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

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.