Massive lower gastrointestinal hemorrhage in Crohn’s disease
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Localization of the site of bleeding is essential whether endoscopic therapy, surgery, or medical management is attempted.
Endoscopic evaluation is preferable, if feasible, as it will provide a broader assessment of extent of disease as well as having a reasonable likelihood of identifying the site of bleeding with possible therapeutic intervention.
An angiogram can be a useful alternative, but therapeutic intervention with embolization should be avoided because of the risk for intestinal infarction. Surgery remains the standard of care for persistent severe acute bleeds.
If the acute bleeding ceases, an interval to attempt pharmacologic therapy may be available, permitting treatment of the underlying Crohn’s disease. Newer therapies such as infliximab, which may produce relatively rapid mucosal healing, may be beneficial; while they offer hopeful treatment alternatives, they have not been demonstrated to be of use for these cases.
KeywordsInfliximab Endoscopic Therapy Bleeding Site Mucosal Healing Injection Sclerotherapy
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References and Recommended Reading
- 1.Driver C, Anderson D, Keenan R: Massive intestinal bleeding in association with Crohn’s disease. J R Coll Surgy Edinb 1996, 41:152–154.Google Scholar
- 3.Belaiche J, Louis E, D’Haens G, et al.: Acute lower gastrointestinal bleeding in Crohn’s disease: Characteristics of a unique series of 34 patients. Am J Gastroenterol 1999, 94:2177–2181. This represents the larest series of patients to date with massive lower GI bleeding in Crohn’s disease; well detailed and reported.PubMedCrossRefGoogle Scholar