Obeidat Ibrahim M, Yahia Yousef, Chandra Prem, Altaiam Amani, Mohamed Ethar, Saffo Husam, Abualsuod Raya, Mousa Ala'a Al-Deen, Shalatouni Duha, Alsa'ed Khaled, Arabyat Mahmoud Y
Gastroenterology and Hepatology Department, Hamad Medical Corporation, Doha, Qatar.
Medical Research Centre, Hamad Medical Corporation, Doha, Qatar.
Int J Colorectal Dis. 2024 Dec 16;39(1):202. doi: 10.1007/s00384-024-04784-8.
Bleeding per rectum (BPR) is a common clinical presentation, and colonoscopy is the gold standard for evaluating patients aged ≥ 45 years. However, its role in younger patients remains unclear. This study evaluated the appropriateness of colonoscopy in patients < 40 years of age who presented with BPR.
This retrospective observational study was conducted over 10 years, including 3422 patients aged 18-40 years who underwent colonoscopy for BPR. The cohort was divided into two age groups: younger (aged 18-30 years) and older (31-40 years). The patients' baseline characteristics, colonoscopy findings, and histopathological results were analyzed.
Hemorrhoids were the most common finding (48%), with a higher prevalence in younger age groups (50.7%). Polyps were detected in 12.5% of patients, with 1.75% having advanced adenoma polyps (AAP) and 1.3% diagnosed with colorectal cancer (CRC). A family history of CRC/AAP was significantly associated with increased CRC risk (adjusted OR 6.35, 95% CI 2.24-18.02, p = 0.001) in explorative logistic regression analysis.
AAP and CRC were detected in a small but significant proportion of patients, particularly among those aged 18-30 years. The detection of significant lesions in this age group highlights the need for targeted colonoscopy based on specific risk factors such as family history and clinical presentation. Future research should prioritize the creation of targeted assessment models to improve clinical decision making in this context.
直肠出血（BPR）是一种常见的临床表现，结肠镜检查是评估年龄≥45岁患者的金标准。然而，其在年轻患者中的作用仍不明确。本研究评估了结肠镜检查在40岁以下出现BPR患者中的适用性。
这项回顾性观察性研究历时10年，纳入了3422例年龄在18 - 40岁因BPR接受结肠镜检查的患者。该队列分为两个年龄组：较年轻组（18 - 30岁）和较年长组（31 - 40岁）。分析了患者的基线特征、结肠镜检查结果和组织病理学结果。
痔疮是最常见的检查结果（48%），在较年轻年龄组中的患病率更高（50.7%）。12.5%的患者检测到息肉，其中1.75%患有高级别腺瘤性息肉（AAP），1.3%被诊断为结直肠癌（CRC）。在探索性逻辑回归分析中，CRC/AAP家族史与CRC风险增加显著相关（校正比值比6.35，95%置信区间2.24 - 18.02，p = 0.001）。
在一小部分但比例显著的患者中检测到了AAP和CRC，特别是在18 - 30岁的患者中。在这个年龄组中发现显著病变凸显了基于家族史和临床表现等特定风险因素进行针对性结肠镜检查的必要性。未来的研究应优先创建针对性的评估模型，以改善这方面的临床决策。
