Incidence and risk factors of rebleeding in Crohn's disease patients with acute lower gastrointestinal bleeding

Abstract

Background/Aims: Acute lower gastrointestinal bleeding (LGIB) in Crohn's disease (CD) is a rare but potentially life-threatening complication. This study aimed to investigate the incidence and risk factors of rebleeding in CD patients with LGIB. Methods: We retrospectively analyzed 137 CD patients with acute LGIB from nine tertiary university hospitals in Korea from January 2000 to October 2020. Patient characteristics, disease features, and treatment modalities were assessed, and re-bleeding incidence, clinical features, and risk factors were analyzed. Results: The median age of patients was 26.5 years, and the male-to-female ratio was 3.72:1. The median duration from diagnosis to first bleeding was 30.6 (0-243) months. Ileocolonic involvement (72 patients, 53%) and inflammatory phenotype (85, 62%) were most prevalent. During index bleeding, 20 and 40 patients were receiving biologics and azathioprine/6-mer-captopurine (AZA/6-MP), respectively. Bleeding focus was confirmed in 58 patients, primarily with endoscopy (33 cases). Management included conservative therapy (115 cases, 84%), endoscopic treatment (11, 8%), embolization (5, 3%), and surgery (6, 4%). After the index bleeding, 77 (56.2%) patients started or changed AZA/6-MP or biologics. Rebleeding occurred in 44 (32%) patients. The median time to recurrence was 13.0 (0.1-209) months. Transfusion requirement was significantly associated with rebleeding in univariate (hazard ratio [HR] = 3.124, 95% confidence interval [CI] = 1.502-6.494; p = 0.002) and multivariate (HR = 3.857, 95% CI = 1.678-8.867; p = 0.001) analyses. Conclusions: Rebleeding incidence in patients with CD experiencing acute LGIB was 32%. Transfusion requirement is a significant risk factor for rebleeding.