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Evaluating the necessity of colonoscopy in patients under 40 with rectal bleeding: insights from a large-scale
Ibrahim M Obeidat1, Yousef Yahia2, Prem Chandra3
1Gastroenterology and Hepatology Department, Hamad Medical Corporation, Doha, Qatar. IObeidat@hamad.qa.
Insights
Colonoscopy in patients under 40 with rectal bleeding found significant colorectal cancer and advanced adenoma polyps, especially in younger individuals. Family history is a key risk factor, necessitating targeted screening.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Oncology
Background:
- Rectal bleeding is a common symptom.
- Colonoscopy is standard for patients 45+ but its role in younger individuals is unclear.
- This study examines colonoscopy appropriateness in patients under 40 presenting with rectal bleeding.
Purpose of the Study:
- To evaluate the appropriateness of colonoscopy in patients under 40 with bleeding per rectum (BPR).
- To analyze colonoscopy findings and histopathology in this demographic.
- To identify risk factors associated with significant findings.
Main Methods:
- Retrospective observational study over 10 years.
- Included 3422 patients aged 18-40 undergoing colonoscopy for BPR.
- Patients divided into 18-30 and 31-40 age groups for analysis.
Main Results:
- Hemorrhoids were most common (48%), higher in younger group (50.7%).
- Polyps found in 12.5%; advanced adenoma polyps (AAP) in 1.75%; colorectal cancer (CRC) in 1.3%.
- Family history of CRC/AAP significantly increased CRC risk (aOR 6.35).
Conclusions:
- Significant findings, including AAP and CRC, were noted in a notable proportion of patients under 40.
- Younger patients (18-30) showed a significant detection rate of serious lesions.
- Targeted colonoscopy based on risk factors like family history is crucial for this age group.
Purpose:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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