Distinct clinical course and poor outcomes of small bowel bleeding in acute hematochezia: a nationwide multicenter study

Although small bowel bleeding is a known cause of acute lower gastrointestinal bleeding (ALGIB), its outcomes compared to colorectal bleeding remain underexplored. This study aimed to identify baseline characteristics and short- and long-term outcomes associated with small bowel bleeding in comparison to colorectal bleeding. This nationwide retrospective cohort study, based on CODE BLUE-J study, involved 10,342 patients hospitalized for ALGIB. Among 195 patients (2.8%) with acute small bowel bleeding, significant associations were observed with laboratory parameters (e.g., low hemoglobin, platelets, and albumin), clinical signs (e.g., tarry stool), and medical history, compared to 6832 patients with colorectal bleeding. Multivariate regression analysis showed no significant difference in 30-day rebleeding or mortality between small bowel and colorectal bleeding. However, small bowel bleeding was associated with higher transfusion volume, lower endoscopic treatment rate, higher rates of interventional radiology and surgery, and longer hospital stay (all p < 0.005). While long-term cumulative rebleeding rates were similar, cumulative mortality was significantly higher in the small bowel bleeding group (p < 0.001). This large-scale endoscopic study revealed differences in several clinical factors at presentation and in short- and long-term outcomes between small bowel and colorectal bleeding. These findings underscore importance of identifying small bowel bleeding in ALGIB.

Authors

Institutions

Publication Details

Journal
Scientific Reports
Published
2026-05-13
DOI
https://doi.org/10.1038/s41598-026-47311-1
Primary Topic
Gastrointestinal Bleeding Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
0.00

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Distinct clinical course and poor outcomes of small bowel bleeding in acute hematochezia: a nationwide multicenter study

Takashi Ikeya, Shu Kiyotoki, Ken Kinjo, Tsunaki Sawada et al.
Scientific Reports
Gastrointestinal Bleeding Diagnosis and Treatment
article

Distinct clinical course and poor outcomes of small bowel bleeding in acute hematochezia: a nationwide multicenter study

Takashi Ikeya, Shu Kiyotoki, Ken Kinjo, Tsunaki Sawada, Yorinobu Sumida, Katsumasa Kobayashi, Sadahiro Funakoshi, Kazuyuki Narimatsu, Takaaki Kishino, Shuji Kanmura, Naoyuki Tominaga, Yuga Komaki, Tetsu Kinjo, Toshiaki Narasaka, Shunji Fujimori, Kiyonori Kobayashi, Eiji Sadashima, Yosuke Toya, Akinari Takao, Jun Omori, Takuto Hikichi, Koji Nagaike, Tomohiro Funabiki, Takahiro Uotani, Taiki Aoyama, Naoki Ishii, Junnosuke Hayasaka, Ryosuke Gushima, Tamotsu Matsuhashi, Fumisato Sasaki, Yuta Fuyuno, Yoshinori Sato, Akira Mizuki, Yuzuru Kinjo, Kuniko Miki, Tatsuya Mikami, Minoru Fujita, Hiroki Sato, Noriaki Manabe, Atsuo Yamada, Kazuhiro Watanabe, Sho Suzuki, Masaki Murata, Hiroyuki Fujii, Naoyoshi Nagata, Mitsuru Kaise, Atsushi Yamauchi, Kazuhiro Mizukami
article en

Abstract

Although small bowel bleeding is a known cause of acute lower gastrointestinal bleeding (ALGIB), its outcomes compared to colorectal bleeding remain underexplored. This study aimed to identify baseline characteristics and short- and long-term outcomes associated with small bowel bleeding in comparison to colorectal bleeding. This nationwide retrospective cohort study, based on CODE BLUE-J study, involved 10,342 patients hospitalized for ALGIB. Among 195 patients (2.8%) with acute small bowel bleeding, significant associations were observed with laboratory parameters (e.g., low hemoglobin, platelets, and albumin), clinical signs (e.g., tarry stool), and medical history, compared to 6832 patients with colorectal bleeding. Multivariate regression analysis showed no significant difference in 30-day rebleeding or mortality between small bowel and colorectal bleeding. However, small bowel bleeding was associated with higher transfusion volume, lower endoscopic treatment rate, higher rates of interventional radiology and surgery, and longer hospital stay (all p < 0.005). While long-term cumulative rebleeding rates were similar, cumulative mortality was significantly higher in the small bowel bleeding group (p < 0.001). This large-scale endoscopic study revealed differences in several clinical factors at presentation and in short- and long-term outcomes between small bowel and colorectal bleeding. These findings underscore importance of identifying small bowel bleeding in ALGIB.

Scientific ReportsVol. 16(1)
Kagoshima University (JP), Kyushu University (JP), University of Tsukuba (JP), Tokyo Medical University (JP), St. Marianna University School of Medicine (JP), Iwate Medical University (JP), Oita University (JP), Kawasaki Medical School (JP), Akita University (JP), Kyoto Medical Center (JP), National Kyushu Medical Center (JP), Tokyo Metropolitan Komagome Hospital (JP), Fukuoka University (JP), University of the Ryukyus (JP), Nagoya University Hospital (JP), Fukuoka University Hospital (JP), St. Luke's International University (JP), National Center for Global Health and Medicine (JP), New Tokyo Hospital (JP), Tokyo Metropolitan Bokutoh Hospital (JP), Hiroshima City Asa Citizens Hospital (JP), Saga-Ken Medical Centre Koseikan (JP), Nara City Hospital (JP), University of Tsukuba Hospital (JP), Suita Municipal Hospital (JP), Fujita Health University Hospital (JP), Naha City Hospital (JP), Saiseikai Central Hospital (JP), Fukuoka Higashi Medical Center (JP), Shizuoka Red Cross Hospital (JP), University of Miyazaki Hospital (JP), Fukushima Medical University Hospital (JP), Shuto General Hospital (JP), University of the Ryukyus University Hospital (JP), Kitano Hospital (JP), Chiba Hokusou Hospital (JP), Hirosaki University Hospital (JP), Toranomon Hospital (JP), National Defense Medical College (JP), Kitasato University (JP), Niigata University (JP), The University of Tokyo (JP), Nippon Medical School (JP), Kumamoto University (JP)
Takeda Science Foundation, National Center for Global Health and Medicine, Smoking Research Foundation, Japan Society for the Promotion of Science
Good health and well-being
Openalex Percentile: Top 5%
Gastrointestinal Bleeding Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.