Lack of colonic neoplastic lesions in patients under 50 yr of age with hematochezia: a multicenter prospective study.
OBJECTIVE
It is still not clear what is the best way of evaluating rectal bleeding in young people. Our aim was to examine the prevalence of neoplastic colonic lesions in these patients.


METHODS
This prospective, multicenter study enrolled 622 patients aged 30-50 yr (F 232/M 390) consecutively seen in 14 open-access endoscopy departments for hematochezia, defined as bright red blood from the rectum, red blood noted either in the feces, on toilet paper, or in the toilet bowl. At colonoscopy, pathology was stratified as either proximal or distal to the splenic flexure. Exclusion criteria were a history of colitis, colorectal cancer, polyps, anemia, significant weight loss, severe bleeding, or strong family history of colorectal cancer.


RESULTS
Malignant polyps were found in two patients (0.6%), aged 30-40 yr, one in the rectum and one in the sigmoid. A malignant polyp of the cecum was found in a 41-yr-old patient. Another, aged 47, had a malignant granular-cell tumor of the rectum. A total of 35 advanced adenomas were identified in 18 patients. In 7 patients (2.2 %) within the 30-40 yr age bracket we found 8 advanced adenomas (all in the rectum/sigmoid). The other 27 advanced adenomas were in 11 patients (3.5%) in the 41-50 yr age bracket. In this age group we observed 3 patients with 10 isolated proximal advanced adenomas.


CONCLUSIONS
In patients younger than 40 yr with hematochezia, advanced neoplastic lesions are rare and usually located in the rectum and sigmoid colon. Sigmoidoscopy appears to be sufficient for evaluation in these patients.
Spinzi
Giancarlo
G
Division of Gastroenterology, Valduce Hospital, Como, Italy.
Fante
Marco Dal
MD
Masci
Enzo
E
Buffoli
Federico
F
Colombo
Enrico
E
Fiori
Giancarla
G
Ravelli
Paolo
P
Ceretti
Ermanno
E
Minoli
Giorgio
G
D000328:Adult; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000150:complications / Q000175:diagnosis*; D012811:Sigmoid Neoplasms / Q000150:complications / Q000175:diagnosis