Incidence and risk factors of rebleeding in Crohn’s disease patients with acute lower gastrointestinal bleeding

Moon, Gabin; Kim, Kyeong Ok; Hong, Sung Noh; Koh, Seong Joon; Jung, Sung Hoon; Choi, Chang Hwan; Song, Eun Mi; Lee, Hong Sub; Lee, Yoo Jin; Bang, Ki Bae; ,

doi:2026.41.3.454

Korean J Intern Med > Volume 41(3); 2026 > Article

ORIGINAL ARTICLE

Korean J Intern Med. 2026;41(3):454-461. doi: https://doi.org/10.3904/kjim.2025.348

Incidence and risk factors of rebleeding in Crohn’s disease patients with acute lower gastrointestinal bleeding

Gabin Moon¹, Kyeong Ok Kim¹

, Sung Noh Hong², Seong Joon Koh³, Sung Hoon Jung⁴, Chang Hwan Choi⁵, Eun Mi Song⁶, Hong Sub Lee⁷, Yoo Jin Lee⁸, Ki Bae Bang⁹, and On behalf of the IBD Research Group of the Korean Association for the Study of Intestinal Diseases

¹1Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
²Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
³Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
⁴Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
⁵Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
⁶Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
⁷Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
⁸Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
⁹Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea

Corresponding Author: Kyeong Ok Kim , Tel: +82-53-620-3835, Fax: +82-53-623-8038, Email: kokim@yu.ac.kr

Abstract

Background/Aims: Acute lower gastrointestinal bleeding (LGIB) in Crohn’s disease (CD) is a rare but potentially life-threatening complication. This study aimed to investigate the incidence and risk factors of rebleeding in CD patients with LGIB.
Methods: We retrospectively analyzed 137 CD patients with acute LGIB from nine tertiary university hospitals in Korea from January 2000 to October 2020. Patient characteristics, disease features, and treatment modalities were assessed, and rebleeding incidence, clinical features, and risk factors were analyzed.
Results: The median age of patients was 26.5 years, and the male-to-female ratio was 3.72:1. The median duration from diagnosis to first bleeding was 30.6 (0–243) months. Ileocolonic involvement (72 patients, 53%) and inflammatory phenotype (85, 62%) were most prevalent. During index bleeding, 20 and 40 patients were receiving biologics and azathioprine/6-mercaptopurine (AZA/6-MP), respectively. Bleeding focus was confirmed in 58 patients, primarily with endoscopy (33 cases). Management included conservative therapy (115 cases, 84%), endoscopic treatment (11, 8%), embolization (5, 3%), and surgery (6, 4%). After the index bleeding, 77 (56.2%) patients started or changed AZA/6-MP or biologics. Rebleeding occurred in 44 (32%) patients. The median time to recurrence was 13.0 (0.1–209) months. Transfusion requirement was significantly associated with rebleeding in univariate (hazard ratio [HR] = 3.124, 95% confidence interval [CI] = 1.502–6.494; p = 0.002) and multivariate (HR = 3.857, 95% CI = 1.678–8.867; p = 0.001) analyses.
Conclusions: Rebleeding incidence in patients with CD experiencing acute LGIB was 32%. Transfusion requirement is a significant risk factor for rebleeding.

Keywords: Crohn's disease ; Gastrointestinal hemorrhage, acute ; Biological products ; Rebleeding