Acute lower gastrointestinal bleeding in Crohn's disease: Characteristics of a unique series of 34 patients

OBJECTIVE: Acute lower gastrointestinal bleeding is a rare complication of Crohn's disease, which represents a diagnostic and therapeutic challenge. T he aim of this study was to define epidemiological characteristics and ther apeutic options of hemorrhagic forms of Crohn's disease. METHODS: Thirty-four cases of hemorrhagic forms of Crohn's disease were stu died retrospectively. Acute lower gastrointestinal hemorrhage was defined a s acute rectal bleeding originating in diseased bowel and requiring a trans fusion of at least 2 units of red blood cells within 24 h. Upper gastrointe stinal tract hemorrhage or anal lesions and postoperative bleeding were exc luded. RESULTS: Mean age at time of hemorrhage was 34.2 +/- 14 yr. Mean duration o f disease before the hemorrhage was 5.6 +/- 6 yr. The hemorrhage occurred d uring a flare up of the disease in 35% of cases. The hemorrhage revealed Cr ohn's disease in 23.5% of cases. The hemorrhage was more frequent in coloni c disease (85%) than in isolated small bowel disease (15%) (p < 0.0001). Th e 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, includi ng 5 successes), or medical. Hemorrhage recurred in 12 patients (35%) withi n 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 nonsurgica l 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 i n two-thirds of cases. Given the potential efficacy of endoscopical or medi cal 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 ).