Other strategies for evaluating rectal bleeding in younger patients

Dr Alonso-Coello also provides an alternative strategy to evaluate rectal bleeding other than colonoscopy. Our study was not designed to specifically answer whether anoscopy would suffice in this population. However, over a quarter of the patients had coexistent colorectal pathology, including adenomas and colitis, in addition to hemorrhoids. Chronic colitis may result in chronic bleeding that would warrant further diagnostic approaches after treatment of hemorrhoids. However, we doubt that the majority of adenomas would present with persistent bleeding and would subsequently be missed in the more conservative approach suggested by Dr Alonso-Coello.

We appreciate the thoughtful comments by Dr Alonso-Coello and concur with his conclusion that a prospective study is necessary to further address some of these important issues.

Robert F. Wong, MD, Scott K. Kuwada, MD
Division of Gastroenterology, University of Utah
Medical Center, Salt Lake City