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A comprehensive review and update on acute severe lower gastrointestinal bleeding in Crohn's disease: a management
Tong Tu1, Mengqi Chen1, Zhirong Zeng1
1Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Insights
Severe lower gastrointestinal bleeding in Crohn's disease (CD) is rare but serious. Effective management involves resuscitation, diagnostics, and often medical therapy like infliximab, with surgery as a last resort.
Area of Science:
- Gastroenterology
- Internal Medicine
- Inflammatory Bowel Disease
Background:
- Acute severe lower gastrointestinal bleeding is a rare but potentially fatal complication of Crohn's disease (CD).
- It affects 0.6% to 5.5% of CD patients during their lifetime.
- Effective management hinges on prompt resuscitation and accurate diagnosis.
Purpose of the Study:
- To provide a comprehensive overview of clinical manifestations, diagnostics, and therapeutics for acute severe gastrointestinal bleeding in CD.
- To propose a management algorithm for clinicians.
- To review prognostic outcomes and rebleeding risks.
Main Methods:
- Review of current literature on acute severe lower gastrointestinal bleeding in Crohn's disease.
- Analysis of diagnostic modalities including endoscopy and CT.
- Evaluation of treatment strategies: conservative, medical (e.g., infliximab), minimally invasive, and surgical.
Main Results:
- Most bleeding episodes are managed conservatively.
- Medical therapies, especially infliximab, are key for mucosal healing.
- Minimally invasive procedures offer immediate hemostasis, while surgery is reserved for refractory cases.
- Rebleeding risk ranges from 19.0% to 50.5%.
Conclusions:
- Acute severe lower gastrointestinal bleeding in CD requires a multi-faceted management approach.
- Early diagnosis and appropriate treatment, prioritizing medical and minimally invasive options, are crucial.
- A structured management algorithm can improve patient outcomes and reduce rebleeding rates.
Abstract:
Acute severe lower gastrointestinal bleeding is a rare but potentially fatal complication of Crohn's disease (CD), affecting between 0.6% and 5.5% of CD patients during their lifelong disease course. Managing bleeding episodes effectively hinges on vital resuscitation. Endoscopic evaluation and computed tomography play crucial roles in accurate identification and intervention. Fortunately, most bleeding episodes can be successfully managed through appropriate conservative treatment. Medical therapies, particularly infliximab, aim to induce and maintain mucosal healing and serve as the leading treatment approach. Minimally invasive procedures, such as endoscopic hemostasis and angio-embolization, can achieve immediate hemostasis. Surgical treatment is only considered a last resort when conservative therapies fail. Despite achieving hemostasis, the risk of rebleeding ranges from 19.0% to 50.5%. The objective of this review is to provide a comprehensive and updated overview of the clinical manifestations, diagnostic methods, therapeutic approaches, and prognostic outcomes associated with acute severe gastrointestinal bleeding in CD. Furthermore, we aimed to propose a management algorithm to assist clinicians in the effective management of this condition.
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