title: Risk factors and outcome of acute severe lower gastrointestinal bleeding in Crohn's disease.
abstract: BACKGROUND
  Acute severe lower gastrointestinal bleeding in Crohn's disease is uncommon, but is a diagnostic and therapeutic challenge. We aimed to identify risk factors for acute lower gastrointestinal bleeding in patients with Crohn's disease and assess the cumulative probability of rebleeding in relation to therapeutic modality.
  
  
  METHODS
  We retrospectively reviewed the medical records of 70 Crohn's patients (4.0%) with acute severe lower gastrointestinal bleeding and compared these with matched 140 Crohn's patients without bleeding.
  
  
  RESULTS
  The cumulative probability of bleeding after diagnosis of Crohn's disease was 1.7%, 3.6%, 6.5%, and 10.3% after 1, 5, 10, and 20 years respectively. At presentation, the median haemoglobin concentration was 8.4g/dL (range, 4.7-11.6g/dL). Use of azathioprine/6-mercaptopurine decreased the risk of lower gastrointestinal bleeding (OR: 0.525, 95% CI: 0.304-0.906, p=0.021). Bleeding recurred in 29 patients (41.4%) after a median time of 3.2 months (range, 15 days-94.7 months). One out of eleven patients treated with infliximab rebled. The cumulative probability of rebleeding tended to be lower in patients treated with infliximab than in those receiving other treatments (p=0.076).
  
  
  CONCLUSIONS
  Azathioprine/6-mercaptopurine may reduce the risk of acute severe lower gastrointestinal bleeding. The rebleeding is common, but infliximab may decrease rebleeding.
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Kyung-Jo
authors.initials: KJ
authors.lastname: Kim
authors.forename: Bong Jun
authors.initials: BJ
authors.lastname: Han
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.forename: Soo Young
authors.initials: SY
authors.lastname: Na
authors.forename: Soo-Kyung
authors.initials: SK
authors.lastname: Park
authors.forename: Sun-Jin
authors.initials: SJ
authors.lastname: Boo
authors.forename: Sang Hyoung
authors.initials: SH
authors.lastname: Park
authors.forename: Dong-Hoon
authors.initials: DH
authors.lastname: Yang
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Park
authors.forename: Kee Wook
authors.initials: KW
authors.lastname: Jeong
authors.forename: Byong Duk
authors.initials: BD
authors.lastname: Ye
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Myung
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D044466:Asian People; D001379:Azathioprine / Q000627:therapeutic use; D001803:Blood Transfusion; D016022:Case-Control Studies; D003108:Colonic Diseases / Q000209:etiology / Q000628:therapy*; D003424:Crohn Disease / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006454:Hemoglobins; D016558:Hemostasis, Endoscopic; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology / Q000628:therapy*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D053208:Kaplan-Meier Estimate; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D008875:Middle Aged; D012008:Recurrence; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D006454:Hemoglobins; D007166:Immunosuppressive Agents; D000069285:Infliximab; D015122:Mercaptopurine; D001379:Azathioprine