Endoscopy 2019; 51(04): S157
DOI: 10.1055/s-0039-1681633
ESGE Days 2019 ePoster podium presentations
Friday, April 5, 2019 14:00 – 14:30: GI bleeding 4 ePoster Podium 6
Georg Thieme Verlag KG Stuttgart · New York

CHARACTERISTICS OF ACUTE SEVERE LOWER GASTROINTESTINAL BLEEDING IN PATIENTS WITH CROHN'S DISEASE

BI Jang
1   Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea, Republic of
,
MC Kim
1   Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea, Republic of
,
MK Kang
1   Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea, Republic of
,
JH Cho
1   Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea, Republic of
,
SB Kim
1   Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea, Republic of
,
KH Kim
1   Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea, Republic of
,
KO Kim
1   Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea, Republic of
,
SH Lee
1   Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea, Republic of
,
TN Kim
1   Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea, Republic of
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Acute severe lower gastrointestinal bleeding (LGIB) is a rare complication in Crohn's disease, which is a therapeutic challenge due to variety of clinical manifestations and extents of disease. We aimed to compare the characteristics of the first bleeding and re-bleeding episodes in patients with Crohn's disease.

Methods:

Between January 2012 and November 2015, 30 patients of severe LGIB of Crohn's disease were retrospectively investigated. Acute LGIB was defined as acute massive rectal bleeding requiring 2 packs of blood transfusion within at least 24 hours or a sudden decrease in hemoglobin level below 9 g/dl.

Results:

Mean age at the time of bleeding was 38.4 ± 10.9 years. Mean duration from diagnosis of Crohn's disease to the first bleeding episode was 66.9 ± 63.7 months. Mean serum levels of hemoglobin and C-reactive protein were 8.6 ± 1.8 g/dL and 7.1 ± 7.9 mg/dL, respectively. And 19 (63.3%) patients had moderate-to-severe Crohn's disease. The bleeding focus was identified in 56.7% of patients, by colonoscopy (46.7%). The bleeding lesion was an ulcer in 81.3% of the cases, and left colon in 56.2%. The treatment of acute severe LGIB accounted for 50% of the medical treatments using systemic corticosteroids. The maintenance treatment were 16 (53.4%) using azathioprine and 4 (13.3%) using infliximab, respectively.

In moderate-to-severe Crohn's disease, re-bleeding episodes occurred more frequently than first bleeding episode, but not statistically significant (p= 0.082). However, utilization of the total parenteral nutrition was statistically significantly higher in the re-bleeding episode group than in the first bleeding group (45.0% vs. 90.0%, p= 0.048).

Conclusions:

Acute severe LGIB in Crohn's disease is usually considered to be a conservative treatment with systemic corticosteroids, azathioprine, and infliximab. However, operative treatment may be needed for poorly controlled bleeding and further studies including prevalence and re-bleeding risk factors are needed.