From the Guidelines
Hematemesis is not a typical symptom of Crohn's disease, but it can occur in rare cases where the disease affects the upper GI tract. According to the WSES-AAST guidelines for the management of inflammatory bowel disease in the emergency setting 1, gastrointestinal bleeding is a common complication in patients with Crohn's disease, but it usually manifests as blood in the stool or black, tarry stools rather than vomited blood. The guidelines suggest that in patients with Crohn's disease who are bleeding, the role of angiography and angioembolization is not yet clear, but it may be feasible in stable patients 1.
Key Points to Consider
- Hematemesis would be more concerning for upper gastrointestinal issues such as peptic ulcers, gastritis, esophageal varices, or Mallory-Weiss tears.
- If someone with Crohn's disease experiences hematemesis, they should seek immediate medical attention as this represents a potentially serious condition requiring prompt evaluation and treatment, regardless of their underlying Crohn's diagnosis.
- The management of gastrointestinal bleeding in Crohn's disease involves stabilizing the patient, localizing the source of bleeding, and considering endoscopic, angiographic, or surgical interventions as needed 1.
Management of Gastrointestinal Bleeding in Crohn's Disease
- The WSES-AAST guidelines recommend a laparoscopic approach to adhesiolysis and bowel resection if emergency surgery is indicated for intestinal obstruction in Crohn's disease 1.
- For patients with gastrointestinal bleeding in Crohn's disease who are haemodynamically stable, a surgical exploration in a laparoscopic approach is recommended if endoscopic and/or interventional radiology measures have been unsuccessful 1.
- In cases of haemodynamic instability, an open approach is recommended to reduce operating time 1.
From the Research
Hematemesis and Crohn's Disease
- Hematemesis is a symptom of upper gastrointestinal bleeding, which can be caused by various conditions, including ulcers, varices, and inflammation 2.
- While Crohn's disease is a type of inflammatory bowel disease that can cause gastrointestinal bleeding, it is more commonly associated with lower gastrointestinal bleeding, such as rectal bleeding 3.
- However, Crohn's disease can also cause upper gastrointestinal symptoms, including hematemesis, although this is less common 4.
- A study on acute lower gastrointestinal bleeding in Crohn's disease found that the bleeding was more frequent in colonic disease than in isolated small bowel disease, and that the origin of bleeding was often an ulcer in the left colon 3.
- There is no direct evidence to suggest that hematemesis is a common symptom of Crohn's disease, but it is possible that it can occur in some cases, particularly if the disease affects the upper gastrointestinal tract 5, 6.
Clinical Considerations
- If hematemesis occurs in a patient with Crohn's disease, it is essential to assess the severity of the bleeding and the underlying cause, and to provide appropriate treatment, which may include endoscopy, medication, or surgery 2, 3.
- The treatment of Crohn's disease typically involves a combination of medications, including aminosalicylates, corticosteroids, immunomodulators, and biologic agents, aimed at inducing and maintaining remission 4, 6.
- Mucosal healing, or endoscopic remission, is an important goal of therapy in Crohn's disease, as it is associated with improved clinical outcomes and reduced risk of complications 6.