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DOI: 10.1055/s-0030-1256356
© Georg Thieme Verlag KG Stuttgart · New York
Is full colonoscopic examination necessary in young patients with fresh bleeding per rectum?
Publikationsverlauf
submitted 27 August 2010
accepted after revision 17 February 2011
Publikationsdatum:
29. März 2011 (online)
![](https://www.thieme-connect.de/media/endoscopy/201108/lookinside/thumbnails/10.1055-s-0030-1256356-1.jpg)
Background and study aims: Guidelines and practices differ regarding evaluation of young patients with fresh bleeding per rectum (FBPR). The aim of this study was to determine the frequency and site of endoscopic lesions in young patients with FBPR, and to thereby determine whether full colonoscopic examination is necessary in these patients.
Methods: Consecutive patients aged 18 – 50 years who were scheduled to undergo full colonoscopy for FBPR at Aga Khan University Hospital between May 2007 and October 2009 were enrolled in the study after giving informed consent. FBPR was defined as the passing of fresh blood per rectum with or without stools and/or noticing blood in the toilet bowl. Lesions were characterized as proximal or distal to the splenic flexure. Patients with positive family history of colorectal cancer, bleeding requiring blood transfusion, bleeding diathesis, or iron deficiency anemia were excluded.
Results: A total of 379 patients met the inclusion criteria and were analyzed. Of these, 248 patients (65.4 %) were under 40 years of age and 131 (34.6 %) were aged 40 – 50 years. Mean hemoglobin was 12.93 ± 1.78 g/dL. In patients < 40 years, seven (2.8 %) adenomatous polyps and malignant lesions were found, all of which were located in the distal colon. In patients aged 40 – 50 years, 10 (7.6 %) adenomatous polyps and malignant lesions were detected, one of which was located in the proximal colon. On univariate analysis, malignant and adenomatous lesions were significant in the 40 – 50 years age group (P = 0.031; OR, 2.84; 95 %CI 1.05 – 7.65).
Conclusion: Endoscopic lesions in patients younger than 40 years with FBPR are found mostly in the distal colon and hence flexible sigmoidoscopy seems to be a reasonable evaluation tool in young patients with no other alarm symptoms.
References
- 1 Talley N J, Jones M. Self-reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking. Am J Gastroenterol. 1998; 93 2179-2183
- 2 Dent O F, Goulston K J, Zubrzycki J, Chapuis P H. Bowel symptoms in an apparently well population. Dis Colon Rectum. 1986; 29 243-247
- 3 Spinzi G, Fante M D, Masci E et al. Lack of colonic neoplastic lesions in patients under 50 yr of age with hematochezia: a multicenter prospective study. Am J Gastroenterol. 2007; 102 2011-2015
- 4 Lewis J D, Shih C E, Blecker D. Endoscopy for hematochezia in patients under 50 years of age. Dig Dis Sci. 2001; 46 2660-2665
- 5 Nikpour S, Ali A sgari. Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer. World J Gastroenterol. 2008; 14 6536-6540
- 6 Helfand M, Marton K I, Zimmer-Gembeck M J, Sox Jr H C. History of visible rectal bleeding in a primary care population. Initial assessment and 10-year follow-up. JAMA. 1997; 277 44-48
- 7 Davila R E, Rajan E, Adler D G et al. ASGE Guideline: the role of endoscopy in the patient with lower-GI bleeding. Gastrointest Endosc. 2005; 62 656-660
- 8 Wong R F, Khosla R, Moore J H, Kuwada S K. Consider colonoscopy for young patients with hematochezia. J Fam Pract. 2004; 53 879-884
- 9 Deo S V, Shukla N K, Srinivas G et al. Colorectal cancers – experience at a regional cancer centre in India. Trop Gastroenterol. 2001; 22 83-86
- 10 Shaikh A J, Raza S, Shaikh A A et al. Demographics, pathologic patterns and long-term survival in operable colon cancers: local experience in Pakistan. Asian Pac J Cancer Prev. 2009; 10 361-364
- 11 Crosland A, Jones R. Rectal bleeding: prevalence and consultation behaviour. BMJ. 1995; 311 486-488
- 12 Shinya H, Cooperman A, Wolff W I. A rationale for the endoscopic management of colonic polyps. Surg Clin North Am. 1982; 62 861-867
- 13 Segal W N, Greenberg P D, Rockey D C et al. The outpatient evaluation of hematochezia. Am J Gastroenterol. 1998; 93 179-182
- 14 Matanoski G, Tao X G, Almon L et al. Demographics and tumor characteristics of colorectal cancers in the United States, 1998–2001. Cancer. 2006; 107 (5 Suppl) 1112-1120
- 15 Norwood M G, Mann C D, Hemingway D, Miller A S. Colorectal cancer: presentation and outcome in British South Asians. Colorectal Dis. 2009; 11 745-749
- 16 Chattar-Cora D, Onime G D, Valentine I S et al. Colorectal cancer in a multi-ethnic urban group: its anatomical and age profile. Int Surg. 2000; 85 137-142
- 17 Sawhney M S, Nelson D B. Yield of colonoscopy for nonacute rectal bleeding. Gastroenterology. 2002; 123 2151-2152
- 18 Vader J P, Pache I, Froehlich F et al. Overuse and underuse of colonoscopy in a European primary care setting. Gastrointest Endosc. 2000; 52 593-599
A. B. KhalidFCPS
Section of Gastroenterology
Department of Medicine
Aga khan University Hospital
Karachi
Pakistan
Fax: +92-21-4934294
eMail: abdullah.khalid@aku.edu