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Title
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Acute lower gastrointestinal bleeding in Crohn's disease : characteristics of a unique series of 34 patients
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Author
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Institution/Organisation
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Belgian IBD Res Grp
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Abstract
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| OBJECTIVE: Acute lower gastrointestinal bleeding is a rare complication of Crohn's disease, which represents a diagnostic and therapeutic challenge. The aim of this study was to define epidemiological characteristics and therapeutic options of hemorrhagic forms of Crohn's disease. METHODS: Thirty-four cases of hemorrhagic forms of Crohn's disease were studied retrospectively. Acute lower gastrointestinal hemorrhage was defined as acute rectal bleeding originating in diseased bowel and requiring a transfusion of at least 2 units of red blood cells within 24 h. Upper gastrointestinal tract hemorrhage or anal lesions and postoperative bleeding were excluded. RESULTS: Mean age at time of hemorrhage was 34.2 +/- 14 yr. Mean duration of disease before the hemorrhage was 5.6 +/- 6 yr. The hemorrhage occurred during a flare up of the disease in 35% of cases. The hemorrhage revealed Crohn's disease in 23.5% of cases. The hemorrhage was more frequent in colonic disease (85%) than in isolated small bowel disease (15%) (p < 0.0001). The origin of bleeding was identified in 65% of cases, by colonoscopy (60%), by angiography (3 patients), or at surgery (1 patient). The bleeding lesion was an ulcer in 95% of cases, most often in the left colon. The treatment was surgical in 20.5% (colectomy in 36%), endoscopical (7 patients, including 5 successes), or medical. Hemorrhage recurred in 12 patients (35%) within a mean time of 3 yr (4 days-8 yr), requiring surgery in 3 cases. No death was observed. CONCLUSIONS: This study performed in a series characterized by a nonsurgical recruitment, the largest to date, shows that hemorrhagic forms of Crohn's disease may reveal disease in 23.5%, occurs in quiescent Crohn's disease in two-thirds of cases. Given the potential efficacy of endoscopical or medical treatment, as well as the absence of mortality, a conservative approach may be suggested as first-line therapy in the majority of patients. (Am J Gastroenterol 1999; 94:2177-2181. (C) 1999 by Am. Coll. of Gastroenterology). |
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Language
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English
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Source (journal)
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The American journal of gastroenterology / American College of Gastroenterology [Bethesda, Md] - New York, N.Y., 1954, currens
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Publication
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New York, N.Y.
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1999
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ISSN
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0002-9270
[print]
1572-0241
[online]
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DOI
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10.1111/J.1572-0241.1999.01291.X
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Volume/pages
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94
:8
(1999)
, p. 2177-2181
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ISI
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000081868900029
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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