NEW ORLEANS—Colonoscopic lesions were found in 93% of veterans with traumatic spinal cord injury who had a colonoscopy for their gastrointestinal complaints, according to a study presented at the 64th Annual Meeting of the American Academy of Neurology.
The most common lesion types were diverticulae, internal hemorrhoids, and polyps. Among veterans with gastrointestinal complaints, the incidence of total colonoscopic lesions increased with age, regardless of whether the veterans had traumatic spinal cord injury.
Detecting Colonoscopic Lesions After Traumatic Spinal Cord Injury
Meheroz H. Rabadi, MD, a neurologist at the Veterans Affairs Medical Center in Oklahoma City, and his colleagues retrospectively reviewed medical charts to determine the type and prevalence of colonoscopic lesions in veterans with traumatic spinal cord injury who were age 50 or older and had undergone colonoscopy for complaints of abdominal pain, as well as rectal discomfort and bleeding.
The investigators identified 71 eligible patients (70 men) who had been enrolled in the spinal cord registry of a tertiary care Department of Veterans Affairs Medical Center between 2005 and 2009. Patients’ mean age was 62; eight patients were African American, three were Native American, and the others were Caucasian.
The mean age of traumatic spinal cord injury onset was 36, and the mean time elapsed since injury was 28 years. Thirty-five patients had been injured at the cervical level, 28 at the thoracic level, and eight at the lumbosacral level. The most common levels of impairment were level A (28 patients), level C (16 patients), and level D (16 patients), as measured by the American Spinal Injury Association (ASIA) Impairment Scale.
In 32 patients, a motor vehicle accident caused the spinal cord injury. A fall caused spinal cord injury in 17 patients, and a gunshot caused the injury in 11 patients. Many patients also had various vascular risk factors, including hyperlipidemia, which was observed in 61% of patients, hypertension, which was seen in 58% of patients, and diabetes mellitus, which was seen in 32% of patients.
A Daily Care Regimen
Among 28 patients who had had a colonoscopy, colonoscopic lesions were observed in 26 persons. The investigators identified 13 cases of internal hemorrhoids, 11 cases of polyps, and 10 cases of diverticulae. Colonoscopic lesions, both individually and collectively, had no correlation with the level of traumatic spinal cord injury or to the completeness of the injury, Dr. Rabadi said.
The fact that 39% of veterans older than 50 underwent a colonoscopy because of gastrointestinal complaints suggests that the procedure is safe, according to Dr. Rabadi. Physicians should “repeatedly remind veterans of the benefits of adhering to a daily bowel care program to help deal with their gastrointestinal complaints because such problems have been found to negatively affect patients’ quality of life and limit their ability to live independently,” he added.
“We have managed to reduce the incidence of hospital admission for chronic constipation and colonic lesions by focusing on the bowel program of veterans with traumatic spinal cord injury,” said Dr. Rabadi. “One can do a randomized, controlled study placing vets in a bowel program versus no bowel program and examine the colonic lesions outcome. The question is whether it would be ethical to do so.”
Ancha HR, Spungen AM, Bauman WA, et al. Clinical trail: the efficacy and safety of routine bowel cleansing agents for elective colonoscopy in persons with spinal cord injury—a randomized prospective single-blind study. Aliment Pharmacol Ther. 2009;30(11-12):1110-11107.
Han SJ, Kim CM, Lee JE, Lee TH. Colonoscopic lesions in patients with spinal cord injury. J Spinal Cord Med. 2009;32(9):404-407.