Colonoscopy Findings in Young Adult Patients with Hematochezia

Introduction: Hematochezia is a common symptom experienced by young adults, and may be more frequently assessed by complete colonoscopy in light of rising incidence of early-onset colorectal cancer (CRC). While patients 45 years of age or older with hematochezia will likely undergo colonoscopy given current guidelines to begin CRC screening at age 45, optimal approach in patients under age 45 is unclear. We aimed to analyze colonoscopy findings in patients under 45 years of age reporting hematochezia. Methods: We performed a retrospective chart review of colonoscopies performed in patients between ages 18 and 44 years old from January 2016 to July 2022. We analyzed patient data including demographics and endoscopic and histologic findings. Patients were included if hematochezia was an indication for colonoscopy and were excluded if they did not undergo a complete colonoscopy. Results: A total of 578 patients were included. The majority were female (57%); 37% were African American, 34% were White, and 29% were of other or unknown race. Only one patient (0.17%) was found to have CRC. Other findings included hemorrhoids (47.6%), normal colonoscopy (36.8%), diverticulosis (6.4%), and inflammatory bowel disease (IBD) (6.4%) (ulcerative colitis (3.6%) and Crohn’s disease (2.7%)). Interestingly, 56.7% of patients found to have IBD had isolated hematochezia as the primary indication for colonoscopy. Conclusion: Our data suggest low yield for performing complete colonoscopy in patients under 45 years of age for the purpose of detecting early-onset CRC despite rising incidence. A majority of patients found to have both inflammatory bowel disease and diverticulosis were more likely to have isolated hematochezia as comparted to hematochezia with other symptoms (Table 1). Table 1. - Findings in Patients Under 45 Years of Age Who Underwent Colonoscopy for Hematochezia Findings on colonoscopy Number of patients (%) Colorectal cancer 1 (0.17) IBD 37 (6.4) Crohn's Disease 16 (2.7) Ulcerative colitis 21 (3.6) Diverticulosis 37 (6.4) Internal hemorrhoids 275 (47.6) Proctitis 3 (0.5) Cytomegalovirus Ulcer 1 (0.17) Unspecified colitis 2 (0.3) Angiodysplasia 1 (0.17)