Bat L, Pines A, Rabau M, Niv Y, Shemesh E
Isr J Med Sci. 1985 Feb;21(2):139-41.
Within a period of 18 months, 387 patients were referred to the Proctologic Service at the Chaim Sheba Medical Center because of recurrent rectal bleeding. Hemorrhoids were found in 194 of these patients and further investigation showed that 45 of the 194 patients (23.2%) had other coexisting colonic pathology (12 cancers, 28 polyps, 4 inflammatory bowel diseases and 1 angiodysplasia). Sixteen of 40 patients with diverticulosis and 13 of 30 patients with hemoglobin less than 11 g/dl had additional colonic pathology. Single-contrast barium enema, which was used in this survey for screening of the colon, proved to be inaccurate. In view of the issue of cost-effectiveness, this study suggests that patients with recurrent rectal bleeding and hemorrhoids (Grades II and III) who had normal rectoscopy should be further investigated by double-contrast barium enema if they are greater than 40 years of age. All patients with anemia, diverticulosis or abnormal findings in barium enema should undergo total colonoscopy.
在18个月的时间里，387名因反复直肠出血而被转诊至海姆·谢巴医疗中心直肠科的患者接受了检查。在这些患者中，有194人被发现患有痔疮，进一步检查显示，这194名患者中有45人（23.2%）还存在其他并存的结肠病变（12例癌症、28例息肉、4例炎症性肠病和1例血管发育异常）。40例患有憩室病的患者中有16例，30例血红蛋白低于11 g/dl的患者中有13例存在其他结肠病变。本研究中用于结肠筛查的单对比钡灌肠检查结果并不准确。鉴于成本效益问题，本研究表明，年龄大于40岁、直肠镜检查正常但反复直肠出血且患有（II级和III级）痔疮的患者，若进行双对比钡灌肠检查，应作进一步检查。所有贫血、患有憩室病或钡灌肠检查结果异常的患者均应接受全结肠镜检查。
