Lower gastrointestinal bleeding in adults in two digestive departments in Cotonou from 2017 to 2022: epidemiological, diagnostic, therapeutic, and prognostic aspects

Abstract

Introduction: Gastrointestinal (GI) bleeding is the main emergency in hepato-gastroenterology, occasionally requiring hospitalisation in an intensive care unit. In lower gastrointestinal bleeding (LGB), the cause is sometimes difficult to identify. This study aimed to describe the epidemiological, diagnostic, therapeutic, and prognostic profile of LGB in Cotonou.

Methods: This was a cross-sectional, descriptive, and analytical study with retrospective data collection from January 2017 to December 2022. It covered the medical records of all patients admitted for LGB during the study period at the University Clinic of Hepato-Gastroenterology (CUHGE) of the Hubert Koutoukou Maga National University Hospital Centre (CNHU-HKM) and the digestive endoscopy department of Mènontin Hospital.

Results: A total of 674 patients with LGB out of 23 864 patients admitted were found (2.8% frequency). The mean age was 49.2 ± 2.5 years. A male predominance was observed with a sex ratio of 2. Hypertension was the most found history (20.8%, 57/274). Haematochezia was the most frequent mode of LGB exteriorisation (94.4%, 636/674). The duration of symptom evolution was less than one month in most patients (54.2%, 365/674). Most patients underwent endoscopy 48 hours after their first consultation (75.1%, 304/405). The most common aetiology was haemorrhoidal disease (35.9%, 223/621), followed by polyps (23.0%, 143/621) and colorectal tumours (15.9%, 99/621). Rubber band ligation was the most commonly used therapeutic means in haemorrhoidal diseases (74.4%, 166/223), and endoscopic polypectomy was used in all polyp cases (100%, 143/143). The evolution was favourable in most cases (90.0%, 559/621), with a bleeding recurrence in 10.0% (56/621). The mortality rate was 2.7% (18/674). Age (> 65 years; p = 0,036), severity of bleeding (p = 0.0003), and bleeding recurrence (p = 0.0001) were associated with death.

Conclusion: LGB is relatively common in Cotonou and can be fatal in some cases. The most common aetiologies were haemorrhoidal disease, colonic polyps, and colorectal tumours.