RHEMITT score: Better to assess bleeding risks after capsule endoscopy

Gastrointestinal bleeding patients often have small intestine capsule endoscopy, with recurring GI re-bleeding. Can RHEMITT score help to predict risk?

RHEMITT score as a predictive tool

• Re-bleeding often occurs in patients with GI bleeding who receive capsule endoscopy of the small bowel.
• The RHEMITT score assesses the risk of bleeding.
• The score can help assess the risk of re-bleeding.

What is the RHEMITT score?

The RHEMITT score is a quantification system designed to predict the likelihood of rebleeding after small bowel capsule endoscopy. Its risk evaluation is based on seven different functions:

• Renal disease (renal dysfunction)
• Heart failure
• Endoscopic findings
• Major bleeding
• Incomplete SBCE
• Tobacco use
• Treatment by enteroscopy

The higher the score achieved, the higher the risk of bleeding.

How reliable is the score?

The current study from the USA has now investigated how reliable the RHEMITT score is in assessing the risk of GI bleeding again. For this purpose, the data of 361 small bowel capsule endoscopies were examined. The results speak for themselves: the more RHEMITT categories were present, the higher the risk of rebleeding. In particular, the following factors significantly increased the risk of bleeding:

• Age of the patient
• Indication for small bowel capsule endoscopy
• Endoscopic treatment of bleeding
• Administration of anticoagulants
• Cirrhosis
• Heart failure
• Extensive bleeding
• Renal dysfunction

Score reliability confirmed

In the study, the RHEMITT score was very reliable in its use to assess the risk of recurrent GI bleeding. The more different functional disorders were present, the higher the individual risk of bleeding. Overall, the study authors attest the test a satisfactory significance.

Implications for medical practice

The RHEMITT score is a reliable tool for evaluating possible re-bleeding after small bowel capsule endoscopy for GI bleeding. Thus, high-risk patients can be treated accordingly and assessed in the course. 

Source: 
Boortalary T, Erwin R, Dong M, Shinn B, Infantolino A, Tofani C. RHEMITT Score Predicts Rebleed After Capsule Endoscopy: First Validation at a U.S. Tertiary Care Center. Dig Dis Sci. 2022 May 11. doi: 10.1007/s10620-022-07527-3. Epub ahead of print. PMID: 35543830.