Consider colonoscopy for young patients with hematochezia

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Diagnostic Endoscopy

Background:

• Rectal bleeding (hematochezia) is a frequent concern in adults under 50.
• Previous research on lower endoscopy for rectal bleeding often excluded younger demographics or lacked lesion localization.
• Limited data exists on the specific findings of complete colonoscopy in this age group.

Purpose of the Study:

• To investigate the diagnostic yield of complete colonoscopy in patients under 50 presenting with rectal bleeding.
• To identify the prevalence and location of colorectal lesions in younger adults with hematochezia.

Main Methods:

• Retrospective analysis of medical records for 223 patients under 50 with rectal bleeding who underwent colonoscopy.
• Data collection included demographics, indications, endoscopic findings, and histology.
• Lesion location was categorized as proximal or distal to the splenic flexure; specific exclusion criteria were applied.

Main Results:

• Colonoscopy revealed normal findings in 21.5% of patients.
• Colorectal cancer was diagnosed in 1.8% (distal colon), and adenomas in 9.9%.
• Hemorrhoids were the most common finding (60.5%), followed by colitis, angiodysplasia, diverticulosis, anal fissures, and rectal ulcers.

Conclusions:

• Colorectal neoplasms, including cancer and adenomas, can be present in younger adults with non-urgent rectal bleeding.
• While most findings were benign and distal, complete colonoscopy is a crucial diagnostic tool for this population.
• The study underscores the importance of considering colonoscopy for younger patients experiencing rectal bleeding.