Acute major gastrointestinal hemorrhage in inflammatory bowel disease

Background: Acute major gastrointestinal hemorrhage is uncommon in inflamma tory bowel disease. Methods: We characterized the clinical features and course of such hemorrha ge in patients at our institution from 1989 to 1996. Results: Thirty-one patients had acute lower gastrointestinal bleeding from inflammatory bowel disease and one had upper gastrointestinal bleeding fro m duodenal Crohn's disease. Three patients had ulcerative colitis and 28 ha d Crohn's disease, representing 0.1% of admissions for ulcerative colitis a nd 1.2% for Crohn's disease. In addition, another patient bled from an ilea l J-pouch. In patients with Crohn's disease, the site of bleeding was duode nal in 1, small intestinal in 9, ileocolonic in 8, and colonic in 10. All u lcerative colitis patients had pancolitis. Medical therapy was initiated in 27 patients, including endoscopic therapy in 3. Five patients underwent su rgery immediately, and 7 medically treated patients eventually required sur gery for ongoing or recurrent bleeding. Conclusions: Acute major gastrointestinal bleeding is uncommon in inflammat ory bowel disease. Most cases are due to Crohn's disease, without a predile ction for site of involvement. The presence of an endoscopically treatable lesion is uncommon, and surgery is required in less than half of cases duri ng the initial hospitalization. Recurrent hemorrhage is not rare, and for t hese cases surgery may be the most appropriate treatment.