THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 94, No. 8, 1999 - 1999 by Am. Coll. of Gastroenterology ISSN 0002-9270/99/$20.00 Published by Elsevier Science Inc.
Acute Lower Gastrointestinal Bleeding in Crohn's Disease: Characteristics of a Unique Series of 34 Patients
Jacques Belaiche, M.D., Edouard Louis, M.D., Geert D'Haens, M.D., Marc Cabooter, M.D., Serge Naegels, M.D., Martine De Vos, M.D., Fernand Fontaine, M.D., Piet Schurmans, M.D., Filip Baert, M.D., Marc De Reuck, M.D., RenÃ© Fiasse, M.D., Jan Holvoet, M.D., Alain Schmit, M.D., Marc Van Outryve, M.D., and the Belgian IBD Research Group
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 6 14 yr. Mean duration of disease before the hemorrhage was 5.6 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 twothirds 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. © 1999 by Am. Coll. of Gastroenterology)