Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Endoscopy. 2011 Aug;43(8):692-6. doi: 10.1055/s-0030-1256356. Epub 2011 Mar 29.
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.
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.
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).
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.
关于直肠新鲜出血（FBPR）年轻患者的评估，指南和实践存在差异。本研究的目的是确定 FBPR 年轻患者内镜下病变的频率和部位，并确定这些患者是否需要进行全结肠镜检查。
2007 年 5 月至 2009 年 10 月，在 Aga Khan 大学医院因 FBPR 行全结肠镜检查的连续患者，在知情同意后纳入本研究。FBPR 定义为新鲜血液通过直肠，伴有或不伴有粪便和/或在便盆中发现血液。病变特征为脾曲近端或远端。排除有结直肠癌阳性家族史、需要输血的出血、出血倾向或缺铁性贫血的患者。
共有 379 例患者符合纳入标准并进行了分析。其中，248 例（65.4%）年龄小于 40 岁，131 例（34.6%）年龄为 40-50 岁。平均血红蛋白为 12.93±1.78g/dL。在年龄<40 岁的患者中，发现 7 例（2.8%）腺瘤性息肉和恶性病变，均位于远端结肠。在年龄为 40-50 岁的患者中，发现 10 例（7.6%）腺瘤性息肉和恶性病变，其中 1 例位于近端结肠。单因素分析显示，40-50 岁年龄组的恶性和腺瘤性病变有统计学意义（P=0.031；OR，2.84；95%CI，1.05-7.65）。
40 岁以下 FBPR 患者的内镜下病变主要位于远端结肠，因此在无其他报警症状的年轻患者中，软性乙状结肠镜检查似乎是一种合理的评估工具。
