Colonoscopy Findings in Patients Over 50 with Lower Gastrointestinal Bleeding

Aims Lower gastrointestinal bleeding is a common reason for emergency consultations, particularly among older patients, and it can pose a significant risk to life. Colonoscopy is the preferred diagnostic tool for accurately identifying the underlying causes and facilitating hemostatic treatment. The aim of our study is to evaluate the diagnostic value of colonoscopy in cases of lower gastrointestinal bleeding in patients aged 50 and older.

Methods This retrospective study was conducted in the Hepato-Gastroenterology department of Fattouma Bourguiba Hospital in Monastir from January 2022 to November 2024. Data were collected from colonoscopy records for patients aged 50 and older presenting with rectal bleeding or melena, with normal findings on upper GI endoscopy.

Results In this study, 117 colonoscopies were performed on patients aged 50 and older, with a mean age of 69.5 years, ranging from 50 to 88 years. A male predominance was noted, with a sex ratio of 1.78 (75 men, 42 women). Medical histories were documented in 48.7% of patients, mainly cardiovascular conditions in 41.9% (n=49), diabetes in 16.2%(n=19), personal history of operated colorectal cancer in 2.6% (n=3), and a family history of colorectal cancer in 1.7% (n=2).The main indications for colonoscopy were melena after upper GI bleeding had been excluded in 59.8% and rectal bleeding in 40.2%. Bowel preparation quality was moderate in 41% of cases, poor in 26.5%, and good in 32.5%. The colonoscopy was complete in 66.7% of cases. In 33.3% of cases colonoscopy was incomplete due to poor preparation (21.3%) and irreducible loops (7.7%).Pathological findings were present in 70.1% of cases, primarily including colorectal cancer in 28.2%, colonic angiodysplasia in 17.9%, colonic diverticulosis in 17.1%, and colorectal polyps in 12.8%. For patients with normal colonoscopy results, proctological exams attributed rectal bleeding to hemorrhoidal disease in nine cases.

Conclusions The findings highlight the importance of colonoscopy in diagnosing lower gastrointestinal bleeding in older patients, revealing significant underlying conditions such as tumors and angiodysplasias. This underscores the need for timely evaluation and intervention to improve patient outcomes in this vulnerable population.

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Artikel online veröffentlicht:
27. März 2025