Age-related differences in the presentation, management, and outcomes of lower gastrointestinal bleeding: a retrospective multinational cohort study.

Authors

Francisco Vara-Luiz, Carolina Palma, Paulo Mascarenhas, Tony C Tham, Marianna Arvanitakis, Enrique Rodriguez-de-Santiago, Isabel Pedroto, Diogo Simas, Franco Radaelli, Marine Camus, Paraskevas Gkolfakis, Konstantinos Triantafyllou, Carlo Fabbri, Marta Patita, Erica Tan, Ellen Campbell, Michael Smyth, Hannah Beattie, Ravish Seeruthun, Alia Hadefi, Gabriela Rodríguez-Francisco, João Pedro Paulo, Luísa Gonçalves, Isabel Caetano, Alberto Savino, Marie Goudot, Antonia Panagaki, Eleni Koukoulioti, Maroulla Nikolaki, Giulia Gibiino, Alberto Gattuso, Ivo Mendes, Francisco Piçarra, Jorge Fonseca

Published in

The Lancet regional health. Europe. Volume 68. Pages 101775. Epub Jul 09, 2026.

Abstract

Population ageing in Europe is reshaping the clinical profile and outcomes of lower gastrointestinal bleeding (LGIB), but age-related comparative data remain scarce. We aimed to compare clinical presentation, management and 30-day outcomes between older and younger adults with LGIB.
This retrospective, multinational, cohort study included consecutive adults presenting to emergency departments with LGIB between January 1 and December 31 in 2024. European hospitals routinely managing LGIB were eligible to participate. Ethical approval was obtained at hospital level. Patients were categorised in two age groups (≥65 and <65 years). The primary outcome was 30-day mortality.
Overall, 1058 patients from 11 centres in seven European countries were included. Of these, 77.3% (818/1058) were aged ≥65 years and demonstrated a higher Oakland (21.0 ± 7.15), ABC (4.0 ± 2.9), and ALIBI (8.94 ± 3.7) scores, and a higher transfusion rate (50.9%, 416/818). Aetiology differed by age, with anorectal and inflammatory bowel diseases more common in younger adults and diverticular bleeding predominating in older patients. Endoscopy was performed in most patients (84.9%, 899/1058) and the rates of endoscopic therapy, interventional radiology, and surgery were similar across groups. Overall, 30-day mortality was 11.7% (124/1058) and was higher in older adults (13.7%, 112/818 versus 5.0%, 12/240), mainly due to non-bleeding-related causes (89.3%, 100/112). In multivariable analyses, ALIBI score (OR = 1.26 per-point, 95% CI 1.14-1.39), ABC score (OR = 1.25 per-point, 95% CI 1.15-1.36), and Charlson Comorbidity Index (OR = 1.25 per-point, 95% CI 1.14-1.37) were independently associated with 30-day mortality (p < 0.001). Age was inversely associated with intensive care unit admission (OR = 0.95 per-year, 95% CI 0.92-0.98; p = 0.0028).
LGIB in older adults presents distinct clinical features with more severe bleeding. Higher baseline vulnerability might explain the age-related differences in escalation of care and worse outcomes. This supports the need for better integrated pathways of care in ageing European populations.
FCT-Fundação para a Ciência e a Tecnologia.

PMID:
42471966
Bibliographic data and abstract were imported from PubMed on 19 Jul 2026.

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