Clin Endosc.  2020 Jul;53(4):466-470. 10.5946/ce.2019.029.

Endoscopic Findings in Patients Under the Age of 40 Years with Hematochezia in Singapore

• Tang MH
• Foo FJ
• Ng CY

• KMID: 2504951
• DOI: http://doi.org/10.5946/ce.2019.029

Abstract

Background/Aims
Sigmoidoscopy is performed in most medical centers to evaluate the distal colons of young adults presenting with hematochezia who are at risk of developing proximal lesions. Colonoscopies offer more complete evaluations but are associated with a higher incidence of complications and possible low yield.
Methods
An analysis was conducted on colonoscopies performed in our center on patients 40 years of age or younger. The study population was sub-divided into 2 age groups for analysis: <30 years of age and 30–39 years of age.
Results
We recruited 453 patients for the study. Patients were 115 and 338 individuals that were <30 and 30–39 years of age, respectively. Hemorrhoids was identified as the cause of bleeding in the majority of cases. The overall incidence of polyps was 6.5%; this was significantly higher in the 30–39 age group (7.4% vs. 1.7%, p=0.026). There were two cases of advanced/malignant polyps. While the majority of the polyps were in the distal colon, 28% of the polyps in the older age group were found in the proximal colon. There was one case of colonic perforation.
Conclusions
Colonic polyps are more prevalent in patients aged 30–39. Colonoscopies should be considered for patients over the age of 30 with rectal bleeding.

Keyword

Colonic neoplasm; Colonoscopy; Gastrointestinal hemorrhage

Reference

1. Dent OF, Goulston KJ, Zubrzycki J, Chapuis PH. Bowel symptoms in an apparently well population. Dis Colon Rectum. 1986; 29:243–247.

2. Fijten GH, Blijham GH, Knottnerus JA. Occurrence and clinical significance of overt blood loss per rectum in the general population and in medical practice. Br J Gen Pract. 1994; 44:320–325.

3. Talley NJ, Jones M. Self-reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking. Am J Gastroenterol. 1998; 93:2179–2183.

4. Wong RF, Khosla R, Moore JH, Kuwada SK. Consider colonoscopy for young patients with hematochezia. J Fam Pract. 2004; 53:879–884.

5. Cha JM, Kozarek RA, La Selva D, et al. Findings of diagnostic colonoscopy in young adults versus findings of screening colonoscopy in patients aged 50 to 54 years: a comparative study stratified by symptom category. Gastrointest Endosc. 2015; 82:138–145.

6. Lewis JD, Shih CE, Blecker D. Endoscopy for hematochezia in patients under 50 years of age. Dig Dis Sci. 2001; 46:2660–2665.

7. Nikpour S, Ali Asgari A. Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer. World J Gastroenterol. 2008; 14:6536–6540.

8. Carlo P, Paolo RF, Carmelo B, et al. Colonoscopic evaluation of hematochezia in low and average risk patients for colorectal cancer: a prospective study. World J Gastroenterol. 2006; 12:7304–7308.

9. Acosta JA, Fournier TK, Knutson CO, Ragland JJ. Colonoscopic evaluation of rectal bleeding in young adults. Am Surg. 1994; 60:903–906.

10. Spinzi G, Fante MD, Masci E, et al. Lack of colonic neoplastic lesions in patients under 50 yr of age with hematochezia: a multicenter prospective study. Am J Gastroenterol. 2007; 102:2011–2015.

11. Khalid AB, Majid S, Salih M, Hashmat F, Jafri W. Is full colonoscopic examination necessary in young patients with fresh bleeding per rectum? Endoscopy. 2011; 43:692–696.

12. Siegel RL, Jemal A, Ward EM. Increase in incidence of colorectal cancer among young men and women in the United States. Cancer Epidemiol Biomarkers Prev. 2009; 18:1695–1698.

13. Meyer JE, Narang T, Schnoll-Sussman FH, Pochapin MB, Christos PJ, Sherr DL. Increasing incidence of rectal cancer in patients aged younger than 40 years: an analysis of the surveillance, epidemiology, and end results database. Cancer. 2010; 116:4354–4359.

14. Robertson R, Campbell C, Weller DP, et al. Predicting colorectal cancer risk in patients with rectal bleeding. Br J Gen Pract. 2006; 56:763–767.

15. National Registry of Diseases Office (NRDO). Singapore cancer registry. Annual registry report. Trends in cancer incidence in Singapore 2010–2014 [Internet]. Singapore: Health Promotion Board;c2015. [cited 2020 Feb 2]. Available from: https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/cancer-trends-report-2010---2014_web.pdf?sfvrsn=0%20found%20the%20reference.

16. Chan PW, Ngu JH, Poh Z, Soetikno R. Colorectal cancer screening. Singapore Med J. 2017; 58:24–28.

17. Pitluk H, Poticha SM. Carcinoma of the colon and rectum in patients less than 40 years of age. Surg Gynecol Obstet. 1983; 157:335–337.

18. Nguyen SP, Bent S, Chen YH, Terdiman JP. Gender as a risk factor for advanced neoplasia and colorectal cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009; 7:676–681. e1-e3.