Published online May 21, 2021. doi: 10.3748/wjg.v27.i19.2353
Peer-review started: February 5, 2021
First decision: February 27, 2021
Revised: March 5, 2021
Accepted: April 25, 2021
Article in press: April 25, 2021
Published online: May 21, 2021
Acute severe lower gastrointestinal bleeding (LGIB) is an uncommon but challenging complication of Crohn’s disease (CD).
Acute severe LGIB in CD has not been well-studied.
To identify the predictors of acute severe LGIB and to evaluate the impact of acute severe LGIB on the subsequent clinical course in patients with CD.
A hospital-based retrospective inception cohort study was conducted. Multivariable analysis with Cox proportional hazard regression was performed to identify the predictors of acute severe LGIB. A matched analysis within the cohort was also conducted to investigate whether acute severe LGIB is a predictor of clinical outcomes of CD. Disease courses were compared using conditional logistic regression analysis.
Early use of thiopurines and female sex were associated with a decreased risk of acute severe LGIB. The risks of behavioral progression, intestinal resection, and hospitalization due to non-bleeding causes did not significantly differ between the bleeding group and the matched non-bleeding group.
Early use of thiopurines may reduce the risk of acute severe LGIB. History of acute severe LGIB may not have a significant prognostic value in patients with CD.
Further studies are needed to investigate whether our findings on the possible null prognostic value of acute severe LGIB in CD was biased by the differential use of anti-tumor necrosis factor agents between patients with acute severe LGIB and those without.