Risk factors and outcome of acute severe lower gastrointestinal bleeding in Crohn's disease

• Published in: Digestive and liver disease 2012-09, Vol.44 (9), p.723-728
• Main Authors: Kim, Kyung-Jo, Han, Bong Jun, Yang, Suk-Kyun, Na, Soo Young, Park, Soo-Kyung, Boo, Sun-Jin, Park, Sang Hyoung, Yang, Dong-Hoon, Park, Jae Ho, Jeong, Kee Wook, Ye, Byong Duk, Byeon, Jeong-Sik, Myung, Seung-Jae, Kim, Jin-Ho
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal Cortex Hormones - therapeutic use; Adult; Anti-Inflammatory Agents - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antibodies, Monoclonal - therapeutic use; Asian Continental Ancestry Group; Azathioprine - therapeutic use; Blood Transfusion; Case-Control Studies; Colonic Diseases - etiology; Colonic Diseases - therapy; Crohn Disease - blood; Crohn Disease - complications; Crohn Disease - drug therapy; Crohn's disease; Embolization, Therapeutic; Female; Gastroenterology and Hepatology; Gastrointestinal bleeding; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Hemoglobins; Hemostasis, Endoscopic; Humans; Ileal Diseases - etiology; Ileal Diseases - therapy; Immunosuppressive Agents - therapeutic use; Infliximab; Kaplan-Meier Estimate; Male; Mercaptopurine - therapeutic use; Middle Aged; Recurrence; Republic of Korea; Retrospective Studies; Risk Factors; Young Adult
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2012.03.010

Abstract Background Acute severe lower gastrointestinal bleeding in Crohn's disease is uncommon, but is a diagnostic and therapeutic challenge. We aimed to identify risk factors for acute lower gastrointestinal bleeding in patients with Crohn's disease and assess the cumulative probability of rebleeding in relation to therapeutic modality. Methods We retrospectively reviewed the medical records of 70 Crohn's patients (4.0%) with acute severe lower gastrointestinal bleeding and compared these with matched 140 Crohn's patients without bleeding. Results The cumulative probability of bleeding after diagnosis of Crohn's disease was 1.7%, 3.6%, 6.5%, and 10.3% after 1, 5, 10, and 20 years respectively. At presentation, the median haemoglobin concentration was 8.4 g/dL (range, 4.7–11.6 g/dL). Use of azathioprine/6-mercaptopurine decreased the risk of lower gastrointestinal bleeding (OR: 0.525, 95% CI: 0.304–0.906, p = 0.021). Bleeding recurred in 29 patients (41.4%) after a median time of 3.2 months (range, 15 days–94.7 months). One out of eleven patients treated with infliximab rebled. The cumulative probability of rebleeding tended to be lower in patients treated with infliximab than in those receiving other treatments ( p = 0.076). Conclusions Azathioprine/6-mercaptopurine may reduce the risk of acute severe lower gastrointestinal bleeding. The rebleeding is common, but infliximab may decrease rebleeding.