TY - JOUR
T1 - Age-related differences in the presentation, management, and outcomes of lower gastrointestinal bleeding
T2 - a retrospective multinational cohort study
AU - Vara-Luiz, Francisco
AU - Palma, Carolina
AU - Mascarenhas, Paulo
AU - Tham, Tony C.
AU - Arvanitakis, Marianna
AU - Rodriguez-de-Santiago, Enrique
AU - Pedroto, Isabel
AU - Simas, Diogo
AU - Radaelli, Franco
AU - Camus, Marine
AU - Gkolfakis, Paraskevas
AU - Triantafyllou, Konstantinos
AU - Fabbri, Carlo
AU - Patita, Marta
AU - Tan, Erica
AU - Campbell, Ellen
AU - Smyth, Michael
AU - Beattie, Hannah
AU - Seeruthun, Ravish
AU - Hadefi, Alia
AU - Rodríguez-Francisco, Gabriela
AU - Paulo, João Pedro
AU - Gonçalves, Luísa
AU - Caetano, Isabel
AU - Savino, Alberto
AU - Goudot, Marie
AU - Panagaki, Antonia
AU - Koukoulioti, Eleni
AU - Nikolaki, Maroulla
AU - Gibiino, Giulia
AU - Gattuso, Alberto
AU - Mendes, Ivo
AU - Piçarra, Francisco
AU - Fonseca, Jorge
N1 - Publisher Copyright:
© 2026 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/
PY - 2026/9
Y1 - 2026/9
N2 - Background: 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. Methods: 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. Findings: 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). Interpretation: 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. Funding: FCT–Fundação para a Ciência e a Tecnologia.
AB - Background: 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. Methods: 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. Findings: 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). Interpretation: 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. Funding: FCT–Fundação para a Ciência e a Tecnologia.
KW - Ageing
KW - Lower gastrointestinal bleeding
KW - Mortality
KW - Multimorbidity
UR - https://www.scopus.com/pages/publications/105044088293
U2 - 10.1016/j.lanepe.2026.101775
DO - 10.1016/j.lanepe.2026.101775
M3 - Article
AN - SCOPUS:105044088293
SN - 2666-7762
VL - 68
JO - The Lancet Regional Health - Europe
JF - The Lancet Regional Health - Europe
M1 - 101775
ER -