeding, often documented as iron deficiency anemia.

Dallas-based University of Texas Southwestern Medical Center's Don Rockey, MD, and colleagues identified 1,460 patients with acute, chronic or acute on chronic bleeding. Specifically 776 patients had acute bleeding, 254 chronic bleeding and 430 had acute on chronic bleeding.

Here's what they found.

1. In patients with acute on chronic bleeding, lesions were common in the:

  • Esophagus — 28 percent
  • Colon and rectum — 27 percent
  • Stomach — 21 percent

2. Researchers identified 260 patients as having upper acute on chronic bleeding. Of these patients, the bleeding was most commonly due to portal hypertensive lesions (47 percent). Portal hypertensive lesions were present in 29 percent of acute bleeding patients and 25 percent of chronic bleeding patients.

3. In all acute on chronic bleeding patients, 30-day mortality rate was lower than acute bleeding.

Researchers concluded, "Acute on chronic gastrointestinal bleeding is common, and in patients with upper gastrointestinal bleeding was most often a result of portal hypertensive upper gastrointestinal tract pathology." They suggested the reduced mortality rate could be an indicator of an adaptive response.

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