Is a Colonoscopic Evaluation Required in Young Adult Patients with Intermittent Hematochezia?

Abstract

Aim:Although the anal benign disorders cover the etiology of intermittent hematochezia, neoplastic polyps and colorectal carcinomas may also cause this situation. The necessity of performing rectosigmoidoscopy or colonoscopy is controversial. The aim of the study was to present colonoscopy findings in young adult patients with intermittent hematochezia without alarm symptoms.Methods:A total of 709 patients aged 20-50 years, who presented to our outpatient clinics with intermittent hematochezia and underwent colonoscopy between September 2015 and September 2017, were included in the study. The patients were divided into proximal and distal colon groups according to the location of the lesions. The diagnoses were evaluated in three age groups: 20-29, 30-39 and 40-49 years.Results:The most common diagnoses were hemorrhoids disease in 219 (30.8%) patients and anal fissure in 186 (26.2%) patients. No neoplastic polyps or malignancy was observed in the proximal colon in patients under 40 years of age. In the 40-49-year-old group, 37 patients (Distal polyp in 25 cases, proximal polyp in 12 cases) had neoplastic polyps and 16 (Distal cancer in 10 cases, proximal cancer in 6 patients) had colorectal carcinoma. The cut-off age at which the neoplastic polyp and colorectal carcinoma were detected in the proximal colon was 45.5 (Area under the curve: 0.879 (95% confidence interval: 0.840-0.918) with 66% sensitivity and 82% specificity].Conclusion:Patients younger than 40 years of age with intermittent hematochezia should be examined by rectosigmoidoscopy irrespective of the presence of alarm symptoms. Colonoscopy should be recommended to avoid possible proximal malignant lesions in individuals over 45.5 years of age.

Keywords

• Hematochezia
• colonoscopy
• rectosigmoidoscopy